07110162 CITY OF CUPERTINO ` ° '
BUILDING DIVISION PERMIT ���T1���C?� �������� '
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PERMIT NO.
au►�g�r�c���esS TANTAU AVE WINDOW BROKER — THE 07110162 ,
lU
OW NER'S NAME: � �� �ATE
N& R OLIVERA 23312 CABOT BLV � 11/28/2007
)NE: SANITARY NO. CONTROL NO.
(510) �65-5600
ARCHITECI'/EWGINEER: BUIC.DING PERMITINFO
BLDG ELECT PLUMB MECH
� � � 0
u o p LICENSED CON7RACTOR DEC�.nxnr�ow Job Description
� � ! hcrcby affirm tAat I am licenacd undcr provisions of Chap�cr 9(commcncins
z� wiW SccGon 7000) aroivision 3 of �hc Busincss and Pro[cssions Codc, and my Iicensc is W I ND R E' P L C MNT L I KE F OR L I K E
^� y in fuil force and cffect S 2 S� ��
,� Z Licensc CIass, C i� Lic. M_ v
� F, � Da�c i I/ Contracmr � r ��
ARCHI7EC1'S DECLARATION
�� U 1 undcrswnd my plans shail bc used u pu6lic rccords
a
L p y Liccnsed Ptufcssional
y � OWNER-BUilAER DECLARATION
I hercby aCfirm ihal 1 am excmpt Gum thc Coniractor's Licensc Law for tlic
i p O CoUowing rc�on. (Scction 7Q31.5, Busincss and P�ofcssians Cadc: Any city or counry
�$� which requires a pcimit to rnnsuuct, il�cr. impmvc. dcmolish. or mpair any swcwrc
'� Z��'„ prior lo its iscuancc, also rcquires thc applicant for such pertnit io filc a signcd sta�emcnt
_< that he is liccnscd pursuanl lo thc �xovisions of thc Conuactar's Liccnsc Law (Chapicr 9 Sq. Ft. Floor Area $ 518 2 Valuation
y F- �(commencing wi�h Scction 7000) of Division 3 of ihc Busincss and Profcssions Codc) or
y �.-. thai Ae is exempt �he+efrom snd ihe buia for �he allcgcd exemption. My violadon of
Section 7031.3 by airy applicant for a pecmit subjecu the applicant to a rivil penalty of Number Occupancy Type
not more than five 6undred dollars (5500). 3 7 5 0 8 0� 8�
❑ I. u owner o[ tl�e p�vpectY, or my employces wiN wages u the'v solc compensatlon,
will do �he work md the stcucw�e is not imm�ded ar oftued for sale (Sec. 7044, Busiws
and Ptofessions Cade: The Conuuwrs License Law does not apply w an owner of RCC]Ul2'C(� TIISPCCt10i1S
proputy who builds a improves thercon, and who does such work himself or tlwugh his
own employces, provided U�at such improvements ue not intended ar offered for sale. if,
however, the building or improvement ia sold within one yeer of compkuon, Ihe owner-
builder will have ihe burden oC proving �at he did no� build or improvc for purpose of
saleJ.
❑ 1, u awner o[ the property, am exclusively conuscting wi�h licenaed rnnvac�s to
con4tnut the p�oject (Sec. 7044. Businw and Pra[essions Cade:) TAe Contrxmr's Li-
cense Iaw docs not apply �o sn ownu of property who 6uilds or improves ihemon. �nd ,
who conuacLS for such projects with a conuactar(s) licensed purswnt to �he Contrutots
Licenae Law.
Q I am aempt under Sea , B de P C for ihia mzwn
pw.�W Date
WORKER'S COMPENSATION DECLARATION
I hercby �rm under penalty o[ perjury one of the following declaradons:
�! hsve and will mainuin a Cuti�ate of Cansent to self-insure for Workers Compen-
ution, as provided for by Sectian 3700 of ihe Iabor Code, for �he pedormance of thc
work for which this pertnit is issucd.
❑ I have and will mainlain Workcr's Compensation Insurance, as �cquired by Scction
3700 of the labor Code, Cor the pedortnanee of the work for which this pem�i� is issued.
M Workers Com naatian Insu n and Poli numbc a�c: 7 ��
Cartier,�d.... �� � �Poliry No.: GVG
CERTIFICATE OF IXEMPI70N FROM RKERS'
COMPENSATION INSURANCE •
(This section necd not bc comple�ed if t6e permit is for anc hundred dollus (S lU0)
or ksa) •
I cenify �hat in thc performance of thc work fw which Ihis permit is issucd. [ shsll not
unploy any person in any manner w u W become subject to the Worlcers' Compensauon
L,aws of Califomia. Datc
Applicant
N077CE T'O APPLICAM: If, af�cr making �his CcniCica�c of Excmpuon, you should
become subject w lhe Worlccr'a Compensetion pmvisions of the I,Iwr Code, you must
� O foMwith comply with such provisions or this permit shalL hc dccmcd �cvoked.
� '"'' CONSTRUCf(ON LENDING AGENCY
Fr � 1 heroby affirm lhat thero is a conswctinn lending agcncy far the perCurmancc of
ai •� thc work fur which Ihis permit is ist�rcd (Scc. 3097, Civ. CJ
W� Q L.endefs Nunc •
a z Lender's Address
(� � I cenify Ihrt 1 have rcad ihis applica�ion and statc thu thc above informatlun is
w�"' cortcc� I agrce w comply wi�h all riry and counry ordinances and sute laws rclaGng w
0 U building consuuction, and he�cby suthoria mprescntativcs of ihis ci�y to cntcr upan pic
� w atwvc-mcnGoned propeny for inspcnion purpa�es
Gy (Wc) agrce to save, indcmnify and kecp harmless the Ci�y of Cupertino against
�� IiabiliUu, judgmcn�s, cosu and expenscs which may in any way accruc against said City
V z in cansequencc oC �hc granting of ihis permi� Date l'' Z��
�"� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOU EG
� L� n ,,�,o� ..� � [ � ���� � Re-roofs
Signaturo of ApplicanVConvacar Da�
HAZARDOUS MATERIALS DISCLOSURE Type of F.00f ` %�i'
wll thc applicant or fuwre building occupant storc or handlc ha•rardous malcrial
u dcfincd by Ihe Cupertino Municipal Code. Ct�aplcr 9.12, md the Hcal�h and SaCcty
c«� Section 25532(a)? �� All roofs shall be inspected prior to any roofing material being installed.
❑ Ycs 0'No
Will thc applicant or fuwre building occupant usc cquipmcnl ar cicvices which If a roof i s installed without first obtaining an inspection, I agree to remove
,it hazardous air conuminanu az dcfincd by �he Bay Area Air Quality Managemen� all new rr �aterials for inspeetion.
�;s����
aY� d.�
I havc rcad Uu hvardous matcrials requiremcn�s undcr Chap�cr 6.95 of �he Califor-
niaHc�IthkSafcryCadc,Secuau25505,25533anc125534.1undcrs�v�dthatiCthe 6uilding
does not currently have a �ensn�, ihu it is my '6iliry m noufy �he occupant nf ihe
rcyuircmcn�s be m l ' r W issu a Ccnificaic of cupan Signature of Applicant Date
Owner or au�hor'vcd agcnl r r �,� All roof coverings to be Class ��8�� or better