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CITY OF CUPERTINO
DIVISION PERMITi�TR4�CT�}I*
BUILDING
BUILDING ADDRESS:
11830 UPLAND WAY
ALLBRAD'D WINDOWS
PERMIT NO.
07110103
_.✓NER'S NAME.
PERMIT ISSUE DATE
VENKATESH BHIMACHAR
23312 CABOT BLVD
11/16/2007
PHONE:
SANITARY NO. CONTROL NO.
(650) 62-0330
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code, and my license is
WINDOW RE PLCMNT ( SAME S I Z E r SAME LOC) 11 RETRO F I T r 1
in full form and effect.
License Class Lle.
BAY WNI IW r 1 PATIO DR S L I DR
Date Contractor
ARCHFMCISDECLARATION
1 understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the
following mason. (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit to construct, alter, improve, demolish, or repair any structure
prior to its issuance, also requires the applicant for such permit to file a signed statement
Contractor's License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
that he is licensed pursuant to the provisions of the
Professions Code)
$10875
(commencing with Section 7000) of Division 3 of the Business and or
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
366030-E Number
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars (s500).
❑ 1, as owner of the property, or my employers with wages as their sole compensation,
Required Inspections
q p
will do the work and the structure is not intended or offered for sale (Sec. 7044, Business
and Professions Code: The Contractor's License Law dors not apply to an owner of
property who builds or improves thereon, and who does such work himself or through his
own employees, provided that such improvements are not intended or offered for sale. If,
however, the building or improvement is sold within one year of completion, the owner -
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044, Business and Professions Cade:) The Contractor's Li.
cerise Law does not apply to an owner of property who builds or improves themon, and.
who contracts for such projects with a contractor(&) licensed pursuant to the Contractor's
"cense Law.
am exempt under Sec. B & P C for this mason
Uwner Dale
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a Certificate of Consent to self -insure for Worker's Compen-
sation, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
g4have and will maintain Worker's Compensation Insurance, as required by Section
3700 of the Labor Code, for the performance of the work for which this permit is issued.
My WorkZCompensation Insurance carrier and Policy number
Cartier. Polity No: Lr1_
CERTIFICATE OF EXEMPTION FROM RKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100)
or less)
I certify that in the performance of the work for which this permit is issued. I shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject to the Worker's Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ. C.)
Lender'sName
Lender's Address
j I certify that I have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating to
building construction, and hereby authorise representatives of this city to enter upon the
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
j liabilities, judgments, costs and expenses which may in any way accrue against said City
in consequence of the granting of this permit
I APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by Date �1
PPTPEE R TIONS. -
-91��
p� - I I Z 1 6 O
Re -roofs
Type of Roof
Signature of-Applicant/Contractor Date
HAZARDOUS MATERIALS DISCLO URE
Will the applicant or future building occupant store or handle hazardous material
Aimed by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety
,ode, Section 25532(a)?
❑Yes
All roofs ;hall be inspected prior to any roofing material being installed.
If a roof i; installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
District? ��
❑ Yes M4.
I have read the hazardrnu materials requirements under Chapter 6.95 of the Califor-
nia Health & Safety Cade, Sections 25505, 25533 and 25534.1 understand that if the building
the occupant
that it ' y responsibility to notify die occupant M the
n
Itoni
met trio mance of a Certificate of
Signature Of Applicant Date
t
All roof coverings to be Class "B" or better
Owner or authorzed agent Datc"'
BUILDING DIVISION FEICM1
)ING ADDRESS:
11830 UPLAND WAY
OWNER'S NAME:
VENKATESH BHIMACHAR
o p LICENSED CONTRACTOR'S DECLARATION
m 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing
Z with Section 7000) oCDivision 3 of the Business and Professions Code, and my license is
dr in full force and effect �"-
i Z License Class Lie, p
p Date 1 Contractor
� � RCHI CTS DF�L.AR T10N
L) 1 understand my plans shall be Used as public records
' w y Licensed Professional
y
OWNER -BUILDER DECLARATION
1 hereby afnim that I am exempt from the Contractor's License Law for the
`pet following mason. (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit to construct, alter, improve, demolish, or repair any structure
Z �? prior to its issuance, also requires the applicant for such permit to file a signed statement
a that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
r (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
y that he is exempt therefrom and the basis for the alleged exemption. Any violation of
Section 7031.5 by airy applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars ($501).
0 I, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale (Sec. 7144, Business
and Professions Code: The Contractor's License Law does not apply to an owner of
property who builds or improves thereon, and who does such work himself or through his
own employees, provided that such improvements are not intended or offered for sale. If,
however, the building or improvement is sold within one year of completion, the owner -
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
0 I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li.
cense Law does not apply b an owner of property who builds or improves thereon, and.
who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's
License Law.
0 1 am exempt under Seo, B & P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
0 1 have and will maintain a Certificate of Consent to self -insure for Workces Compen-
sation, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
9-l"havc and will maintain Worker's Compensation Insurance, as required by Section
3700 or the Labor Code, for the performance of the work for which this permit is issued.
My Wor s Compensation Insurance carrier and Policy number
Cartier. h, e, Policy No. •
102
CERTIFICATE OF EXEMPTION FROM RKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100)
or Icss)
1 certify that in the performance of the work for which this permit is issued. I shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California. Date
Applicant
N077CE TO APPLICANT. If, after making this Certificate of Exemption, you should
become subject to the Worker's Compensation provisions of the Labor Code, you must
Oforthwith comply with such provisions or this permit shall be deemed revoked.
�b CONSTRUCTION LENDING AGENCY
H rr I hereby affirm that there is a construction lending agency for the performance of
(� ✓ the work for which this permit is issued (Sec. 3097, Civ. C.)
a A
Lender's Name
Z
Lender's Address
V Q I certify that I have read this application and state that the above information is
correct 1 agree to comply with all city and county ordinances and slate laws relating to
building construction, and hereby authorize representatives of this city m enter upon the
®U
H aabove-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
Fy t/2 liabilities, judgments, costs and expenses which may in any way accrue against said City
L) T in consequence of the granting of this permit.
r7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
KMWE RFTIONS.
WgnatureofApplicam/Contractor f Date
HAZARDOUS MATERIALS DISCLO URE
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
Code, Section 25532(a)?
0 Yes V.
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
District?
OYes
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health & Safety Code, Sections 25505.25533 and 25534,1 understand cwt if the building
dors my have a tenant, that it y responsibility to notify the occupant of the
- mrem hi mel tvpan prio trance oC a Ccnificatc of Occup
�1 b
t Date
ALLBRAND WINDOWS
23312 CABOT BLVD
(650)622-0330
PERMIT NO.
07110103
PERMIT L55UE DATE
11/16/2007
SANrrARY NO. CONTROL NO.
BUILDING PERMrr INFO
Job Description
WINDOW REPLCMNT(SAME SIZE,SAME LOC)11 RETROFIT,1
BAY WNDW,1 PATIO DR SLIDR
Ft.
36603056;`
Issued by:
Re -roofs
Type of Roof
$10875
Required Inspections
Date #.'
(6-,e-.
/t/
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
all new materials for inspection.
Signature of Applicant
Date
All roof coverings to be Class "B" or better