1005001477TY OF CUPERTINO Bi ILDING PERMIT
BUILDING ADDRESS: 8080 PARK VILLA CIR
OWNER'S NAME:
o LICENSED CONTRACTOR'S DECLARATION
.icense Class Lic. #
CONT�OR: AMERICAN VISION
CT
WINDOWS INC
365 RI.ED ST
SANT k CLARA, CA 95050
Date
'ontractor
[ hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Secions On full force and effect.fthe Business & Professions
Code and that mylicense
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued. rovided for by
I have and will maintain Worker's Compensation Insurance, as p
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
d state the
infoation is
I certify that I have read this application an to dinances ve and state laws relating
correct. I agree to comply with all city and county
to building construction, and hereby faoithp rize ectionrpurposess(We) agree to saveof this city to r
upon the above mentioned property of Cu ertino against liabilities, judgments,
indemnify and keep harmless the City Pth
costs, and expenses which may accrue against said City in consequence of e
cant understands and will comply
granting of this permit. Additionally, the app
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Date_ --
Signature
DB DESCRIPTION: RESIDENTIAL
PERMIT NO' 10050212
DATE ISSUED: 05/28/2010
PHONE NO: (408)617-0901
COMMERCIAL
PLEPLACEMENT OF (6) WINDOWS AND 1 SLIDING GLASS
)OOR NON-STRUCTURAL
Sq. �'t Floor Area:
API1 Number: 35610022.00
Valuation: $5500
Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF AL ED INSPECTION.
IT ISSUANCE OR
180 DAYS FROM LAST C
Date:
I=sued by.
RE -ROOFS:
A 1 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
it spection.
r OWNER -BUILDER DECLARATION
hereby affirm that I am exempt from the Contractor's License Law for one of
he following two reasons:
as owner of the property, or my employees with wages as their sole compensation,
, asill do the work, and the structure is not intended or offered for sale (Sec.7044,
3usiness & Professions Code)
as owner of the property, am exclusively contracting with licensed contractors to
;onstruct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
declarations:
I have and will maintain a Certificate of Consent to self -insure for Worker's
for the
Compensation, as provided for by Section 3700 of the Labor Code,
performance of the work for which this permit is issued. provided for by
I have and will maintain Worker's Compensation Insurance, as
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
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 Worker's
Compensation laws of California. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I muss
forthwith comply with such provisions or this permit shall be deemed revoked.
Date:
Signature of Applicant:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
APPLICANT CERTIFICATION
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 faocthn rectioze n purposes (We) agrs of this ee to save
ty to er
-non the above mentioned property P
emnify and keep harmless the City of Cupertino against liabilities, judgments,
Lgranting
)stsand expenses which may accrue against said City in consequence of the
ermit. Additionally, the applicant understands and will comply
nt source regulations per the Cupertino Municipal Code, Section
ADate
HAZARDOUS MATERIALS DISCLOSURE
have read the hazardous materials requirements under Chapter 6.95 of the
-alifornia Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Muni Is to sal tore handdcq lter 9.12 and the
Health & Safety Code, Section 25532(a)
shouldmaterial. Additionally, should I use ayequipment Air Quality Management District I
air contaminants as defined by the Bay
with the Cupertino Municipal Code, Chapter 9.12 and
will maintain compliance
the Health &Safety Code, Sections 25505, 533, a5534. � � /6
/, /,
Owner or authorized agent:
CONSTRUCTION LENDING AGENCY
hereby affirm that there is a construction lending agency for the performance of
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional