08090227CITY OF CUPERTINO
BUILDING DIVISION PERMITQ1"�tJl
T
eu1L�CLADPERMIT
�9.36 FS
CIR
CREATIVE WINDOW CO
PERMITNO.
08090227
720 NORTHRUP ST
09/30/2008
PHONE:
SANITARY NO. CONTROL NO.
(408)297-8800
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of DivWon 3 of tho Business and Profossionscode, and my license is
ADDING RETRO FIT WINDOWS LIKE 4 L I KE NO STRUC TURL
in full fort and effect,
License Class Lic. /
Date Contractor
ARCHITECTS DECLARATION
I understand my plans shall be used as public records
Licensed Professional
OWNER-BUnDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the
following reason (Section 703M. 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
he is licensed to the the Contractor's License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
that pursuant provisions -of
Section 7000) Division 3 the Business and Professions Code) or
6 0 0 0
(commencing with of of
that he is exempt therefrom and the basis for the alleged exemption Any violation of
3 75 4 3 0 3 4 Number
Occupancy Type
p y yp
Section 7031.3 by any applicant for a permit subjects the applicant to a Civil penalty of
not more than five hundred dollars (5500).
.'°
❑ L as owner of the property. or my employees with wages as their sole compensation,
Required Inspections
will do the work. and tits structure Is not intended or offered for sale (Sec. 7044, Business
and Professions code The Contractors 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 employes, provided that such improvements art not Intended or offered for sale. IL
however, the building or improvement is sold within one you of completion, the owner -
builder will have the Auden of proving that he did not build or improve for purpose of
sale-).
L1� 4 as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044. Business and Professions Code:) The Contractors U -
cense Law does not apply to an owner of property .who builds or improves thereon, and,
who contracts for such projects with a contractor(s) licensed pursuant to the Contractors
LicenseL aw,
❑ I am exempt under Sec , B & P C for this reason
Owner f Date 36 cc
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations
❑ 1 have and will maintain a Certificate of Consent toself-insure for Workers Compcn.
sation, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued
❑ I have and will maintain Workers Compensation Laurance, as required by Section
3700 of dee Labor Code, for the performance of the work for which this permit is issued
'
My Workers Compensation Insurance carrier and Policy number am:
Carrier. Policy No.:
CERTimcATE OF IDO7dFIION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed U the permit is for one hundred dollars (S 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 mannerso 51ne 'ecu to the Worken' Compensation
Laws of California. Date, '
Applicant —
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject to the Workers 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 s construction lending agency for the performance of
etc work for which this permit is issued (Sec 3097, Civ. C.)
L.endces Name
,
Lenders Address
1 terrify that 1 have read this application and state that the above information is
-
corrocL I agree to comply with all city and county ordinances and state laws relating to
building construction, and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes-
urposes(Wer)
_
(We)agree to save, indemnify and keep harmless the City of Cupertino against
liabilities, judgments, costs and expenses which may in any way accrue against Said City
In consequence of the granting of this permiL
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE REGULATIONS.
Re -roofs
C1 r
Signature of ApplieantlContractor Dare
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applicant or future building otxvpanL atom or handle hazardous material
as defined by the Cupertino Municipal Code. Chaplet 9.12, and the Health and Safely
Code. Section zss32(e)7
All roofs shall be inspected prior to any roofing material being installed.
❑Yrs �No
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building emrpant 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 CINo
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health & Safety Code Sections 25505, 25533 and 25534.1 undersand that if the building
does not currently have a tenant. that it is my responsibility to notify the omrpam of the
requirements which mat be met prior to issuance of a Cerdficale of Occupancy,
Signature of Applicant Date
-f 13t% W?
All roof coverings to be Class's"' or better
Owner '
or authorized ai ocw Date