08010002CITY OF CUPERTINO
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
10875 NORTHVIEW SQ
OWNER'S NAME:
PHONE:
ARCHITECr/ENGINEER:
0 o O LICENSED CONTRACTOR'S DECLARATION
m I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7009) of Division 3 o! the Business and Profession Code, and my license is
.� ,,, in full !once and elfecL
Z License Class Le. N
Date Contractor
t ARCHITECTS DECLARATION
UI understand my plans shall be used as public records
=aF
O Licensed Professional
h OWNER -BUILDER DECLARATION
+� I hereby affirm that 1 am exempt from the Contractors License Law for the
oO following reason. (Section 7031.5. Business and Professions Code: Any city of county
y which requires a permit to construct, alter, improve, demolish, or repair any structure
Z r prior to its issuance, also requires the applicant for such permit to file a signed statement
_ < that he Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9
I- e] (commencing with Section 7000) of Division 3 of the Business and Professions Cade) or
y that he is exempt therefrom and the basis for the alleged exemption Any violation of
Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars (1500).
❑ L 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. 7044, 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
Vsale.
. as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044. Business and Professions Code:) Mte Contractor's Li.
cense Law does not apply to an owner of property who builds or improves thereon, and
who contracts for such projects with a conuactor(s) licensed pursuant to the Contractor's
License Law.
❑ 1 am exempt
under penalty of perjury one of the following declarations:
] I Its re and will maintain a Certificate of Consent to self -Insure for Workers Compcn-
.ration, 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 Insurance, as required by Section
3700 of the Labor Code, for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number are: .
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(this section need not he completed if the permit is for one hundred dollars (110D)
or less)
I ceni fy that in the performance of the work for which this permit is issued, 1 shall not
employ any person in any manner so as to become subject c ri Compensation
Laws o! Californi . ate
Applicant
NOTICE TO LICA[�� f, after m king this Certificate of Exemption, you should
become subject t "Workers Compensation provisions of the Labor Code. you must
.J ,Z forthwith comply with such provisions or this permit shall he deemed revoked.
z CONSTRUCTION LENDING AGENCY
[� 1 hereby affirm that there is a construction lending agency for the performance of
p+ the work for which this permit Is issued (Sec. 3097, Civ. C-)
Lfa Q Lender's Name
0 Z Lenders Address
V 0 1 certify that I have read this application and state that the above information is
V. E: correct I agree to comply with all city and county ordinances and state laves relating to
O U building consuuction, and hereby authorise mprescmativcs of this city to enrcr upon the
W above -mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
F,s liabilities,judgments. costs and expenses which may in any way accrue against said City
L) in consequence of the granting of this pemriL
APPLICANT UNDFF��RRSTANDS AND WILL COMPLY WITH ALL NON -POINT
SOURCE REGU ATIQNS:
, 1 0
Signature of A lieant/Conuactor Dare
AZARDOUS MATERIALS DISCLOSURE
Will the aWficant or fuurre building occupant store or handle hazardous material
as defined by the Cupertino Munici al Code. Chapter 9.12. and the Health and Safety
Code, Section 25532(a)?
❑ Yes ❑ o
Will the applicant or future building occupant use equipment or devices which
nit hazardous air contaminants eftned by the Bay Area Air Quality Management
nstnct7
❑Yes No
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health & Safety Code, Sections 25505. 25533 and 25534.1 understand that i! the building
does not currently have a tenant. that it is my responsibility to notify the occupant of the
Dq
Owner or authorised agent Date
CONTRN&OR jNFORMATION
PERMIT NO.
ARGONAUT WINDOW & DOOR, INC 08010002
PERMIT ISSUE DAIS
1901 S BASCOM AVE STE 8n0 01/02/2008
SANITARY NO. CONTROL NO.
(408)378-4018
BUILDING PERMIT INFO
-BLDG ELECT PLUMB MECH
0 0 0 0
Job Description
REPLACE WINDOWS.2 WNDWS,3PATIO DRS, LIKE 4 LIKE
TEMP & EGRESS
Sq. Ft. Floor Area $ 4 5 0 0 Valuation
3163 6 0 0 7 '°dlp Number Occupancy Type
Required Inspections
Issued by: Date
Re -roofs
Type of Roof
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