06090040CITY OF CUPERTINO
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BUILDING DIVISION PERMITCipR'ACTOR
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BUILDING ADDRESS:
ALLBRAND WINDOWS
PERMIT NO. 06090040
OWNER'S NAME:
FIRM" ISSUE DATE.
ATUL & MEETA PATEL
551 INDUST TAT, RD
9/nr/2nng
E:
SANITARY NO. CONTROL NO.
650)622-0330
ARCHITECT/ENGINEER:
BUILDING PERMITINFO
SLOG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
P
1 Wmby affirm that 1 am ]focused under providers of Chapter 9 (comm umin{
with Section 7") of Division 3 of Ne Business and Pmfessium Code, and my license is
m ren renal and errata. g 7
REPLACING 6 WINDOWS.RETROFIT
uanm
Dale i5�6Contrmr
ARCHf1EcT•S DECLARA ION '
I undcmand my plans shill be used as public surds
Licensed Pmfeuional
OWNER -BUILDER DECURA71ON
I hemby aliirm that I am exempt from the Contractors License law for the
following mann. (Section 7031.5, Business and Profossiom Code: Any city Of County
which requirm a permit to consmct ales. Wpmw, demolish. or repair any structure
prior 0 its issuance. aha requires Me applicant for such permit to Be &signed statement
CarmcWrs License Law 9
Sq. Ft. Floor Ar ea
Valuation
that he is licensed pursuant W the prevlaWm aides (Chapter
(commencing with Section 7000) of Division 3 of t e Busmemand Professional Code) or
that he is exempt themfhom and the bash for the alleged exemption. Any vioshen of
Occupancy Type
Section 7031.5 by any applicant for a permit subjecta the applicant W a civil penally of
not mom then five hundred dollars (5500).
I, u owner of the property, or my employees with wages as their Who compensation.
Required Inspections
9 P
will do the work and she structure isnot intended or.Rend for axis. 70th, Business
and Profeul.ns Cade: The COmMuctan ral License law doret apply W an Owner Of
property who buildaorimphones thcteon, and whoalassuchwork h reselfmtnough his
ownemployen, provided that such improvements art ret intended er.Qered for sale IL
however. the Wilding or improvement u sold within are year of 000pletia, the owncr-
builder wi0 haw the Wrden Of proving that he did Int MJW a Improw for purpose of
sale.).
El I, as oxer of the property, am actua lY contracting with lica ed contractors W
construct the projen IS= 70x4. Business and Prefesaou Code:) The CmWwmra Li-
cense law dos not apply se an owner of property who Wilds or Improves thereon, and .
who contracts for such projects wish a conuacsets) licensed "nun, In the Commutes
License Law.
❑ 1 am exempt under Sec. . B & P C for this reason
war Dau
WORKERS COMPENSATION DECLARATION
1 hereby affirm under pemity of perjury One of the following declaretans:
] haw and will maintain sCenifinu of Camera W self-mmum fa Wakees Compen-
sation, u provided for by Section 3700 of the labor Cade. for the performance of thea
wort for which this permit is issued.
❑ I haw and will maintain Workers Compensation Imuramt, as acquired by Section
3700 of the lobo Code, far the performance of the wmrk forwhich this permit is Wal
My Workers Compemstiom hun ramz prim uW Policy number art:
=
-
Cmnm, S }h �'o F Policy No.: I A CO 972 J
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
This auction need not W compPoud if the permit Is foram hundred dollar OilIXO
or loss.)
1 cenify that, In the performance of Ne work for which this Permit Is Wood 1 shall net
employ any person In any mannerso as In become subject W Ne Worker'Compensation
Laws or California. Date
Applicant
NOTICE TO APPLICANT. If. after making this Certificate of Exemption, you should
become subject se the Workers Compensation previsions of the Labor Cade you most
forthwith comply with such provisions a this permit that W domed rewked.
CONSTRUCTION LENDING AGENCY
I herebywhallure that then is a lending7,Cagony for the performance of
Wood (Sec.
thea work for which its permit h Wad (Sec. 3097, Civ. C.)
Zanders Name
larders Address
5 I coAry that I have mad this application and stare that the above informal o is
comet. 1 agree to comply with all city and county ordinances and use laws miming to
building consuurtion, and hereby authorize representatives of this city to toter upon tic
above-menriuned property for inspection purposes.
4 (Wo) agree to save, indemnify and keep humiess tic City of Cupertino against
Iiabililln,judgments, costs and expenses which may in any way acerve agarol aid City
x in consequence of the {mmmg of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
tetra f u aPs���..�rr O� 06 6
Re -roofs
Type of Roof
Signature of Applica UCco mefor Da1C
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant o rutme Wilding oese.mousWn or Wndlc ha'rarr ors material
as defined by Ne Cupertino Municipal Code. Chapter 9.13, and the Health and Safety
alto. Section 15532(1)7
Yet
All roofs shall be inspected prior to any roofing material being installed.
C] VM.°
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future Wilding occupant Use equipment or devices which
emit havammus ar rommumants as; dcrrmd by the Bay Ara Air Quaily Management
all new materials for inspection.
DiWicR _J
❑Yes ILLsrO
I have mad the has kt.smamrials requirements unto Chapterfi.95of the Califor.
nia Health &SaciyCOde, Seetious15505,25533 and 25534.1 understand MatUthe building
don not curemly haw a mount, that It i$ my responsibility to notify the occupant of the
reuiremf"�"his tbCmely� WhaaanccaracemrmamarOcaumy.
q
Signature of Applicant Date
//• t r: S/e- � 5; Ji.06
All roof coverings to be Class "B" or better
Owner at anthatwd agent Dam