08040160 CT
OF CUPERTINO -(�}�'"L� -��k, � ' ^
BUILDING DIVISION PERT A+O"CUQRIL,E�FOR .r,
BUILDN4 DRESS: PERMIT NO.
�11��j ALVES DR UNITED CALIFORNIA GLASS & 08040160
R'S NAME: UUUN PERMIT ISSUE DATE
YOUNG MEN S CHRISTIAN ASSOC 701 CESAR CHAVEZ 05/14/2008
PHONE:t' SANITARY NO, CONTROL NO.
(415) 824-8500
ARCHTIECf/CNGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
me+oa LICENSED CONTRACTOR'S DECLARATION - lob Description
C 1 hueby affirm Nat I am lived Omer Pmism
vu of Chmocr 9(wmmcncin6 P
i> viNSeeuon]01111)ofDivi8on3OlNCBuarry+mP{oreacamcodn.ammylieuaxu FURNI-SH & INSTALL ONE PAIR OF STANLEY AUTOMATIC
^ H in full rani and c1ra7. (�
gip? LiccnmC Lica �RTING DOORS. REMOVE/REPLACE (E) MANUAL
f,q Da¢ canlMor I ro la• eco' .
7W ARCHI EC1'S DECLARATION J O S,
I undcmand my pWu mail W exam as public rounds
U
SG Licensed Professional
3 OWNER-BUILDER DECLARATION
y1 krohy affirm Net I m exempt from acm Jan Conalor's ULaw for the
i a o following mama.(Sauon 71111.5,Business and Pmfrssinm Code:Any city m munry
3_ which mqumos a permit to coommoL alter.improv,dcmulbb,or repair my"return
fluor be utaccoana.aimrcquims mW pistom;of fm sahpemi'bicew Law
mem
x�g< (.. ullcgrt 1.h SaU.7.theprovislamor ft Conambr'e Licebclaw(Chapter Sq.Ft. Floor Area Valuation
(commencing with Smiumn ndth Divisionr of allcpd cscam Profess vi Cade)or - $11800
Q�—
that W u emmpd Nerefmn and dan bssu for dan ailcgm emmptlon Any violaGan of
Sad.7031.5 by any applicant for a permit mbjecu thc applicant to a dvR pmmlp ofNumber Occupancy Type
nal man dun 15.hummd dollars(S500). 3 2 6 3 2 0 3 9:V U'
❑Lot owner of Age WOProct re mY otimeym with wag.ss thea m.mnpmvared
will Pr l c ima Co An ammum ra nminbmed ora w do rarssk ply M an Buaimu
Ad orty, h oro Cade The Cmbmmis and whc oes uch mb,apply forduo gh or Required Inspections
Own cnywho Wlldaorirepml machermn,ecnacros oernahwmk himWfm Nm ugh his
awns .meWiprag Or ithansohimprowm within
t inmliemltlmmpkdon.for axle U.
howmWilder .Ne Wilding a impmwmml4 cold wldid Out year of c prove fn,the owna-
builds will low de buNan of proving that W did Out build or improve Ire purµmm of
axle.).
0 1,u swam of An property,ma atlutively c atow1mg with ficauc-^mrowcoma to
mmlmct dan prajm(Sc.7014,Bmimu and Professions Corm)M CanuaebYa Li-
ceom raw dura nm appy to an owner or property who Wilds or improves Nevem.am.
who comets for such pmpms with a eonuanom(d liamed parsaam no Ne Condamine, .
Licmm Law.
moernp under Sm .B&PCforthismsmn
Dau
WORKER'S COMPENSATION DECLARATION
1 hereby alEm under pcnslly of pmjmy arc of the following dmaradom:
❑I lowm awill mumu.a Cmoe
iBofcommot to selr-imum rmworme.compen" '
On.u provided for by Sauna 3700 of the Labor Code.for IW perfamana of the
work for which this permit is bmadl.
0 1 have and will maintain Work s Compemauon Imurancc,as mqubcd by Secdo.
17w.f the labor Code,for lW perfomance of the work fm which Nu perm,u iswed.
My W,rimer Compemadan Innow.carries and Polity mmbcr art:
Carr Itj"rPwa.lt mow^' ft,,NO: W.DL1Ib t�1 � I
ldour jR'nFICATEOFEXEMPTIONFROMWORKERS'
1 COMPENSATION INSURANCE
mdaaccllon reed not Inc completed BNe permit at..hundred dolan($100)
or less)
I angry that N the performance of IW work for which Nis permit is issued.I shut not ,
mn,loy any perm.in my manncrm as b Wcome aubp,tb Ne Wonccor Cempmoulom
Laws of California.Dame ..
Applicant
NOTICE TO APPLICANT.IL arm-making this Cerurmob or Eami dion,you Amid
boc.subjm to the WOW,Compemiuon provisions or An Lahr Codi you moa
.� z forthwith comply with such Provisions or this petit Nall W domed revoked.
Z OCONSTRUCTION LENDING AGENCY
� I Wmby afrim Nar dere b a conmuctinn kering apnry for 0ac pMamanoe of
C'
the work for which Aria pemld is istmd(Sec.3097.Civ.C.)
01. Lomim's Name .
Z) z L.cmicea Address
lJ O I occulty thud I haw rod this Wficaum am sum dist Ne Ann infmmauon I,
[2.P coned I agme to comply with all city and county o.finanas and stain laws misting b
DU Wilding comuuction,and hemby mthaur ocpremntadws of this city In now upon de
IT7 aWw-manudgmpmpeny for impcnion which
mA
LL (We) S.m saw,indemnify and kap harmless Ilan City of Cupcnim against
h incoflabiliunajmg,of
nuand expis perm ich may in any way accrue againsdsud City
z inconsequence or the grana L of this peril.
^ APPLICANT U RST DS AND WILL COMPLY WITH ALL NO -POINT Issued by: � Date
SO RCE RE LAyN)O'N
�4 a+g Re-roofs
Sig um altAppliomIC.HAZ DOUSMATERIALS DISCL.OSURE ab Type of Roof �
Will Neapplianlorfubmbulldineacupantumembandlelm ommaurul
by de Cupenim Municipal Code.Chapter 9.13,and the Holth and Safely
Scott.
1 25532(.)?0
y. Na All roofs shall be inspected prior to any roofing material being installed.
~ Will An applicant or rum¢Wilding oaopam um equipment or dcHccs which If a roof is installed without first obtaining an inspection,I agree to remove
emit loc,odous air co munimna ss lined by the Bay Ama Air Quality Manacemcnl all new materials for inspection.
Dlsaicl7
❑lb NO
Ihoemad Neh,.%V m M5. 5533 ne554.luChap¢rd.95ofdanCalifon-
nuHLalNkSaietyCak,Sc 'mu353U5.2S533 am25534.1 W OOU nd Nmif de Wilding
doesrolcumndv haw•I nl.Naldumyroponao.".Ybroufy de TK
xis antofthe
mqui me w h Amst W el r.,tc gumma of a Cerureme of Oc pm
M 51 rep Signature of Applicant Date
ow 2U,amh oindagcnt Clan, All roof coverings to be Class'W'or better