08040165 CITY OF CUPERTINO
BUILDING DIVISION PERMIT qCfClNMOW
.�I1�'�RMATIOI�i''�•"
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BUIL ESS: PERMITNO.
MC CLELLAN RD BROTHERS HOME IMPROVEMENT 08040165
R'S NAME: PERMIT ISSUE DATE
11WENNETT TONI J 2510 DOUGLAS BLVD 04/23/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHITECTYENGINEER: BUILDING PERMIT INFO
REPLACEMENT OF 14 WINDOWS & BLDO ELECT PLUMB MECH
pPATIE)
40p LICENSEDCONnsed rOWS c,pontoonsof bin JobDescri tion
FeR
1 baMby 0)of Nal 1 am flow Bu under d Professions
of Can, 9(commencing ••^ P
' with Section an10)of Divirion]of NO Business anal Profcssiow GOdC,arW mylicenac ie
y in full form and effect
j 2 License Clw Lk.• '
? Dam Qs.1 VY ox.macmrA
ARCHITECTS DECLARATION f
I understood my piens shall W need as public records
C
Licensed Profeamnal '
OWNER-BUILDER DECLARATION
I barehy alarm that I am exempt From the Contractor's License Law far dm
C n o following Munn.(sued7071.5.Business ad Professions,Professions,Cade:Any my or county
42E! which requires a permiton m comment,alms borrow,demolish,or mptir my atmctuM
:zi prior to its issuance.also requires the applicant for such permit to file a signed statement
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that he is licensed innocent to the provisions of the Contractor's Umnm Law(Chapter 9 Sq.Ft. Floor Area Valuation
$ (commencing with Section 7000)of Division 7 of the Business ad Profusions Code)or
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that he it exempt meM(rom and the basis for the alleged eumptioo.Any violation of
Section 70715 by any applicant for a permit subjects the applicant to a civil Penalty of APN Number Oceu ane-Type
not mese dun five hundred dollen(ISOILL p y
0 1.as owner of the property,or my employees with wags as their cele computation.
will do tine wank,and the structure Is not utetsded"offered for sale(Sm.T(IN,Business
and ProfeWan Cede The Canvases Liam Law does at apply in an owner of Required Inspections
pmpwywhobuilds orimpmves thereon.andwho doesswh work himselrwtiuough his -
own employes.provided that such improvements as rat intended oroffesed forstlp if.
however,the building orimpmwment usold wimin ane Sem of arnpledan.the nwner-
builder will haw W burden of proving mat ha dial at build or improve for purpose of
,ale.).
❑1,as a Mex of the property,am exclusively cantreating with licensed mnlra bars to
cownct the project(Sec 7014.Business am Prefem ow Cede:)The Contractor's U.
mw Law does not apply m an owner of property,who Wilds or impmwes demon,sod,
who contracts for such pmjecu with a conusumns)licensed pursuant to the Contractor's
Lama L.
❑I am exempt under Sea. .B k P C fes this ewon
Date
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty or perjury om of the following doclarWow:
❑Ihave andwO for
by eCretiMte ofCownter Code.
erformSCompthe
Sudor,r pmvitlhi fm by it an]700 of dte Labor Cede.Far du per(armance of the
soh for which anis permit is issued.
❑I haw and will malmam Workers Campeneation Insurance,es mquired by Smdoa
3700 ofthe Labor Codo.per the peRamranceofthe work for which this permit aalesmd. '
My Workers Smevasid..Ines.cerrice and Polity number ma: -
Cartier. L2 C PolicyNo.: RS' O ZG
CERTIFICATE OF EXEMP ION FROM WORK
COMPENSATION INSURANCE .
(rhusttdm need out bacmmplewd Iran permit is faom hundred dollars($100)
car leas.)
I certify that in the pufarra me of me work for which this permit Is issmd,I shall not
employ any Person in my mmmrse as in Wounto subject to dte Woskers'Compensation
Laws of Califomia.Dam
Applicant
NOTICE TO APPLICANT.If,after making this Certincate of Exemption,you should
become Subject to the Worker's Compensation provisions of me labor Cede,you muss
.J O f(Mwith comply with such previsions m this permit shall ba deemed mveked.
.zt" CONSTRUCTION LENDING AGENCY
N
[ribamby affirm that Hers kantwtrnetinn lending aCency far the peH'armance of
ai the.,it for which this permit u issued(Sm.5097,Civ.C.)
W� Q lender's Nurse
Z z Lenders Address
U Q 1 certify that I haw seed this application anal suns that the show infmmaGon is
LL E eormmm.I ysm comply with all city anal county ordinance and sum laws miming to ,
C)Lr'J building connotation,mal hereby aunodm representatives of this city in enus upon me
W above-mentioned Property for lex eNan purposes
(We)agree to save,indemnify and kap hamtkss dte City of Cupertino against
Uti in
of u,cusnaed eapcweawhich may in anyway ucmc aCalwtaaldCity
U`s. in cansequeme of the granting of this permit,
'•" APPLICANT UNDERSTANDS ND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS, O
Re-roofs G7
signmue of ppb IL6.MMOUS MATERIALS DISCLOSURE y Type of Roof —�
Will the applicator future Wilding meanest a=w handle nearness material
Omd by tite Cupertino Municipal Cade.Chapter 9.1;and the Health and Safety
seeden zssn(.)7 All roofs shall be inspected nor to an roofing material beim
❑Yes No
P P Y g g installed.
Will mea nems or future building occupant use a ut If a roof is installed without first obtainin 'an inspection,I agree to remove
pp geequipment Qu m devices which g P g
emit hvardnw air cmuminenu u defined by tite Bay Atha Air Quality Management all new materials for inspection.
District?
❑Yen No
I haw mad the havardms materials requirements under Chapter 6.97 oftha Califor-
nkHeal"Safety Cade,Sack.25505,255]]and 75574.1 umkmaM mat if me building
does net currently have a sot.that it is my responsibility m mdfy the occupant or me
requirements whichmh malpdwto iesuanm of a Certificate of /
/ Signature of Applicant Date
Owner or mann cd agent /I�if- (�� All roof coverings to be Class'W'or better