08090171 CITY OF CUPERTINO a �� � ,n�,r '+• - '_ :�_ *`-
BUILDING DIVISION pERMIT Y�CONTRA�CTCIRINk'OB,MA.TI1V
BUIIDIIiG 2OBESS: PERMITNO.
1U�t5b VIRGINIA SWAN PL HOLDER INC DBA ABLE GLASS 08090171
NEWS NAME: PERMIT ISSUE DATE
MUTTART HARRY C ET AL 1129 RICHARD AVE 09/25/2008
PHONE: SANITARY NO. CONTROL NO.
(408) 496-9960
ARCHRECffENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�OpI LICENSED CONnRd underSoECons of Cory Job Description
u
1 WrtbY affirm Nn 1 w lironsd under provisions oI Clupmr Y(rommendng
cath Sdctim]OOU)of Dividonlaf thm Butlm,•am Pra(eniom Code.ammylimns is REPLC EXTNG WNDWS& PATIO DR W/NEW LIKE4LIKE
M 13
lull forte and erce A 5`Ld9/4
Li¢ns Class -
Contract
b
��p Dam -SuEr�
e'= ARCHnECI•S DECLARATION
D- 1 unosh
ndcnJ my plansall M useda ro
public cors
tl
to.
G Licensed Professional
OWNER-BUILDER DECLARATION
i<E 1 hereby enrm that 1 am seempt form Ne Conuncmfa liters law for she
w following mayor.(Secdon]0313,Business and Profetions Cade:My city or county
which re9uirm a permit to construct alter,improve,dorroduh,or repair any sucturo
5_y prior m its issuance.also requires Ne applicant for such Permit in rik a signed moment
ESG
that he is licensed pursuant othe pmvisiomoftheConuscka,yUccmeLaw(Chap=9 Sq.Ft. Floor Area Valuation
ti-s (commenting wish ScNon]000)of Division 3ofthmBusimasand ProRsimtsCode)or $12500
-.
that he is eanmpt therefrom and the basis for the alleged exemption.Any violman of
Section 7031.5 by arty applicant for a permit sbjecu she applicant to a civil penalty ofNumber Occupancy
ort mart Nen five hundred doll.(S500). 31646004 .' Parc Y Type
❑1,U owner of the Propmy.m my MPlaYcm With urges U their ante WMNMtim,
and cit the Work std Ile The
Cool la notNmnded car aRC do(W apply
]Dani wrier of
and Professions code:The Conuadors License law does trot apply lf an owner car Required Inspections
Man ertywW Wildsmimphats such
imrevedwho an,
Werk bwuelrar through his
Man employees,provided that such improvements art not intended m pRemd for own It.
however,the building st improvement 4sld Within arc year of improve
for the purpose
o-
sals). will have she WNm of pmHng that W did not build m improve for Puryos of
saw.).
❑1,as owmr of the property.am exclusively torturing with l masod contractors to
rousmxr the project(Sec.7014.Business and Professions Code:)The cmaacses Li.
come Law does not apply to an owner of property who builds or improves shemm,and
who eonsoees for such projects wish aronuusr(s)licensed p..,to the Contractors
License
Law.
pturS ,B A P C far thn reason
honer
Dale
WORKER'S COMPENSATION DECLARATION
1 hereby aifum under pemlty of perjury one of the following decwradorc
131hmamwlmanunac. fimmofcamntself-imamfmWortaComPen-
wweoralksfor which this Permit
mi tSection 3]00 car Um labor Cotle,fm the pedormana of Ne
u iaymd.
1 have and will maintain Workrls Compensation Insurance,u required by Section
3700 of shc labor Code,fm thc pcdarmanm of the work for which Nis pemtit u issd
m '
My Workers Continuum.In.carrier and Polity numb.am:
Cartier.T!�m6g _.Poliy NoMWL
GIEOEXF.MON FROM S
COMPENSATION INSURANCE
mussctim need ort W completed if the Permit is forme hundred dollars(SIM)
or host)
1 c.tih Out In the purf-mmrce of thm work f.which this permit is issued.1 slWl nm
employ anypersn in any manner s Is to become subject o Lou Wor4dr'Compemekn
Laws of California.Dam
Applicant
NOTICE TO APPL ICA ..If,after making this Ccoilicam of Exemption,yon should
become subject in the Workers Compensation provisions of the labor Cmc,you muse
,JO forthwith comply with such provisions or this Permit shall be&Coned invoked.
Z y CONSTRUCTION LENDING AGENCY
[-i I barony affirm that there is a comwcdon lending agency for the performance of
CL the were for which this Permit b bsWA(Sec.3197,Civ.C.)
GQ L-cnders Name
z lenders Address
U O 1 unify that I have read this application and sum that the above inrounn m b
W corteeL 1 agree s comply with all city and county OMJimd e;and sum lam relating to
CU building construction.and hereby authadm Mpresmutiv<s of Nb city to enter upon Inc
r W above-mantimed Property for inspected pmpmes
0. (We)agree to eve,indemnity sad smp ho reduce dive City of Cupertinoagainst
r,A Iiabilities,jWgmenu,ants and expense which may in say lay seems against said City
V z in conwequenec of the granflng of this permb
^' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
Issued b t�rC�
SOURc�ULATIONS. Y•— S Date ��
lG 9'K'6( Re-roofs
Signeure of Applica ulContnctar Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Inwill the applicant or future building occupant acre m handle bayardvm material
defined by the Cupertino Municipal Code.Chapter 9.13,and the Health and Safety
dia.sr`°mn53a(a)?
❑Y. $NO/ All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection,I
Will On applicant or fumed Wil Ing occupant use equipment or dcvicca which g agree to remove P
..it barardnm it cddiamimnb fined by the Bay Arse Air Quality Management all new materials for inspection.
DimricR
0Yes No
1 have mad the ha encloses mamdabrequimmenuumcrCWpmr6.95ofthe Califor.
nia Health d:softy Codd,Sccdons 255W,25533 and 25534.1 undenund theif the building
dnm nut c Y have a moot.the it b my responsibility s noofy one occupant of the
rcquisem 'hmmtWmetPoortoinummeofaCcrufmamofdxt��✓ Signature of Applicant Date
Owner Oramhov dagent 9 DameAll roof coverings to be Class';W'or better