07050113 CIT�I OF CUPERTINO ' ` ' ` `
BUILDING DIVISION pERMIT ���'T`���������TI��' :
,;.;:: >;; ,.:.:.....:. ... . _....:.: :
PERMIT NO.
BUiLD,��o�RE�s�UIREHILL CT HOLDER INC DI3A ABLE GLASS 07050113 •
OW NER'S NAME: PECtMIT ISSUE DATE
FISHER JAMES L AND BEVERLY P 1129 RI�HARD AVE
vE: SANITARY NO. CONTROL NO.
(408) 739-8829
ARCHITECTBNGINEER: BUILDING PERMITINFO
HLDG EI.ECT PLUMB MECH
� � 0 �
i o p LICENSED CONTRACTOR'S DECLARATtON JO�]DeSCT1pC1017
i V� I hcrcby affirm that[am liccnscd undcr provisions ot Chaptcr 9(commcncing
;z� wi W Sccaon 7000)of Division 3 of thc Business and Profcssions Cadc,and my liccnsc is RE P LAC E W I NDOW S L I KE F O R L I KE.
?�y in WII force and e ct C� �p
��^ Licenac Clasa �.•�.� .
;�,w Datc Conueetor
� CHRECTS DECLARATION
i a Q 1 undcrstanJ my plans shall bc uscd as pubiic rccords
)aU
'u.y Liccnsed Pnifcssional
�y� OWNER-BUILDER DECLARATION
>' I hcrc6y alTirm that 1 am ezcmpt Crom�hc Contractor's Licensc Law far thc
jp O following rcason.(Scction 7031.5,Business and Profcssions Calc:Any ci�y or county
`<�Pi which mquires a permit io conswct,alicr,impmvc,dcmolLth,ar repair any swciurc
�Z y prior w ils issuancc,alsu rcquircs thc applicant for such permit to filc a signcd statcmcnt
�_� thai hc is IiccnscJ pursuant to thc provisions of thc Conuactur's Liccnu Law(Chaptcr 9 :>q.Ft.Floor Area Valuation
�F-� (commcncing with Scction 7000)of Division 3 oC�hc Busincss and Profcssions Codc)or $9 5 0 0
,,�.. thai he is exempt theicfrom and the buu(or the allegcd exemption.Any violaGon of
Sectlon 7031.5 by airy applicant!or a petmit subjccts ihe applicant to a civil penalty ot �ypT Number Oceupaney Type
not more than five hund�ed dollars(5500). 3 6 2 2 3�2 7�V
�[,as owner oC the prnperty,ar my employces with wages az the'v satc compensaGon,
will do the work,and�he strucwce is not intended or ollered forsale(Sec.7044.Husiness Re uired Ins eetions
and Professions Cadc:The Conuxtor's License Law dae5 aot apply tn an owner of Q P
property who builds or improves thereon,and who does such work himselt or through his
own employces,provided that such improvements are not imended ar ot&ced for sala It,
howevu,the building or improvement is told within one year of wmpletion,tl�e ownu-
builder will have the burdrn of proving Uiat he did not build or improvc[or purpose of
salc.).
❑I,as owner of the property,am exclusively conuacting with licensed rnnvactors to
construct the projett(Sec.7044.Business and ProCessions Code:)7Le Contnctor's Li•
ccnse Law docs not apply to an owner of propeny who builds ar improves�hemon,and.
who conuacts fot such projects wi�h a conuanor(s)licensed pursuant w Ihe Convxwr's
License Law.
❑I am ezempt undu Sec ,B 8c P C for�his rcason
Owner �a�
WORKER'S COMPENSAT[ON DECLARATION
1 hcrcby afficm under pcnalty of pe�jury onc of the[ollowing declaruions:
❑I hsve and will maintain a CeniGcatc of Consent lo self-insure for Worker's Compen-
sation,as providcd for by Section 3700 oC�he Labor Code,(or�he performancc ot Uie
work fo�whicd Ihis pertnit is issued.
havc and will maintain Workcr's Compensauon Insurancc,u�cyuired 6y Scction
700 of the Labor Code,Cor the pcA'ormance of�he work for w6ich this permit is issued.
My Worke�s Compemation Lisnrancc carticr and Polity numbcr a
Carrier.�l $ PoI"�cy No.: ��
RTIFICA OF EXEMPI'ION FRO WORKERS'
COMPENSATIONINSURANCE
(This section necd not bc complctcd if the permit is for onc hundred dollars(5100)
or Icsa) '
I ceni(y ihai in thc performance of the work for which�his permii is issued,I Shall not
employ any perwn in any manncr so az ta bccomc subject io the Workcrs'Compcnsation •
Laws of Cali(omia.Da�c
Applicani
NOTICE TO APPL.ICANT:I(,af�cr making this CcniGcatc of Exemplion,you should
bccome subjcct to�he Workcr's Compcnsation provisions oC thc Lahor Codc,ynu muu
.J O forthwith camply with such provisions or this permil shall 6c dccmcd rcwokcd.
�""' CONSTRUCTION LENDING ACENCY
(-~-�►�-+ I hcreby affirm U�at thcre is a conswctinn Icnding agenry 1'or thc perfortnan��c of
Cli� ihc wurk for wAich ihis permi�is issucd(Scc.3097,Civ.C.)
W Q Lcndcr's Namc '
�z Lender's Address
U� 1 ccrtify U�at I havc rcad this application and statc that thc abovc in(ortnauun is
�►" cortect.I agrce�o eomply with alI city and county ordinances and sta�e Iaws relating to
0 U building conswction,and hcreby authori�e rcprcscntativcs of Nis ciiy to cn�cr uEmn thc
� W ahovc-mcntiuncd properry for inspccuon purposes.
a (Wc)agrce to save,indcmni(y and kccp harmless�hc Ci�y of Cupertino against
�� IiabiliUcs,judgmcn�s,cosa and cxpcnscs which may in any way accruc against said City —7
(„)z in consequcnce oC thc 'ng oC�his permit. Date S ( �/
►-� APPLICANT UN DS AND WILL COMPLY WITH ALL NON-POINT Issued by: �
SOURCE REGU �����
Re-roofs ���
Signawre of ApplianUConuactor Dalc `
HAZARDOUS MATERIALS DISCLOSURE Type of R�of
Will ihc applicant or futurc building accupant storc or handlc ha•rardous matcrial
az dcfincd by the Cupenino Municipal Codc,Chaptcr 9.12,and�hc HcaIW and Safcty
coa�.Scction 25532(a)? � All roofs:�hall be inspected prior to any roofing material being installed.
O Y�
Will the applicant or fumre building occupant usc eyuipmcnl or dcviccs which If a roof i:c installed without first obtaining an inspeetion,I agree to remove
cmit harardous air contaminants ac dcfincd by the Bay Arca Air Quality ManagcmcM all new m�terials for inspection.
Disu;ct? _y
Q Ycs Dlf Nu
P"
1 havc rcad�he ha�ardous matcrials rcquircmcn�t unAcrChaptcr 6.95 of�hc Cali(or-
nia Hcalth&S tyCodc,Scctions 25505.25533 and 25534.I undcrstand thu iCthc building
docs noi c avc a tcnan4�a�i�is my responsibili�y w nodfy Ihc occupant af thc
rcyuirc mus�be mel prior�o issuancc of a CcNfica�c of Occ Signature of Applicant Date
Owncrorauihorizcdagcnt o„� All roof coverings to be Class��8��or better