06100136 CITY OF CUPERTINO ` ` `
BUILDING DIVISION PERMIT ���`����������'�`���*
<::, ,: ;:: ,.. .,..:
BUILDING ADDRESS: HOLDER INC DBA ABLE GLAS S PERMITNo. 0 610 013 6
PERMIT LSSUE DATE
OWNER'S NAME:
FISHER JAMES L AND BEVERLY P112
SANITARY NO. CONTROL NO.
iNE:
408 739-8829
BU[LDING PERMIT INFO
ARCHI'i'ECT/ENGiNEER:
BLDG ELECT PLUMB MECH
� � � �
i o p LICENSED CONTRACTOR'S DECLARATION JOb DCSCi1�7L1017
;V� I hcrcby aflirm that I am limnsed un�icr provisions o[Chapur 9(commcncing
;z� wiU�Section 70(M))of Division 3 of thc Busincss and Profcssions Codc,and my liccnsc is
;�y infull(oreeandef � � REPLACE (1) WINDOW & (2) PATIO DOORS LIKE FOR
,�? Liccnsc Class '-��' L I KE
;i..,o Datc Contractor
� p C['S DECLARATI
i a Q l undcrswnJ my plans shall bc uscd as public reconls
�yU
'u.y Liccnsed ProCcssional
�y� OWNER-BUiLDER DECI.ARATION
>' I hercby afiirm th�t t am e�ccmpt frum thc Contractors Liccnu Law far thc
3 O O (ollowing reazon.(Scction 7U31.5,Busincss and ProCccsions Cak:Any city or county
%�Pi which requims a pertnit to conswct,altcr,improvc,dcmolish,or repair any swcwre
?Z� prior ui i�s issuancc,alsu rcquircs thc applican�for such permit to filc a signcd su�cment Ft. Floor Area Valuati�r7 5 0 0
:_� that hc is licenscd pursuant to thc provisions o!thc Comractur's Lic�cnsc Law(Chaptcr 9 S�]•
�F-� (commencing wiih Scction 7000)of Division 3 0(thc Busincss and Profcssions Cadc)ur
„�... that he is ezempt therefrom and the basis Cor tAe allegcd exemption.Any violation of
Section 7031.5 by arry applicant Cor a permit subjec�s ihe applicant to a civil penalty of ppN Number Oeeupancy Type
not more ihan fivc hundrcd dollars(5500). 3 6 2 2 3 O 2•� . ��
❑I,u owncr o[the property,or my cmployca with wages az the'v solc compensatinn,
willdothcwork,andiheswctueeisnotintendedorafieredfarsale(Sec.7044.Business Re uired Ins ections
and ProFessions Code:The Conuactor's License Law do��not apply to an owner o( Q P
propeny who 6uilds or impraves thercon,and who does such work himsel[or Wrough his
awn emplayces,p�ovided that such improvemenLa are not intended or olTered(or sale.l[,
however,the building or improvement is sold within one year oC complction,the awner-
builder will have the burden oC proving�hat he did not build or improve Cor purpose of
salc.).
�I,as owner of the propeny,am exclusively convacting with licensed rnnvactors w
wnstiuct the pmjca(Sec.7044.Business and Professions Code:)The Contrdcmrs Li-
ccnse Law docs not apply io an owner of propeny wha builds or improves�6ereon,and,
who conuacts Cor such projects with a contractor{s)licensed pursuant to We Convactor's
License Law.
❑I am ezempt undu Sec. ,B�P C(or this rcuon
Owner Datc
WORKER'S COMPENSATION DECLARATION
I hercby affirtn under penalty o[perjury onc o(ttie following declarations:
,J I hs�e and will maintain a Certifiptc of Consent lo sclf-insure(or Workcr's Compen-
sation,u providcd for by Secrion 3700 of the Labor Code,Cor�he perfortnance ot thc
work for which U�is permit is issucd.
❑I havc and will maintain Workcr's CompensaUon Insurancc,as reyuircd by Scction
3700 of ihe Labor Code.Cor the performance of the work for which�his permit is issued.
My Warke�s Compensatio nsurance carticr and Policy number are:
•
Cartier.V1�4�M�� �Z�1 Poliry No.:
ERTIFICATE OF EX Pf10N FROM WORK RS'
COMPENSATION INSURANCE
(fiis sectian necd not bc complctcJ if the permit is for anc hundred dollars(S 100)
or Icss.)
I certify ihat in ihc per(ormancc of thc work for which�his permit is issucd,I shall not
cmploy any person in any mannar so as a bccomc subjcct io the Workcrs'Compcnsation
Laws of Califomia.Datc
Applicant
N077CE TO APPLICANT:If,aCtcr making�his Ccrtilicate of Excmption,yau should
bccome subjcct to thc Worker's Compensation provisions oC thc I.alwr Codc,yau muu
�O (orthwilh comply wi�h such provisions or this permit shall bc dccmcd revokcd.
Z"" CONSTRUC7'ION LENDING AGENCY
(.~.�� 1 hcrehy alTirm that thcre is a conswcdon Icnding agcncy Cor thc per[armancc oC .
�.7 �hc wurk for which this permit is iuucd(Scc.3097,Civ.CJ
W Q L,endcfs Namc
�z Lender's Address
V� I certiCy U�a�1 have rcad this application and s�atc�hat ihc aAovc infortnaaun is
w►�-� cortect.1 agrce io comply with all city and county ordinances and sute laws relating�o
O U building conswction,and hcmby authari�e rcprescntativcs o!this city to cntcr u�n thc
ahovc-mcntioncd property foc inspccuon purposes.
�"a (We)agree to save,indem�i(y and kecp hartnleu thc Ci�y of Cupertino against
�� liabiliuu,judgmcnls,costs and expenscs which may in any way accrue against said City /�
(�,'� in conxqucnce oC�hc ting of this permil. Date C e—��--��
►� APPLICANT UND NDS AND W1LL COMPLY WITH ALL NON-POINT Issued by:
SOURCE REGU
��� �Q� ��—
Re-roofs
Signaturc o( licant/Convactor �a� Type of Roof
HAZARDOUS MATERIALS DISCLOSURE
Will Ihc applicant or futurc building occupant starc or handlc ha•rardous matcrial
az dcIIncd by the Cupertino Municipal Codc.Chaptcr 9.12.and thc Hcalth and Safcty
c�,Scction 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Y� �° .
Will the applicant or fuwrc building occupant use cyuipmcnt or dcvices which If a roof is installed without first obtaining an inspection,I agree to remove
.iit harardous air conuminants az dcfincd 6y the Bay Arca Air Quality Managcmcn� all new materials for inspection.
Districi?
❑Ycs J�Nu
1 havc rcad the ha�ardous ma�crials rcquircmcn�s unJcr Chaptcr 6.95 oCthc Cali(or-
nia Hcalih&Safcty Codc,Scctions 25505,25533 aru125534.I unckrsiand tha�iCihc building
docs not currently have a tenan4�hat it is my responsiAili�y to nodl'y the occupant o(�hc
rcyuircmcn�s w ' ust bc met prior to issuance o[a Cenifica�c or Occupancy. $�gnatUI'e Of e�►PPI1Caflt Daie
'� '� All roof coverings to be Ciass"B"or better
Owncr or aut arizcd agcnt Datc