07110015 CTTY OF CUPERTINO `:: ' -'
BUILDING DNISION pERMIT ���R���� ���������� ?
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BUILDING ADDRESS: PERMIT NO.
10135 S[nTAN OAK LN ALLBRAi1D WINDOWS 07110015
;VER'S NAME: PERMTT ISSUE DATE
B& A GOEL 23312 (:ABOT BLVD ' 11/02/2007
PHONE: SANITARY NO. CONTROL NO.
(650) 6�:2-0330
ARCHTIECT/EWGINEER: BUiIDING PERMR INFO
HLDG ELECI' PLUMB MECH
� � � �
� o p LICENSED WNTRACfOR'S DECLARATION
� I hcreby affirm that I am liccnscd undcr provisions of Chaptcr 9(commencing JOb DeSCClpt1011
� z� wiih SccGon 7000) of Division 3 of thc Business and Pro(cssions Codc, and my licensc is Wj�JD��/1T F: PLCMNT ( SAME S I Z E SAME L�C �� 5 RETRFT
�� y in full fo�ce and effect ,
�� i[.�«� ci�$ ��. +r WNDW S
�-
y �, � Da�c Contractor
� ARCHITECCSDECLARA7'lON PATIO I)OOR SLIDER
; W U t undcrstand my plans shall be uud ss public recnrds
e.
; � y Liccnsed Profcssional
y � OWNER-BUILDER DECLARA'CION
�`� I hcrcby al7irm �at 1 am czcmpi trum thc Convactor's Liccnsc Law for thc
L p O following mason. (Scction 7031.5, Busincss md Rofcssions Ca1c: Any city or county
K, Pi which requires a permit w conswc4 s��cr, improvc, dcmolish, or �epuir any swctwc
y Z� prior ui iLS issuancc, alw rcquires thc applicant for such pertni� to filc a signcd summeni
< that hc is liccnscd pursuan� to �hc provisions of thc Conuactor s Licensc Law (Chap�cr 9 Sq. Ft. Floor Area Valuation
Y F� (commcncing wi(h Scction 7000) of Division 3 of �hc Busiacss and Profcssions Codc) or � . $ 3 F) O O
y�� that he u exwnpt �heeefrom and the besis for the alleged exempdon. Any violation of
Section 7031.3 by arry applicant tor a pem�it subjecu �he applicant to a civil penalty of Number �CCU 8I1C T e
not mme �han five hundred dollars (5500). 3 4 2 3 21: 5`. P Y YP
❑ I, u owncr o[ ttie property, or my croployces with wages u ihe'v sole compensaUon,
will do the work, end i6e s�cuctum is not intcnded or ofiered for salc (Sec. 7044. Business
and Rofessiona Cade: The Conuactofs License I.aw doa not apply ta an owner of Required Inspections
propeny who builds or improves thercon, and who does such work himaelt or tlwugh hia
own employces, providcd that such improvemen�s are not in�ended or otfeced for sala If.
however, the building or improvement ia sald wiihin one year of eomple6on, d�e ownerv
builder will have the bueden af proving that he did not build or improvc for purpoae of
sa�k. �
(�f, u awner af the property, am taeclusively contrac�ing with liansed rnnvactars W
wnswct �he project (Sec. 7044, Businas and Pro[essions Cade:)'Ibe Convactnr's Li-
ccnse Law does not spply to an owner of propeny wha builds ar improves �hemon. and ,
who conuac�s tor such projeas with a conuactar(s) ticensed purswnt w �he Convac[ofs
License Law.
' I am exe . B dc P C fw �his reaaon
.vnv � 7 9tit.. ��. Date i 2 �
WORKER'S COMPENSA'ITON DECLARATION
I hereby afium under penalty o[ perjury om of �he tollowing declarations:
❑ 1 hsve and will mainuin a Cenificate ot Conaent w ulf-insure for Worker's Compen-
sation, as providcd for by Section 3700 ot the Labor Code, for the performance ot thc
work for which this pertnit is issued.
❑ I have and will mainlain Workcr's Compensation Insurance, u �equircd by Scction
3700 oC the Labor Code. Cor thc pedormance of the wrork for which this pecmil is issued. '
My Worker's Compenaalion insucance carticr and Policy number are:
Cartier: Poticy No.:
CER7'IFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION 1NSURANCE .
(This sec�ion necd not be completed if the permi� is for anc hundred dollua (f I00)
or Icu) ,
I cenify thut in ihc performancc of Wc work for which this permii is issucd. ! shall not
employ any person in any manncr so u to bccomc subject to U�e Workcrs' Compcnsation
Laws of California. Datc
Applicmt
NOTICE 7'O APPLICAM: If, aftcr making Wis Ccrtifica�c of Exemptian, yau should
bccome subjcct to ihc Worlccr'� CompcnsaUon p�ovisions of �hc Isbor Codc, you must
�,� forthwiW comply with such pmvisions or this permi� shalt bc dccmcd revokcd.
z O CONSTRUCTION LENDING AGENCY
.�
Fr i-r I hc�chy affirm Uut thcre is a conswctinn Icnding agcncy Cor thc perCurtnance of
R; � �hc work for which this permit is issucd (Scc. 3097. Civ. C.) �
W� Q Lendcrs Namc ,
� z Lender's Address
V Q 1 certity �hat I have read ihis application and siatc tha� Wc above informaliun is
w� cortect. I ageee w comply with all city and counry orttinances and sute Iaws relaung w
0 U building consvuctioo, and hcreby authorim represenuUvcs of ihis ciry to cnter upon thc
w alwvc-mcnlioncd p�opcny for inspcc�ion purposes
(Wc) asree �o save, indemnify and kecp harmless the City of Cupertino against
�,.� � liabiliues, judgmcnls, coau and expenacs which may in any way accruc against said City
C, ;Z io consequence oC tl�c granting of this permiL /�
�"'� APPLICANT UNDERSTANDS AN ILL COMPLY WITH ALL NON-PO1NT Issued by: Date �, / ^�
s� wass.� EGU �� ��� � � � 2 ��� Re-roofs
� ��
Signazurc af ApplicanVComracwr ��
HAZARDOUS MATERIALS DISCLOSURE Type of R�of
wll thc applicant or futurc building occupant storc or handlc haiardous matcrial
Jefincd by the Cupertino Municipal Codc, Chap�cr 9.12, md thc Hcalth and Sa(cty
.�. SccGon 25532(a)? All roofs : hall be inspected prior to any roofing material being installed.
❑Y � �'
Will thc applicmt or future building occupant usc cyuipmcn� or dcviccs which
If a roof i: installed without first obtaining an inspection, I agree to remove
cmi� ha•r.ardous air comaminan�s u dcfincd hy the Bay Arca Air Quality Managcment all new m; �terials for inspection.
��5�;���
❑ ves o
1 havc rcxl ihe ha�a�dous maicrials rcquircmen�s undcr Chaptcr 6.95 of �he Glifor-
nia F1calU� & Safcry Cadc. Scctioat 255Q5, 25533 aix125534.1 undcrsmnd that iC�c building
docs iw� curren0y havc a mnan4 Wat it ia my msponsibiliry w nodCy �he accupant of the
rc uim cnts which muu��t pcior m i o[a Ccnit�cam of occu ancy. � Signature ��f Applicant Date
�� 2
Ow r or aumod�cd agcnt „� All roof coverings to be Class "B" or better