08060181CITY OF CUPERTINO
DIVISION PERMITI
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GO
BUILDING
aurLfTAp(�R REGNART RD
ALLBRAND WINDOWS
08060181
:
SANITARY NO. CONTROL NO.
(650)622-0330
ARCH71FECr/ENGINEER:
BUILDING PERMIT INFO
BL.DG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that I am licensed under provisions of chapter 9 (cummencing
with Section 700M of Division 3 of the Business and Profe.Wom Code, and my lkcn is
RP LC 9 WNDW S , 1 BDRM WNDW TO BE LWRD 4 " TO MEET
in full fora and effccL
L� 21011
Litt ass Lie.:
44"SILL HEIGHT
Date Contractor
ARCET ECTS DECLARAT
i undcmand my plans shin be used as public records
Licensed Professional
OWNER -BUILDER DECLARA7ION
I hereby affirm that I am exempt from the Contractor's License Law for the
following reason. (Section 7031.5, Business and Professions Code: Any city ter county
which requires a permit to Conant, alter, improve, demolish, or repair any arnretum
prior to its issuance, also requires the applicant for such permit to Ole a signed stautm nt
"he is licensed pursuant to the provisions of Lite Contractor's License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 700M of Division 3 of the Business and Professions Code) or
6 9 0 0
that he Is exempt therefrom and the basis for the alleged exemption. Any violation of
3 5 6 2 2 0 0 9. Number
OCCll
Occupancy Type
Section 7031.5 by arty Applicant for a permit subjects the applicant to a civil penalty of
not more than Eve hundred dollars (SS00).
❑ L, as owner of the property, or my employees with wages as their sale compensation,
Required Inspections
will do the work. and the stractme is not Intended or offered for sale (Sec 7044, Business
and Professions Code: The Contractors License Law does not apply to an mvner of
property who builds or improves thereon, and who does such work himself or through his
sawn employes, provided that such improvements are not intended or offered for sale. If,
however, the building or improvement is sold within one year of completion, the owner.
builder will have the bwdm of proving that he did not build or improve for purpose of
sale.).
❑ L as owner of the property, am exclusively contracting with licensed contractors to
consuod the project (Sec. 7044, Business and Professions Code:) The Contracmes L.i-
cerse Law does not apply to in owner of property who builds or improves i c.,con, and
who contracts for such projects with a contractor(s) licensed pursuant to the Cnmractoes
License Law.
❑ I am exempt under Sec. , B & P C for this reason
Owner Date
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a Certifiale of Consent to self -insure for Workers Compcn.
-
sation, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issud
I have and will maintain Worker's Compensation Intumm as required by Section
37M of the Labor Code, for the performance of the work for which this permit is issued
My Workers Com�peln�sation,
WORKERIT
COMPENSATION I14SURANCE
qftstcctionnczd oot be completed if the permit is for one hundred dollars (S 100)
I certify that In the performance of the work for which this permit is issued. 1 shall not
employ arty person in any manner so as to become subject to the Worked Compensation
Laws of California. Datc
Applicant
NOTICE TO APPLICANT: If, alter making this Certificate of Exemption, you should
become subject to the Workers Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this peunit shall be deemed revoked -
CONSTRUCTION LENDING AOENcY
I hereby affirm that there is a construction lending agency for the performance of
the work for which this permit Is issued (Sec. 3097, Civ, C.)
Lender's Name
'
Lcrhdet's Address
I certify that I have read this application and state that the Above iamnnation is
correct I agree to comply with all city and county ordinances and state laws relating to
building construction, and hereby auoorim mpreserttadves of this city to enter upon the
above -mentioned property for inspection purposes
(We) agree tD save, indemnify and keep harmless the City of Cupcnino against
liabilities, judgmcns, toss and expenses which may in any way accrue against said City
in consequence of the granting of this permit.
2 ��
APPLICANT
the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code. Chapter 9.12. and the Health and Safety
Code. Section
n 25532(a)?o
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
District?
NNo
❑Yes
I have read the hazardous materials require mers under C*W 6.95 a the Call iror-
ma Health & Safely Code, Sections 23505. 25533 and 25534. I understand that it the building
does not currently have a Lcr=L that It is my responsibility to notify the occupant of the
requirements chmguskbemetpror