05020083 CITY OF CUPERTINO
BUILDING DIVISION PERMIT 1CONTRACTORINFORMATION:
Bu1LDINGADDRESS: THE WINDOW BROKER PERMIT Nt5020083
851 T-A MAR DR
W NER'S NAME: PERMIT ISSUE DATE
RICHARD & TERRY YU 2385 LINCOLN AVE nM4 /2nofs
NE: SANITARY NO. CONTROL NO.
800) 639-4527
ARCHITECTRENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
a00 LICENSED CONTRACTOR'S DECLARATION N i tion
y 0 C 1 hc¢by affirm Ihn 1 am littnxd under provisions of Chapter 9(commencing ]ob DescriP.on�
Zw with Sation70 )of Division3of Oe Budnmv dProfmssions Codc,al mylicenwis
h in full foam and effect t Q
5p: ueenaeclalassss C t7- Lic.g 3b' WINDOWS REPLACEMENT M `�
n^p Dao: VJ�IG //tc�Cono c.—
FFry � ARCHITECTS DECLARATION
K� 1 understand or,plans shall Mused ss public records
DyU
30t; LiccrucO Profusional
3 Oat I am exempt
from
DECLARATION
0 E 1 hereby maso .(firmSec Not 11. exempt from Ne Cantnerars e:Any C Lew for the
2O following mason.permit
](131.5,Business and Professore Code:Any city nrcounty
K m which requires a o,also to mm t,thel,pier,improve.h Permit t fi repair any swmentChure, 99986060
F•z< poor w its tensed .also requims IAC applicant for such patch m Elm a signet gesmcm
Nat me ccenaepurstion7 )provision of the the
LianaLaw(Chapter Code)
Sq. Ft. Floor Area 'daB3Valua[ion
��$ (commencing axe pttSeeirom and
of Divisiofr tof he
Business pt Professions Cndc)of
dual he is exempt therefrom and the basis for Ne alleged exemption.Any violation of '
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of e10 0 Occupancy Type
not mom With Gm hundred dollars(S50D):
I,mmmrofrhepmpmny,ormycmplo withwaganlheir WICCOMNRUIiDn.
will do the walk,and the structure is not succeed or offered tarsale(Sm.704,1,Business
and Professions Code:The Contractor's Liana law does not apply w an humor of Required Inspections
property who builds of improves thcroon,andwho doessmh work himalfar Waugh his
ownemployxs,previdmi Nal such improvemenu art natimeneed ser offered for sale.If.
however.the building or improve ent is hold within one year of completion,the owner-
builder will love the burden of proving that he did not build Or improve for purpose of
sathJ.
❑1,as owner of the propene,am exclusively contracting with licensed contractors to
compact the prelim(SCC.7W,Business and Ptofeig mos Code:)That Character's Li-
meem Law does aol apply to an Owner of property who Wilds Of improvrs thenar,and,
who contracts for such projects with a contractor(s)licensed pursuant to the Contractors
License law.
❑1 am exempt under Sec. .B&P C for this rtaaun
her Dale
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of Ne following declarations:
1 have and will maintain aCerdficas of Consent w self-iusun for Wortrrs Compere- ,
IC3311M
provided fm by Section 3700 of W labor Code,for the perfurmana of the
k for which Nis permit is issued.
1 have and will maintain Worker's Comperualion Insurance,as required by Section
of the labor Cade,for W performance of that work for which this permit is issued Workers Compens/a�tion Insunnce carrier and Policy number siterrier: �4g�'ia gd�ho-.s.I, F Policy No.: .33
CERTIFIR OEMPPr1ON FROM WORKERS'
COMPENSATION INSURANCE
(Ttris section reed notbccompleud if the permit is foram hundred dollars(SIM)
or less.)
1 cedifv duel in the performance of Ne work for which this permit is issued.I shall not
employ any person in any mannerse,as to become subject to the Workers Compensation
Laws of California.Date
Applicant '
NOTICE TO APPLICANT.If.after making this Cenifcaw of Exemption.you should
become subject to the Wolkcr'a Compensation provisions of the Labor Codc,you mug
.J O forthwith comply with such provisions or this permit shall be deemed revoked.
?w' CONSTRUCTION LENDING AGENCY
[-.� I herebyafntm Nat then ire•coustructirn lendingagem,,for the performams of
lY the caulk for which this permit is issued(Sec.3097.Civ.C.)
0.5
Q Lenders Name
D z Lender's Addmas
IJ Q 1 certify that 1 have read this application yW sirs Net red above information u
W (—' corrott I agree to c cam ply with ill city and county nNiwtco and sus laws r upon the fi t) abovenmentioruction.xnd hereby euthonxrepfeanutisrs of this city wens(upon lM
r Irl above-mentioned ogre propene for inspection pappus.
(We)agree ro save,indemnify and keep harmless the City of Cupertino against
U y incoisequen eofthecommand expenses which may in any ss'+Yaceroc a8sinss mid City
V z A APPLICANT
of thegranting of this permit.
^ APPLICANT UNDERSS'{{ANDS ANO WILL COMPLY WITH ALL NON-POINT Issued by:
SO EG ATIOt/S.
I � �d((e car o?- I LI I JS
Re-roofs
Signewrt of ApplicaHAZARDO D�
MA2ARDOe MATE RIALS DISCLOSURE Type of Roof
Will the applicantor(mboat building acupans score or handle hvallous mesnil
u defined by the Cupertino Municipal Cade.Chapter 9.13,and the Health and Safety
Codc,Section 255321a)? All roofs shall be inspected prior to an roofing material being Dy. p p y g g installed.
Will Ne applicant or future building Occupant sea equipmchl of devices which If a roof is installed without first obtaining an inspection,I agree to remove
716.0widr
mh ha ardous air contaminants 0 defined by the Bay Area Air Quality Management all new materials for inspection.
i llicl?
Yes
1havenal Nehma msmawrialsmquimmmnuunderChaper6.95ofWCalifor-
a Health&SafciyCWe,S dm755)5.15533and35534.1undergonethairNc building
ens not currently haw a tenant that it is my nomonxiblidy w notify W ottupanl of the
quire h mussbcelpnorwiss ecofaCcnilie eor01m.lancy' Signature of Applicant Date
L1All roof coverin s to be Class"B"or better
of authonzed apent ac g