04020081 (2) CITY OF CUPERTINO MR ''
BUILDING DIVISION PERMIT CONTRACTORJNk'ORMA
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BUILaR
DING ADDRESS: ARGONAUT WINDOW & DOOR PMTre004020081
-An WATRRFQPn TIP
r ER'S NAME: PERMIT ISSUB DATE
DAN & LIL
ONE: SANITARY NO, CONTROL NO.
408 996-9670
ARCHITECUENGINEER:
9 -
ARCHITECDENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
p D O O O
y 866 LICENSED CONTRACTOR'S DECLARATION
}try I hereby affirm that 1 am licensed under previsions of Chapter 9(commencing 70b Description
Ma;1 with Srcdon 7")af Division 3 of the Business and Professions Code.and my license is r�I �I��ID
N
_< in full to=and affect. REPLACE WINDOWS
]nz_ License Class Lk.
1,9 Dne coniruws 1
3 ARCHITECTSDECLARATION CCD 1 6 Z�O4
1 understand my omit.hall be tial as public records FEB D
3Kud
Licensed Pmf .ons IBUILDING
OWNER-BUILDER DECLARATION
1 hereby alum on 11. exempt from Ne Consncsurt License Law o far the
E00 follwhich
mads a Permit
90 s S,Business and ProResale um h,or ac ai city or county
crura
$� which reyuirea a permit m construct,otter.impmw,demolish,ns repelr my swnuw
z prior in its tauanrc,also requires the applicantfor such permit in Ole a signed statement
i4 < Nal he is licensed pm.anlmNeProvidentofuse CmursemisLima.U.(Chapter 9 Sq. Ft.Floor Area Valuation
K 8 (commencing wish Settlor]IDO)dfDivision Jaf the Businea and Profeuinm Cnde)m
3 dos briis exempt dominion and the bu0 for Ne alleged exempdm.Any violation of
Schon 7031,5 by any applicant fora permit subjects dre applicant in a civil Penalty of 3 C�NH`Ghd$3er0 0 Occupancy Type
not mon Nan five hundred dollen(5300).
❑I.aawner oftbe propenY.ormY amPloyw with wwgaa Nek.le compewtian,
will dodo work and e: Theatre xi tor's Lia ora w does
set (Sec.70a4,Bwinw
and Pmfahiobu Cade:The Canuumrs and
Law arcs rot apply lf an owner is Required Inspections
propertywho
builds orimproves thereon,endwho doesetchworkhimselfter through Is his
ownemployers,provided proveh Improwmenmaw not leaded oeoffered fm owner.
however.the Wilding or improvement is mid avidin one year of mproe far Ne owner.
mother will have she WNcn of proving but be did cal Wild m improv(or purpose of
ale.).
ja
wner of the property,am exclusively contracting with licensed contractors w
the project(Sec.70x4,Business and Pm(asiow Code:)The Contractors Li.
w does not apply m an owner of property who builds or Impmws demon,and,
acts for such projects with a canuactor(s)Iircmed penwnl to the Contractors .
awze der See. ,B&PCfar Nis recon
DalyWORKERS CO ATIONDECLAB.!I hereby e1Bon under Penaltyof perjury oneof tis(ollawing lantiom:
end will malnmina C. r. ofConanImcelGlnsureforWarkefaComPcn-
provided for by section 3]00 of Ne Ube,Code,far the perfomnanrc of doe
work for which this permit is issued.
1 have and Will maintain Workers Compensation Insun ms.as required by Section
37M of the Lather CWe.for the performance of be work for which this permit is issued.
My Worker's Compi m ilon Insurance carrier and Polity number are:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section nerdaniscoma mond if the pence 1,for..hundreddatlars(SIM)
or]as..)
1 unify that in the perfassname of the..,it for which this permit u issued.I dell nut
employ any Person in any mender m a in become subject to he Workers'Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you Nould
become subject o the Worker's Compensation provisions of dm Labor Code,you mail
.JO foMwith comply with such provisions or this permit shall be decmcd reveled.
Zo CONSTRUCTION LENDING AGENCY t
[—i Iboreby affirm diel then its construction lending agency for the performance of
CC> the work for which this permit is Wood(Sm.301 Civ,C.)
0GQ Undoes Name
z Under't Addrea
V Q I minify Net I have mad this application and sow that Nc above information is
it, cosnci I agree 10 comply with all city and county ordinances and oma laws mkting to
O building construction,and hereby sulhone,mpresenuaims of this city in enter upon Inc
movc-mention dl property for impaction pugmses
tF^^y (We)egme W ol indemnify and keep hamka the City of Cupertino against
h liabilities,judgments,costs and expenses which may in my way amme against mid City /
VT
t.)z APPeof the Staining of nD
LICANT UNDERSTANDS ANWILL COMPLY WITH ALL NON-POINT Issued by: Date I
S EREGULATIONS.
F Re-roofs
alum of APPlican C cmr Dft
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIIl tiro applicant or future building ore dist itme orhandle hasrdaus co osird
tined by the Cupertino Mwicipa7 Cade.CNPter 9.13.and the HcaIN and Safety
.see Y25s33(a)7
. All roofs shall be inspected prior to any roofing material being installed.
❑Yu
Will the applicant or fuwre building occupant tau equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
.,it huesrdous air contaminants a dcfned by dw Bay Area Air Quality Management all new materials for inspection.
Win'?
[3 Yes aNu
I have,catl the box
materiels requiscmen t under Chapter 6.95 of Ne Calif er.
nm Hcalth&Safety Cade.sections 3330.5,35533 and 25534.1 understand dust tfthe Wilding
Jona not currently how•.nano Nat it u my rupowihiliiy m notify Nc rceupant of the
reyuiremen wh matt be met prorw issuancaofa Certificate ofampancy. Signature Of Applicant Date
° All roof coverings to be Class"B"or better
Ownc raw ari'red egenl D