07040229 CITY OF CUPERTINO C�11TRA�TOR INFC�RATIQl�1.
BUILDING DIVISION PERMIT
PERMIT NO.
BUILDING ADDRESS:'
OWN r�t
•IN K & JUNKO HOMEST]EEAD RD
S@r4T/kwpy'-2 O O 7 CONTROL N0.
BUILDING PERMIT INFO
ARCHITECTIENGINEER: BLDG ELECT EC
PLUMB ML�H
t Z LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby affirm that I am licensed under provisions of Chapter 9(commencing
Uwith Section 7000)of Division 3 of the Business and Professions Code,and my license is
ow in full force and effec Lie (q 93 7 REPLACE WINDOWS & DOORS, LIKE FOR LIKE, IST & 2ND
z License Class FLOOR
p Date 4 7'7"�� Contractor
m T— ARCHITECTS DECLA AT
ti a I understand my plans shall be used as public records _
L1U
F" Licensed Professional
OWNER-BUILDER DECLARATION
_ 1 hereby affirm that 1 am exempt from the Contractor's License Law for the
O following reason.(Section 7031.5,Business and Professions Codc:Any city or county
which requires a permit to construct,alter,improve,demolish,or repair any structure Sq.Ft. Floor Area Valuation
to prior to its issuance,also requires the applicant for such permit to file a signed statement
that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9
— (commencing with Section 7000)of Division 3 of the Business and Professions Co'on of de)or eeupaney Type
that he is exempt tang applicant
florbasis mit subjects r the leged the applicant to a cn. iviltolad pe penalty of APP 1 Number
Section 7031.5 by arty app Pr
not more than five hundred dollars(5500). 7 1 1
I,as owner of the property,or my employees with wages as their sole compensation, Required Inspections
will do the work,and the structure is not intended or offered for sale(Sec.7044,Business
and Professions Code:The Contractor's License Law docs not apply to an owner of
property who builds or improves thereon,and who does such work himself or through his
own employ ,provided that such improvements are not intended or offered for sale.If,
ees
however,the building or improvement is sold within one year of completion,the owner
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business and Protons builds r improves thereon,and
Li-
cerise Law does not apply to an owner of property who
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's
License Law. B&P C for this reason
1-1 I am exempt under Sec.
Date
Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
have and will maintain a Certificate of Concent to self-insure for Worker's Compen-
m,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
I have and will maintain Worker's Compensation Laurance.as required by Section
3700 of the Labor Code,for the performance of the work for which tris permit is issued.
My Worker's ompensadon Insurance carrier and Policy number %
Carrier Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed it the permit is for one hundred dollars($100)
or less.)
I certify that in the performance of the work for which this permit is issued.1 shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
Z forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
.�. 1 hereby afrirm that there is a construction fending agency for the performance of
h7 the work for which this permit is issued(Sec.3097,Civ.C.)
"~ Lender's Namc
ZLender's Address
C—) re
I certify that 1 have ad this application and state that the above information is
►� correct.I agree to comply with all city and county ordinances and state laws relating to
Ubuilding construction,and hereby authorise representatives of this city to enter upon the
W above-mentioned property for inspection purposes.
OA (We)agree to save,indemnify and keep harmless the City of Cupertino against
In liabilities,judgments,costs and expenses which may in any way accrue against said City Date �r
Z in consequence of the granting of this permit. LL NON-POINT Issued by: C
APPLICANT UN ANDS D WILL COMPLY WITH A
SOURCE R A
f/-27-0' Re-roofs
Signature of t/Cootractor °are T of Roof
HAZARDOUS MATERIALS DISCLOSURE Type
Will 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 25532(a)? All roofs shal.be inspected prior to any roofing material being installed.
C3 Yes o If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment ordevices whicb all new materials for inspection.
hazardous air contaminants as defined by the Bay Area Air QualityManagement
,trio?
0 yns u
I have read the hazardous materials requirements under Chapter6.95 of the Califor-
nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building
does not current) a tenant,that it is my responsibility to notify the occupant of the �— Date
requiremc ich ust t prior to issuance of a Certificate of Occupancy. Signature Of!�ppllcant
2 -d All roof coverings to be Class"B"or better
Owner ordi
rzcd agent Date