06070082 CITY OF CUPERTINO ,r s;'&wx • .>F`:ai<v max" `'` `'"* ` "`£' ,
-BUILDING DIVISION PERMIT ..ICON'TRAC""TQT23TNFOxi1�"IAT;ION
BUILDING ADDRESS: ' ALLBRAND WINDOWS PERMITNOO 6070082
10226 CAMBERLEY LA
OWNER'S NAME: PERMIT ISSUE DATE
JACK HASLING 551 INDUSTRIAL RD 07/11/2006
ONE: SANITARY NO. CONTROL NO.
(650) 622-0330
ARCHI ECTMNGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
:0G LICENSED CONfRACTOWSDECLARATION Job Description
I U F 1 Mreby afRrm Nm 1 am Iimnrcd ureter pmviaiom of LTepur 9(c-ono-U ng
with Sermon 7000)c(Dlvision 3 ofdu Busimv and Professions Code.aad my license is
'a'1n inrallfameanacrrmL REPLACING WINDOWS LIKE FOR LIKE. 9 WINDOWS, RET
j ZLiccnu Claaa `1 _ Conlrador
Dae r'S FIT INSTALLATIONr 1 DOOR SLIDERr NF INSTALLATIO
IT
ARCHECTS DECLARATION,
I undersand my plans shall M used as public men,W
g`U
-G S Licensed Professional
y OWNER-BUILDER DECLARATION
1 hereby affirm that I am comp,from lruuf
the Cona Uccom law for tie
Z a o following moon.(Section 7031.5,Business and ProfOoians Crock:Any city or county
5$ which requires a Parent to emmavum,almr.Improve,demolish.Or repair any Structure
iy prior to its issuance.also inquires the applicall for Such permit to file a Sigurd Statement
2�o that he is licensed pursuant to the provisions of dm ComSacmfa License LAw(Chap=9 Sq.Ft. Floor Area Valuat}b'd285
2 (eommendnem ith Smtia rn and of basis n 3 of da aged cas u d on.Any vi Cede)of
��$ dot he u cempl thme(rom and the buss fm the alleged eanmptm.Any violation of
Section 7031,5 by any applicant for a permit objects the applicant In a civil Penury of �syapN ben Occupancy Type
nes,more than five hundred dollars(SM. 3 4 L 4 L U 15 . 0 0
❑I,as owner of the property,m my employees with wages as Weir Sok compeasol
will da the wart.and the amcwm is rot inutMW mORercel for Sale(So.70th,Budneu Required Inspections
and Pro(wh obis Code:The CantSareon,and
who law dao rot apply lf r through awmr of q p
property who bisitchearirethawch impr and a bo Ones Suchwork hboel!edhis
own a however,
do Wilding
pr Such improvements wit in not intended moQemd for Sale.If,
builder We buildingorimprowmesnInsuldwithin arc you of completion,theowmr-
builder will low the bmdcn of proving that Ire did rot build or improve for purpose of ^^y
mounts Las ower of property,..704 .B sines ad eonuaeiinal with IlameCmnoaion u
e Lthe project(Seco an finer of rope property
who Wifessionallds
Codec)The Career art.Li.
come Lew dam not apply mU with
a of property who od p ra improve Contra and, /
who conuacu for imb wakma with a eondalor(a)Iirensed punwnt ro the ConvacmM1
LleeoLaw.
❑ O�
I exempt under See .Bd<PCfm Wu mann ,
Owner Data
40 WORKER'S COMPENSATION DECLARATION
I hereby e1Nm under penalty of perjury am of the following declarations:
I ham and will maintainaCarffresm of Consent a sel6imum far Wader'aCampn-
.he.,u provided fm by Section Poo of the labor Code.for the Performance of the
work for which this permit Is Issued.
Mhaw and will maintain Worker's Compensation Insurance,as required by Section
37M.1 We Inbar Cade•for We pmformance of the work fmwhich this Permit is Issued
My Workees Compensation Mounded carriatind Policy numbed 6 number
: 7 Z S
Carder:'9 f'N. �Qrr-s. L rpolicy Na.:
CERPFIGTE OP EKEMMON FROM WORKERS'
COMPENSATION INSURANCE
(Thus action recd not ba comPlemd I(the permit Is(arae hundred dollars($100)
orlesa)
I artily oat in the parliaments of We work its which this Permit is lomd,I shall nes,
employ any parson in any manners is an become subject to We Worit rs'Compensation
Laws of California,Dam
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Emmp,ian.you should
become subject to the Worker's Compensation provisions of thea Labor Code,you must
.,O forthwith comply with Such provisions m this permit shall he detract!revoked.
Z► CONSTRUCTION LENDING AGENCY
[ti Ibereby affirm that Cert is a construction lending agency for the performance of
LYi 7 that wart for which this permit is issued(Sec.3097,Civ.C.)
V4Undoes Undoes Name
0.M Lendees Address,
U Q I certify that I have read this application and mm Net the above information 6
L7. F' camecL I agree w comply with all city and county onlinaees and sum laws relating to
OU building conshuction,and hereby anthorim representatives of this city to enter uponthe
L7.1 above-memioned property for inspection purposes.
0. (We)agree to Save,indemnify and keep harmless the City of Cupertino against
o-y 0 liabilities,judgments,costs and expenses which may in any my accrm against old City
U Z in emrsequcme of the glancing of this pemit.
'--' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOU GU A 5.
12' Re-roofs
Si azure of ApplicamAConuacrar Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will to appliesnt or rutum building mmupanutore or handle UnudauS material
as clefted by the Cupertino Municipal Cade.Chapter 9.13•and the Health and Safety
Cods.Section 35537(x)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes V.
Will the applicant or(mum building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
omit hoardam air commanums as defied by the Bay Area Air Quality Management all new materials for inspection.
District?
[:3 yo QfMu
I have mad the humna u mauials requiremew under Chapter 6.95 oftim Califor.
nia Health @Safety Cade.Seedam 35505,25533 and 25534.1 understand that lftho building
does rot Currently how a meant.that it is my mryansibility a notify the Occupant of the
mqulremcnu 'hon meta" Issaancearaeerti&em ofOcapae Signature of Applicant Date
�G All roof coverings to be Class "B"or better
Ower or authorized agcm Dam'
CITY OF CUPERTINO
Jem 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . 1 . : 34242015 . 00
DATE ISSUED. . . . . . . : 07/13/2006
RECEIPT # . . . . . . . . . : 35247
REFERENCE ID # . . . 06070082
SITE ADDRESS . . . . . : 10226 CAMBERLEY LA
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : JACK HASLING
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : PAWEL BORDEWICZ
CONTRACTOR . . . . . . . : JACEK PASTERNAK LIC # 24829
COMPANY . . . . . . . . . . : ALLBRAND WINDOWS
ADDRESS . . . . . . . . . . : 551 INDUSTRIAL RD
CITY/STATE/ZIP . . . : SAN CARLOS, CA 94070
TELEPHONE . . . . . . . . : (650) 622-0330
�EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
- - -------- ------------- ---------- ---------- ---------- ---------- ----------
BENERGY PERMIT FEE 147 . 96 71 . 02 0 . 00 71 . 02 0 . 00
BPERMFEE VALUATION 7 , 285 . 00 147 . 96 0 . 00 147 . 96 0 . 00
BSEISMICRE VALUATION 7 , 285 . 00 0 . 80 0 . 00 0 . 80 0 . 00
---------- ---------- ---------- ----- -----
TOTAL PERMIT 219 . 78 0 . 00 219 . 78 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER 219 . 78 VISA
------------
TOTAL RECEIPT 219 . 78
•
Community Development
10300 Torre Avenue
-' 't'o Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building Department
JOB ADDRESS: PERMIT #
d 0WO-7 ,
OWNER'S NAME: PHONE #4M-ZW
GENERAL CONTRACTOR 1 ID # —03
Ttr
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
• Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
•
Owner/Contractor Signature Date
aloF
CITY OF CUPERTINOCUPfPERMIT APPLICATION FORM
APN # �1� � /1, oI� Date:
Building Address:1 `T \\ Mailing Address (if different from building address):
10220 6a,--Itlelll LOvZ , �✓ Seri p Cr-) 9SGILl
Owner's Name: Phone#:
CLH9 slip 00 Z5-5 -
Contractor: `• 1 License#:
ROS , VA ,,\ w5 -? q 7 S
Contact: I Phone: fl00 GOO_wl' Cupertino Business License#:
A�-C\ A2WSV1 Fax: !70 6•}O-9 5L
Buil ing/Permit Info:
Bldg [5 Elect ❑ Plumb ❑ Mech ❑
Job Description, v HdOws rP� gL'� 5;'22 O" 5 Zc v Ow5 .- ve}JO r�5 A dD '✓
Residential (Td i Zr s :AeN F ;IsVQAat?o-1 Commercial ❑
Sq.Ft. Floor Area: Sq.Ft.:
Cost of Proje W
LO n o C` Occupancy Group:
Type of Construction: J Please check this box if the project is a
second-story addition: ❑
ro ect Size: Standard LJ
Large ❑ a'or ❑
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 100K to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to 1M Btu MECHANICAL
BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL
BBOILER5 Boiler> 1.75M Btu MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/Off/Comm/Quasi BUILDING
BCONSTAXBQ Con. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Constax—Resi/Mobile BUILDING
BELEC1000 Elec 600V <_ IOOOA ELECTRICAL
BELEC1001 Elec 600V > 1000A ELECTRICAL
BELEC200 Elec Svcs 600V<=200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
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CITY OF CUPERTINO
CUPEf�TINO PERMIT APPLICATION FORM
Quantity Fee ID Fee Description Fee Group
BMISCELL Miscellaneous Fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BOVERTIME Inspection Overtime BUILDING
BPBACKFLOW Atmospheric Vacuum PLUMBING
BPCESSPOOL Cesspool PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPFIXTURE Pblg Fixture PLUMBING
BPGAS Gas Piping System Fee PLUMBING
BPINTERCEP Ind Waste Interceptor PLUMBING
BPLANCHK Plan Check Fee BUILDING
BPLANCKADD Plan Check Add Multi BUILDING
BPLANCKREP Plan Check Repeat Fee BUILDING
BPREPIPE Re i e Of Fixtures PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BPSEWER Sewers PLUMBING
BPSPRINK Lawn S rinkler/Backflo PLUMBING
BPSTORM Storm/Rain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
BPVENT Alt of Drain &Vent PLUMBING
BPWATER Install/Alter Water Pie PLUMBING
BPWHEATER Water Heater/Vent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfrn MECHANICAL
BREMAgtHAN A/C Units <= 10,000 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Furnace> l OK btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISC Misc Apparatus ELECTRICAL
BREMNRAPP Rem Non-Res Appliance ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
BRE POWER Power Device/Apparatus ELECTRICAL
BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT Repair/Alter Heating MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
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Q - CITY OF CUPERTINO
CUPEI�TINO PERMIT APPLICATION FORM
AMLQuantity Fee ID Fee Description Fee Group
BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS Remodel Signs, Marquee ELECTRICAL
BREMTHEATR Theatrical Lighting Fix ELECTRICAL
BREMVENFAN Vent Fan Single Duct MECHANICAL
BREMVENSYS Ventilation Systems MECHANICAL
BSCBLVD Scb Specific Plan BUILDING
BSEISMICOM Seismic Commercial BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSPECIAL Special Inspection BUILDING
BSWIM Swimming Pool BUILDING
BTEMP Temporary Power ELECTRICAL
BTEMPPERM Temporary Bldg Permit BUILDING
BTEMPSVCS Temp Dist Svcs ELECTRICAL
BUSLIC Business License BUILDING
ELECTRIC Electrical sq foot ELECTRICAL
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMFEE Mechanicals . foot MECHANICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING
PLLONGRNGR Planning Long Range Residential PLANNING
ZADDCHG Address Change BUILDING
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