04040014 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATIbN• .
BUIEDINGADDRESS: QUALITY WINDOW Fie DOOR PERMITNO.O4040014
OWNER'S NAME: PERMIT ISSUE DATE
KUSH P
NE: SANITARY NO. CONTROL NO,
(408) 777-9090
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
t� 0
uoo LICENSED CONTRACTOR'S DECLARATION
FC 1 bcteby air.Ina 1 a.Eecned ander pmvMam nfChap.'9lnnmmenamg Job Description
iW in fullin=adEfTEf Division Sof Ute Budrcu and Proleuium Code,and myliceduc is
^<yIn full fora and cUaL
License Class Lie.g UPGRADE WINDOWS
Data
FED COD.nor
'J` ARCHITECTS DECLARATION
I understand I undernJ my plan mall hu e used public records
,yU /3 t; Cleansed Pmfcssinnal
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OWNER-BUILDER DECLARATION 11/�
<3 I betehy aRrm that 1 am exempt fru.the Contractors License Law far the
00 following reason.(SCc4on 7031.5.Business and Proforaoni CWC:Any eity or county
$ which requires a Permit w construct.altar,improve,demolish,or repair any structure
Fa> prior or its issuance.also nextiru the applicant for such Permit o rile a signed statement
s< mal he is liaised pursuant In the provisions of Be,Contractor's UansC law(Chapm,9 Sq.Ft. Floor Area valuation
c€m (command,with Section 7")of Division 3 of the Business and Professions Code)of
of $ that he Is exempt mertfmm and de basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant o a civil penalty of 31WN9-0"cr00 Occupancy Type
nut mote Nan Ove hundred dollars(3500).
1,as owner of the property,or my employees with virgas as Oak sole compensation,
will do the work.and me swclum is not intended or offered for sale(Sce.7044,Boom.,
and PmfcaVons Cede:The Contractor,Llceme Law does not apply w in Owner of Required Inspections
pmpeny who builds orimprmes dharenn,and who doessuch work him Jf ortnmugh his
own employers,provided mat such improvements and notiniondW oroRered for some,If,
however.me building or improvement is sold within one year of completion.Ne owner-
builder will tuve me burden of proving that k did not build or impmw for purpose of
ale.).
1,as owner of the prupeny,am exclusively contracting with licensed contractors to
46nsurer the Project(Sec.7W4,Business and Profusions Code:)The Contractor's Lt.
come Taw does not apply in in owner of property who builds or improves Redeem,and
who contracts for such projects with,a eonwctor(s)liaised pursuant m the Contractors
License law.
❑I and exempt��uaed.See .B&P,C for this team
ner 141L� YG-c�-a1�t- Do.jT 1 Zia
WORKER'S COMPENSATION DECLA
RATION
I hereby inn under penalty of perjury ane of the fallXI declarations:
haw and will mainuin a Certificate of Consent o self-louvre for Workers Cmmpcn-
alum.as provided for by Section 3700 of the labor Code.for the Performance of the
work for which Bis Permit is issued.
❑I haw and will maintain Worker's Compenatian Imusex,u an ined by Section
3700 of the Inbar Cede,for the performana of the work for which this permit is issued.
My Workers Compensation Insurance camfcr and Policy number are:
Canna: Polity No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(this section need not becompleted if the Permit is Doran hundred doflare(glp)
less)
1 certify that in me p nfimma t.of me work Ire which this Pemrit is issued.I shall not
employ any person in any manner an as to become abject m the Workens''Compentation
Laws of California.Data
Applicant
NOTICE TO APPLICANT.If,after making this Cenifcam of Exemption,you should
become aabjecl do one Worker.Comparati..provisions of me"nor Cede,you most
.J O forthwith comply who such provisions or this Permit.ball be decmcd revok.d. '
zDi CONSTRUCTION LENDING AGENCY
[—ice Ihereby affirm that mete is a concoction lending agency for doe Performance of
me work for which this permit is issued(Sec.3097,Civ.C.)
CA lenders Name
0. Z Lenders Add=
V Q I coni!,ma I have mad this application and some that the above wremommn is
t" COOTEM I agree a comply wire all city and county on inances and same laws relating to
0U building construction,ad hereby suhmire rep.serautiws Of this city to crater upon the
W ahove-mentiomad Property for impaction purposes I
(We)agree to sow,indemnify and kap harmless the City of Cupcnino against
FraA Iiabilillu.judgments,eosts and expenses which may in any way accrue against said City
U Z in cooso uence of the granting of this Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURC REGULATIONS.p
+�� 4 Re-roofs
S m of ApplicanUConmoctor -
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant mom or handle havardous material
of defined by the Cupertino Municipal Cuda.Chapter 9.12,and the Health and Safety
,djJLWc.seeuora 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
Yes ONu
70wn�Will mea fieanl or f'orr...building..pool ase a era,or device.which If a roof is installed without first obtaining an inspection,I agree to remove
PP 6 pan aAir
�mlmrcrcd
havardnus air contaminants az defined by the Bay Arta Air Quality Management all new materials for inspection.
[l?
0Ycs t6N.
1 have read me havardnusmamrials requirements under CluPmr6.95 of the Califor-
caltn&Safc,y Code,Sections 25505,25533 aW 23534.1 andcrmad thmifthc Wilding
not em.mly haw a Etna..that it is my mapemibility w nous,IM a<uPml of Ne
mcntswhichmunk eEprorwissuadecofaCenificamoraaapmay. Signature of Applicant Date
agcm � All roof coverings to be Class"B"or better
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(gip WITY OF CUPERTINO*
CUP
CITY OF
O PERMIT APPLICATION FORM 01 ° U
N
Building Address: a / 6 7/� �,J g dress (if iff nt fronhiiihUng address):
Owner's Name: Phone #:
�SN ?ACttqu,e i tko '—I2s- 26Z ,
Contract License #:
8-laALI-r-t w iN Dow + Dooz u- bt
Contact:, Phone:\4od`1 i 7-ICQD Cupertino Business License#:
—Z0 C_ M . O U-SS ET Fax: p-08.R8S.`7 3
Building Permit Info:
B g Elect ❑ Plumb ❑ Mech ❑
Job Description:
Residential E] V RMmer
Sq.Ft. Floor Area: S/Sq.Ft..
Cost of Project: Occupancy Group:
Type of Construction: / Please check this box if the project is a
second-story addition:
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBLDGFEE Bldg Permits . foot BUILDING
BBOILER1 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 <= 1000A ELECTRICAL
BELEC1001 Elec 600V > 1000A ELECTRICAL
BELEC200 Elec Svcs 600V<= 200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
I of
r
(Cd- SITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPEI�TINO
Quantity Fee ID Fee Description Fee Group
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 cfm MECHANICAL
BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREVE URN 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
BREMPOWER 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
13REMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS Remodel Signs, Marquee ELECTRICAL
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*CITY OF CUPERTIN(o
CITY OF' PERMIT APPLICATION FORM '
CUPEkTINO
Quantity Fee ID Fee Description Fee Group
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 Insection 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
ZADDCHG Address Chane BUILDING
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