02080057 (2) CITY OF CUPERTINO
BUILDhNG DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
1160 ELMSFORD DR CRYSTAL CLEAR WINDOWS IS, DOORS 020800}}5,7
d &,EDWARD R AND MILDRED J 396 SOUTH BASCOM AVE APPLICA6?rn j0002
( I PHONE: (408) 977-1003 SANITARYCNO. COMAOLNO.
GOO ARCHITECTIENCINEER: BUILDING PERMIT INFO
L02 BLDG ELECTPLUMB MECH
a6 —U I---U I= IJ
ZO SH2 LICENSED CONTRACTOR'S DECLARATION
n o 1 hereby of ino that 1 am licensed under provisions of Chapter 9(commencing Jib Description
FHFw wiNSection7000)pfDivision3ofNeBusincssandPorfeuionsCode,andmyliccnu WINDOW REPLACEMENT
6 Y I is in full force and effect.
irc0 w S u License Clava Ltd.
i co Date Ctr r
w ARCHITECT S MULARATION
g I understand my plans shelf W used
s�RSs�sr
co
as public records
wta
6 p 0 Licensed Professional FEB 13 2003
^-
OWNER-BUILDER DECLARATION e 1 hereby afford Nat 1 am ucm
y in from the Can asses is License Law for the $9500
following reawm(Section 7031 S.Bi sineal mal Professions cou
Code:Any city or nry
F.❑ which requires a permit toconstruct.other.improve,demolish,or repair any structure BUILDING
o.3ve Prim to its-damance.also requires the applicant for such Permit to file a siprod statement -- - - - _ _ ____._ ._.-...._
- Nmhe islicensedpur. ,ho rise ProvisionsofNeConhaz,or Ladmosel., (Chapter 9 „1"-,:,.,3(53WID0�20Tfta t... - Valuation
(<ommcog N Sectin 7W0) f Dr,ison 3 of me Bnsyk aegrofa onaCud) k.p„ _ am, .., , _ l,l_hs 7I,J,
.,,hot he is exempt therefrom and the bass for the alleged eiempuon.Any violation
of Section 7031.5 by any applicant for a permit subjects me applicant to a civil penaltr
of not more man rive hundred dollars S5S500) l O TARN NOMUAT ION I,. Occupancy Type
°I,as owner of the property,ser my employees with wages as their sole compensation. 102 - PIERS
will do the work'.and the structure is not interWed or offered for sale(Sec.'704,L- 10 3 - UFER
Budocss'and Profusions Code:The Contractors License law does not apply to an Required Inspections
or through
r of property Who builds ser improves thereon,and who does such work himself 104 - REBAR
or Ned for
his sewn employes.provided that such improvements ere not intended or
.or ion.One B.hnwaede wileavingserimyrurfprovisBaldhedidnot Wild .... ...._.. -.1-05. _ ANCHOR-BOLTS.- .._. .. ....... . .. ..._ -. . _. _
completion,tlm owner-builder will have the burden of proving met he die not build or '
improve for coronae ser sal=.). 106 - SEWER & WATER
I f Phe p opertY.am excluvm
velY=oaning w m I d ctu
o n t
- -202 - UNDERFLOOR—'PLUMBING -
tio t to p ject ise= 70x1.Business and Professtnna Cod )The Co tats 203 - UNDERFLOOR MECHANICAL
License Law does not apply to an owner of property who Wilds or improves thereon,
.. _and who contacmfor such projects with axontractor(s)Imemed.pursuant m the _- _ -204- ----UNDERFLOORS-FRAME. . . . ... ..... ._..-.sass
__. . .
i ns`°r'P`yn`s�,�jj e'&P( farthismasion 205 - UNDERFLOOR '3INSUL'ATION
ow Ke AzAllGaz 301 - ROUGH PLUMBING
WORKER'S COMPEN NDECLARATION 302 - TUB & OR SHOWER
.'sl tIfherebyaPormunde,Knatfyofperjury eofinernuowingdeclaations: 303 - ROUGH MECHANICAL
:.
.° I have and will maintain a Certificate of consent to self-insure for workers 3 04 - ROUGH ELECTRICAL
11 Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for whim thus Permit is i..aw. 305 - FRAME
111 have and will mainain Workers Coinpanation Laurence.as required by Section 306 - HOLDOWNS
37M nr m=Labor Cade.rill Ne performance of the work for whim his omnis is 307 - INSULATION
' ids It . k ,'se x r amsur erawPoly 1w are 308 SHEETROCK
Can i t ,.u. •.,Pol.yNo' e`,s 1 1,
CPR F, ATION OF EXEMM06N FROM WORKERS ' •� . S.O 9- iEXTERI OR ,LATHI ,
-,, COMPENSATION INSURANCE '"""" t _
- -31-0— -INTERIOR--LATH-- ---- --
(rd' limn need on be camplct d ifffic,p.rmit is for one hundred dnaar.. 311 `. SCRATCH COAT
<s 1 W l or less.)
313 -,-- .
ROOF NAIL.-..,..
�3 ...... ..... .._
'Ic n,fy that in the pert ' I iiie wink'fiarN's pe 1- ids ed,I , "--
cumpeI °Iy pe,,or ym /_ t&bJbi tt theWorkers' 501 - FINAL ELECTRICAL''ENERGY
.,at If �D�.e 502 -,-,,,_.FINAL- PLUMBING ENERGY _
APoI cam .. .-_.._ .. .-
rvoTle ucnN'nf terilk gNscrfrmt fEsemPi yousn .Id 503 - FINAL MECHANICAL 'ENERGY
z becom u 3ec1to th W rke(s C pe sat p ions of he LaborCore you most
ZQ fnnhw rh c�mplywm urn prodannsm'hspe.I,shag To dee ed revoked. 504 FINAL BUILDING ENERGY_
505 - FINAL ELECTRICAL
CONSTRUCTION emisacLENDINC AGENCY -
a.7 1
he
affirm that mere ids c,.cd Sec.
W7.lendingagency for the,pertormar¢e 506 - GAS TEST -
a,Q of the work for which Nrs permit is issued(Sec.3097,Co,CC.) --- - -
1Ls`mcrsn"neresa; ....... ..... . .507FINAL_-PLUMBING ' - .. - ..... .._
U0 I nfYdon lh reamed application drat Nath .W formatonis 50 - FINAL MECHANICAL'
f+ F. ten n 1 g , nn pini
ly In II 'ry-and ry oN nc and state laws relaung 5 9 - I NAL GRADE
0.1- wWldngc t do dh by tone premi e,% fm city to enter noon
p y the b p p ny for p t n propose,
5 0 - INAL NG
a (W )agree to aindemnity and eh rte) saver re �rtagainst 5m liabilities, t. a mas which y tam Y - INAL
RKSU Z cidyconsequence of granting r thispermit.
�V
AAICA VI'UNDERSTANDS y)'D WILL COMPLY WITH ALL NPt /
u' r�/Jt13dcGuflLA'rfp-s/IG/J/� _fA' _ Issued bye Date
Signature or Applmanbeoenmcter "/' Data C� Re-roofs
HAZARDOUS MATERIALS DISCLOSURE, ,
- Will theapplicant o tet re bonding c pant some or handle nazwows mmcdal Type of Roof,., . ...:
as def ed by,theCupcn no Municipal Coa Chapter912 and the Health d Safety
'.. - ...' •. _. -.. ..
Code S ti n 25532(el 7 , k i ,.a a b ':_ }` cl-,{.t .. c: •>., 'v
All roofs shall be.mspected poor to.anyrooftng material being Installed. .
. lYlltheapplicant
i from bulAingx pad Am.Airequipment deviceswhim If a roof is installed'without first obtaining an inspectidri, I'agree to remove
emith aM m , d toed hyla Bay Quality Management g
J_ Diso '°Y all new materials for inspection. A Meant understands and will comply with
$N all'non-pointSource reglattons�., pp
1 have.read me h card .ma¢riels rcm
quueems under Chapter 6.95 of the -
Celif m. HeaIN&Safety Code.Sections 25505 25533 and 25534 1 understood Out
iflM Wilding dors not cuncntly hevnn tenehr,11 itis my msprinsiblliry tohoiify Nc - -
cupam of the reyuirementy which must W ten prior to issue ce of a Cenifcme of
O
a -
Signature of Applicant _ Date
roraurnonrcdagrnt ' .. „ Dmc All roof coverings to be Class "B"or better
._.... .. —OFFICE
• /b/ t/- 10300 Torre Avenue
rtino,California 9.1014
CITY OF ( u i YYY��% n �Y Telephone (408) 777-3228
CUPEkTINO l�!( ` l/ FAX (408) 777-3333
COMMUNITY DEVELOPMENT/BUILDING DIVISION
February 11, 2003
Homeowner -
1160 Elmsford Drive
Cupertino, C" 95014
S�JtECT: Permit: #02080057/Window rep
l cement, needs final inspection
Dear omeowner:
Our records l ' e at the above listed permit is due to expire on March 20, 2003.
If due to circumstances beyond your control, you have been unable to schedule an
inspection, you may submit a letter to the City of Cupertino Building Official
requesting a one-time extension for his review. Please state in the letter the reasons for
your request If no extension is granted and no inspection is called before the expiration
• date, this permit will be voided and the permit application discarded. After this point, you
will need to submit new plans for plan review and pay permit and plan check fees to be
issued a new permit.
If your records show that the permit card was signed and released by an inspector as
being complete and final, please notify this office at your earliest convenience. We will
update our computer files and close your permit, and we apologize for any inconvenience
this matter may have caused.
Thank you for your attention to this matter.
Sincerely,
( — 7
CITY OF CUPERTINO �/13 0
Christy Akatiff, Administrative'Clerk
t-
Printed on Recycled Paper