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04100152 CITY OF CUPERTINO t `-� �� t BUILDING DIVISION PE ',C, .112ACTAORINF ORMA�N BUILDING ADDRESS: PERMR NO. PELLA WINDOW & DOOR CO. 04100152 2NER'S NAME:.LW434 DR PERMIT WUE DATE PHONE: SANITARY /22 OL NO. ARCHnECDENCINEER: BUILDING PERMITINFO BLDG ELECT PLUMB MECH _00 LICENSED CONTRACTOR'S DECLARATION Job Description wF 1 hereby affirm Net I ser(icer ad underPPmvisome,of chapter 9(commencing i'uj wiOScaion] )of ton 3 of the Easind7,L2n ofrsi tins ode+nda�•limmeeis ?� in full fo deffecs. //�"' l(S/ _�—'? Daea aas� covtrecu REPLACE WINDOWS & SLIDER ro A HHECI'S D A I N '� 1 shall W used u pub ie records isc liccnuJ Pmfcssiuml OWNER-BUILDER DECLARATION ContrON E: 1 naso affirm than 1 1 exempt from the Cantmema License Law for the o o following reason.Permit t ]11313.Bui•.r.and Profdssimo Calc:Any city st county K S�i which requires a pertnit m cnnswn,alar,improve,demolish,or repairany structure La prior on its issuance.also mquium the applicant for such permit to rile a signed statamcntValUat that he islicensem d puranttothc provisions of Ne Contracturss,'s CheUw(Chapef9 Sq.Ft.Floor Area mHa (commencing with Section 10)07af Division 3nfthc Businusand Professions Cadc)of to that he is marept therefrom and the basis for the ailo of exemption.Any violation of Section 1031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 69t!,NYTIFr 0 0 Occupancy Type not roam Nan fits hundred dollars(5500). ❑1.0 My of Nepmpmty,mmyemploycawithwaguaztheirrolecampcnsation. will do Ncwark.and the awcture is nal inendN or offered fmande(See.10th,Business Required Inspections and Pmrcwum Code:The Commenor's License Law dace not not apply 10 In owner of q P pmperlywho builds orim mover thereon.and whodoessuch work himselfor through his own employees.provided Nat such impowrou nu art not Intended ornlrand forcole If. however.On building or improvement Is mid within ane year of completion.the owner- builder will have On burden or proving Nat W did our Wild or improv,for purpose of sak.). s u owner of On properly,am exclusively ad canhacling with licensed Contractors m consumer La Ne prolan apply in n Guiness and property who Code:)The Conlrsmon. nd whoa Law does not apply am owner of properly who Wilda or impmvu thereon,and who convects for such pmjeas with a contranmr(p licensed pursuam to On Convathree cnu me 1 om exempt unticr Sec. .B k P C for Nis mazon I weer La Dare WORKER'S COMPENSATION DECLARATION 1 hemby affirm under penalty of perjury one of use following dodmations: 1 have and will maintain aCenificam of Content to air-imam for Worker'sCompen- nation,ss provided for by Section 3100 of On labor Code,for the perfnrmanu of the work for which this permit is issued. ❑1 have and will maintain Wmkefs Compensm test I...as Inquired by Section ' 3100.17 On Labor Code,ra On performance crone work for which this permit is issued. My WPrime cop s on InInnnce carrier and Palo num 1` T^III —�J✓� 6axof}; LV P� j/- CERTIFICATE OF EXEMPTION FR MWORKERS' COMPENSATION INSURANCE ffbls section need out W completed if Ne pmmh is faone hunArtddollars($IW) or leu) 1 certify that in the performance of the work for which this permit is issued.I shall na employ any person in any manner m as to become subject to be Worluma Compamadon Uws Of Califomia.Data Applicant NOTICE TO APPLICAM:IL after making this Certificate of Exemption,you should become subject in the Worker's Compensation previsions of On Labor CNB you must .�,Z foM WIN comply wish Inch provisions or Nis .it small W deemed revoked. z� CON9 RUCTION LENDING AGENCY r(r E Iherthy affirm Nm Vertu isacovuainn lendingtt nyfar Neperformmmof 7 she wool,fa which this permit is issued(Sec.3091,Civ.C.) W QLenders Name G Leader's Address Vz 1 certify that 1 haus read this application and state Nat On shout information is fl W. emmm.l agree to comply with all city and county ordomtts and mute laws totaling to V buildingWe).,construction, ..indemnid hereby y and eprurmatimsn Niscity menter upon nst r W above-mentioned property for inspection purpsam. a' (We)agree to cove,Indemnify and keep hay I.an the City of Cupertino against f\// rp liebilidu,judgmcnu.rosu and cxpcnsu which may in anyway accme ageinal said City Uz in cmuryoence tine of Ira moil. Dale APPLICA D TANDS AN WILL COMPLY WITH ALL NON ON-POINT Issued by: SOURCE G �, t, � = r Re-roofs Si m fAupplicmyCom '"m HAZARDOUS MATERIALS DISCLOSURE Dare Type of Roof Will Ore applicant Or future Wilding occupant stat or handle hamrdou material defined by the Cupertino Municipal Cade,Chapter 9.12.and the Health and Safcry .Section 25532(01 `' All roofs shall be inspected prior to any roofing material being installed. 0y. N No ,attire Wilding Occupant tea aquipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove Will the applicantor emit hatardous air coulaminams to darned by the Bay Area Air Quality Management all new materials for inspection. Dimier? 0 Yes _XNu I have mad On,hanrdousmami istequirtments underomperb.95oftheCatifor- nuFiealN&Safer Code,Secdom25N15,25533 mJ]553d.l understaN thmifNe Wilding Jou n Ip rt aw a enmt Nal it u my malushility a anally the occupant of the rtquiryhcnts amtbcmepoor toismmceoracemrieaenraeap cn7 Signature of Applicant Dale CL,J�L,7 nom, ' Date All roof coverings to be Class"B"or better O forauthari..J a1 a � M M CE c®py ore � v :yob' oa a ota � 8 ��",cep • 3HA11 N� � boA. 6P �pg111$tlt�0�� Q?- CITY OF CUPERTINO* S' 2 • CITY OF PERMIT APPLICATION FORM CUPERTINO APN# �/ ` Date: /�r T Building Address l Mailing Address (if different from building address): O '0%1 - N 1 Phone#: r^��, /�j Co r c r l \l License#: 18 Contact, `,\J W (Phon : ( �' I, Cupertino Business License#: J�V` Fax ZS 7 {�� 4 Building Permit Info: Bldg Elect ❑ Plumb ❑ Mech ❑ Job Descriptio61n ( 7 l 4 DKi Residential Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: Occupancy Group: r e of Construction: vV Please check this box if the project is a second-story addition: ❑ Project Size: Standard Laze ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER OtherAppliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to IM 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 23 1 of 3 WITY OF CUPERTINOO •CUPE(�TWO PERMIT APPLICATION FORM QuantityFee 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 BOVERTDAE 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 rinklerBackflo 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 BRENLUUTAN A/C Units <= 10,000 cfrn 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 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 2 of 3 am WITY OF CUPERTINOO CUP TYOF O PERMIT APPLICATION FORM QuantityFee ID Fee Description Fee Group BREMSIGNAD Rmd] 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 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 �r • 3 of 3 CITY OF CUPERTINO BUILDING DIVISION PERMIT �CONTR'ACTORRRR INFORMATIO�yN BUILDING ADDRESS: PERMIT NO. PELLA WINDOW & DOOR CO. 04100152 OWNER'S NAME: PERMIT ISSUE DATE E: SANITARY OL NO. ARCHITER/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 nee, LICENSED CONTRACTOR'S DECLARATION Job Des tp■�p� y FF;j I hereby affirm that I am licensed under py vBiom of Clupur 9(rnmmcncin{ VI�L E <n�Nwith lions )of on 3af de Budrks�yso 'ons oa 'ny�liccnu is V N in full]to dcffmL L(3% 5q, Lice. Lica REPLACE WINDOWS & SLIDE NOV /. ZQFQ wyp Dam Contracts A HI'IECTSD A I N O / 204 Ky a< I dull Ito used m pub is raorth 7yU i G Luensed Professional OWNER-BUILDER ad de,CATION ^� 1 I�®�� '��f I hereby affirm Net I em ucmpt from the Conwcsors l.iccnso Lew for de ■`b(/)U Sap following won.(Section 7131.5.Bearers,and Professions Code:Any city m aunty 2 ff which reporns a permit m ennsmmn,than.impmrs.demolish.or¢pail any gmeure t-Zi prior in us issuance.also=lot s the applicant for such Permit to file a signed sulsment Valua[ i< Nat he is licensed pursuant to Ne pmvis;ons of the Com e).Loo.law/Chapmr 9 Sq.Ft.Floor Area 'l-$ (commencing with Section 7")of Division3 of the Business and Professions Cole)or y Nat he is exempt thcmfrom and the basis far the alleged cmmpdom Any violation of `Dpf g�, {�� c more Nut stet h y applicant for a pen Il subjects the applicant m a avd penalty or 41731tl"r 0 0 Occupancy Type I,as owner of the Property m my employ=with wa{ea m their Bole compenmdoo, will M the work.end the structure isnot Intended o offered basalt,(Sce.'1W.Business Required Inspections and Professions Code:The Contracmrs License Law does nut apply m in owner of q P property who hand Ids or im proms deacon,and who does such wok himself or through his own employes.provided dust such improwments are notinunded oroffered formic.If. however,the building or improvement is sold within one year of completion,the owner- bobby will now dee burden of proving that he did not build or improve for purpose of sale.). I,as owner of use pmNny,am eaclusimly contracting wide licensed contractors,to commoner the project(See.10,14.Business and Professions Code:)The C musee e',Li- cense Law does not apply to an Owner of Property who builds or improv thereon,and who caramels for such pmjccls with a conaacur(s)licensed pursuant o the Comtracmrs License law. Fl I em aampt under See .B g:P C fm Nu reason Owner Dau WORKER'S COMPENSATION DECLARATION 1 hereby affmn under penally of perjury as of the following declarations: ave and will maintain a Certificate of Consent asalt-insurefmWokersCorePen- on.as provided for by Section 37M of the labor Cade,fm the Performance of the work for which this permit is issued. 1 hoot and will maintain Whf s Compensation Insunna,an required by Section 311of the tabu Code,fo the perfurna.or de wok for which this Permit is issued. �1 My rkee he ofn:nsurenceearicPn num 1` �TII -(N4 CEMPlCATE OFE EMMON FR MWORKERS Y) COMPENSATION INSURANCE (This section need not Weomplemd;f the Permits for one hundreddollafs(SIM) or mss.) 1 unify Nat in the Performance of the work for which this Permit is issued,)shall not employ any person in any manneran at to become subject m the Workars'Cacranno do t Laws or California.Data Applicant NOTICE TO APPLICANT:If,aper making duo Ccniricem of Exemption,you should become subject m thc Worker's Compensation provisions of V,a labor Code.you mug Oforthwith comply wit such provisions or this Permit sail M deemed nested. Z H CONSTRUCTION LENDING AGENCY F.. 1 berthy affirm that Vere is a construction lending agency for the Performance of [(7 the wurk for which this permit is issued(Sec.30)9,Civ.C.) W Q Iardcrs Name G Landers Add. e U 2 1 certify that I hem rad this application and Santa that the show information u '1 D. correct.I agree to comply with all city and county mdinsm'es and suis laws re1a0ng to or building construction,and ..indemnify d ,presenalm unf this city upoim,against r above-mentioned preperty for inspection purposes (-'G m,jugragree mmw,indemnify and keep Mmnsa de City of .,im,s ageing fn liabilities,judgments,coats and expenses which art,in any way accrue against said City U z in commquenee ting of this it. Issued by: Date ^z APPLICA D TANDS AN WILL COMPLY WITH ALL NON-POINT SOURCE G Re-roofs S;g MOfApplicandCOntrsemr D. Roof HAZARDOUS MATERIALS DISCLOSURE Type Will de,applicant or future building occupsm store or handle hamohou msterial m defined by Ne Cuanino Municipal Code,Chapter 9.12 and the Hesph and Safety Code.Section u53y(e)+ ��/// All roofs shall be inspected prior to any roofing material being installed. ❑Yes pp No /} If a roof is installed without first obtaining an inspection,I agree[o remove Will the applicant or rwure building Occupant use equipment Or devices which mallous air comaminanu as dcfncd by the Bay Ara Air Quality MenaScmcnt all new materials for inspection. ictT oyes _)(No 1hvertNNeh zrdmsmaerialsrequimmenuuntier Clmpmr6.95ofde Califor- ria Hcallh&Saret Code,S =ZM5.25533wd25534.1undcrgaM idler Wading Jos,wt I m a unane Net it u my maponsihility u notily tits aaupant of Ve nequ; ats a unbcme pnortoissuanamat ofaCcrdoor0ccu Signature of Applicant Date 0 ermauthorimdagen Dam All roof coverings to be Class"B"or better