06070009 CITY OF CUPERTINO
444
BUILDING DIVISION PERMIT ORMATIONkl
BUILDING ADDRESS: ALLBRAND WINDOWS PERMIT NOO 6 0 7 0 0 0 9
10713 PEBBLE PL
OWNER'S NAME: PERMIT ISSUE DATE
KEVIN PARK 551 INDUSTRIAL RD 07/05/2006
NE:
SANITARY NO. CONTROL NO.
(650) 622-0330
ARCHI'IECTYENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
iaa LICENSED CONTRACTOR'S DECLARATION
%m❑ Ibe¢byafprmdon,lamlicensed motor provisions ofChapter 9(commencing Job Description
$Ily with Section 70M)of Division 3 of no Business and Professions Code.and my flecrae is
+« infull(orteandeff REPLACING WINDOWS : 2 DOOR SLIDERS 2 WINDOWS,
j Z Liccnu Lac.p 2 n
Do. Contractor IZE FOR SIZE
ARCHITECTS DECLARATION
r
f 1 understand my plans anon W used AS public recnNn
)yU
a o y
Licensed Profcsxional
OWNER-exempt fr DECLARATION
m e I mason alum that 11. exempt from the feamms Co License Law for IW
a 0 fallowing mason.(Section 703 L5,Business and tie,derom Cale:Any dry or county
5 m which mquim a permit re tires due alter,improve,dpermit.or repair any gunmen
_iy prior to its issuanec.gw requires due applicant for Such permitmfilc asigad sukment
< that hcu licensed pursuant to the provisions of the Contractor's Liccve Law(Chapter 9 Sq.Ft.Floor Area Valuer 289
eFC (.commencing with Section 78(10)of Division 3 of NC Business and Prortmons Code)ur
y 5 Nat he u exempt therefrom and do ani far the alleged exemption.Any violation of
Section 7031.5 by any applicant for a Permit subjccu the applkanu0 a civil penalty of ,��yp7��•i u�1Py�er Occupancy Type
.at mate Nan fnvs hundred dollars($500). 3 L O'4 4 b . 0 0
1,u owkr of dm progeny,err my wploycu with wage u they role mompewtion,
'will do he at and the swoon is not intended ar offered for uk(Sec.7W.Business
and Professions Code:The Contractor's ndw License Law does oro apply lf an owner of Required IDSpeCtl
progenywhobuilds i improves Namr andwho dosstenwort himselredthrough his
awnmer.do,
provided Nm such improvements;an not intended uroRercd for sale It.
however,IW Wilding or improvement is sold within one year of improv for IW owner.
builder will have IW Wrdcn of proving that W did Out build or improve far purpose of
D 1,as owner of the property.am eaelusively contracting with licensed canuumn u, l/ �1—
cangruct the project(Secapply
to in weer of rod Pholissame,property
who Wilds
Cade:)The ms daemon,
red
who law docs not apply je e;owner of assa who Wilds err improwu Centro,ant
whocontractsLace for such pmjecu with 9 ennvauorts)licensed pursuant m IW Convectors O
License Law. /
❑lam ucmpt undo See ,B&PC far Nu m,.m s/O
10311Wi.'nc'f
Dam
WORKER'S COMPENSATION DECLARATION
I hereby appeal under Paudlty of perjury ane of the following loclantiama:
I breve and will mainmia a CeNpcateof Concent m calf-insurefor Workcre Compel.
on,u provided for by Section 3700 of Ne labor Code,for the performance of the
far which Nis permit is issued.
1 haw and will maintain Worker's Compensation Insurance,ss tcquircd by Section
ONe Labor Code,for Ne Performance of Ne work for which Nis pewit is unwed.Workers Compemation I once and Paliryer. Paliry '6V
CERIIFlCA IF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(ITU seNm need nahcermPlercd if Ce permit Is foram hundred dollars(5100)
or less.)
1 cenify Cat in Ne performance of the work for which Nis pewit is warned.I shall not
employ any person in any maroaso as to become subject in the Warkns'Compewtion
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If.after making Nis Cadficae of Esemption,you should
income Subject in the Worker9 Compensation provisions of the Labor Code,you mug
., O forthwith comply with such pmvuiaas or Nu permit shall W dcemad muted.
'Z.,'rA CONSTRUCTION LENDING AGENCY
IWreby ARrm that Vert is a eomsuacrion lending agency for the performanc,of
C> Vtc work for which this Permit is usual(Sec.3097,Civ.C.)
(� Landch Name
7 z Lenders Address
U C) 1 testify that 1 have read this application and sue Nat IW above infrrmadon is
I2. cornet.1 agree in comply with all city and county adina=a and gain laws minting to
OV building construetion,and hereby andmim nPmsenmu ivof Nis city to enter upon the
U above mcmioncd progeny for inspection purpose.
(We)agree to save,indemnify and kap hawles he City of Cupertino agaiva
limilidem,judgmenu,costs and expenses;which may in any way same against mid City
V z Aconsequence Of OC Of
LICANT UNDERSTANDS IDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOU E U ATIONS.
r ro 0;-12S-06 Re-roofs
Signature m(ApplicanUContmor -
Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant err furore building=Upset gree or handle huardous ma menial
AS de0m l by the Cupertino Municipal Code.Chapter 9.1;and the Health and Safety
Code,Section 25332(a)?
oye6b`-� All roofs shall be inspected prior to any roofing material being installed.
Will the applicant car future Wilding occvpanr tine equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit harardm A air Contaminants AS defined by On Bay Arca Air Quality Management all new materials for inspection.
District? /
Dyes di.`G
1 have read do haaaMoumaterials rtsryimments underCMpkr6.95 a/Ne Califon
his HcalO&SafelyCedc,Sccim.25505.25533 and25534.1 tedcnand thaziflW With.,
deer rot c..dy have a enanl Nat it u my mupomihility m mdfy Nc Occupant Of the
mquinmcptwwh.It mug tPat ta�t eerr a Ccelficae err Occupancy. Signature of Applicant Date
72 /7:;,C_ ' DTOSOF
Owner or Authorized agent All roof coverings to be Class "B" or better
pate'
CITY OF CUPERTINO
om 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32643046 . 00
DATE ISSUED. . . . . . . : 07/05/2006
RECEIPT # . . . . . . . . . : 35103
REFERENCE ID # . . . : 06070009
SITE ADDRESS . . . . . : 10713 PEBBLE PL
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : KEVIN PARK
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : PAWEL BORDEWICZ
CONTRACTOR . . . . . . . : JACEK ,PASTERNAK LIC # 24829
COMPANY . . . . . . . . . . : ALLBRAND WINDOWS
ADDRESS . . . . . . . . . . : 551INDUSTRIAL RD
CITY/STATE/ZIP . . . : SAN CARLOS, CA 94070
• TELEPHONE . . . . . . . . : (650) 622-0330
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- - - -------- -- - ------- ------ - - - - ---------- ----------
BENERGY PERMIT FEE 137 . 16 65 . 84 0 . 00 65 . 84 0 . 00
BPERMFEE VALUATION 6, 289 . 00 137 . 16 0 . 00 137 . 16 0 . 00
BSEISMICRE VALUATION 6, 289 . 00 0 . 70 0 . 00 0 . 70 0 . 00
BPLANCHK PERMIT FEE 137 . 16 183 . 04 0 . 00 183 . 04 0 . 00
---------- --- - - --- - - ---------- ----------
TOTAL PERMIT 386 . 74 0 . 00 386 . 74 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER 386 . 74 MASTERCARD
TOTAL RECEIPT 386 . 74
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iN ACCORDANCE WITH THE CITY
CUPERTINO C ES N D INANCES
F �ZU �1T
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ao r MD-
31GNE ons am eciflcS and
This set of p' oh at a1P1 times and it is
1�as <I �� ' �e�'1"` �� _ oe kept on the 1 chanes or alterati
f, e far h7 e) f,out to make a, ermission h
1 me Wdhunt written P ertino.
nheb DePt, CitfanandsPeCdicati
` U the burlamrprng of this p
2 Sao ,5 The e held to Permit or to he
3HAll NOT bl proar"
�i,j�l�"� approval of the viol ce Oorr
F�� p 5 20p6 ,f anv City Oromane o
AUL
•
OFMCE COPY