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04120142 CITx OF CUPERTINO BUILDING DIVISION PERMIT d`NT ' Gte ANFORMAT=I(�N _------ r�,I , BUILDIN ADDRFSS: CRW INDUSTRIES - - PERMTTND04120142 ' 10204 POTTERS 'HATCH NER'S NAME: PERMITISSUBDATE * ' MARGARET CHEW 1157 DELL AV NE: SANITARY NO. CONTROL NO. (408) 378-2477 ARCHRECT,ENGINEER: - BUILDING PERMIT INFO BLDG ELECT 'PLUMB MBCN �oo \\ ENSEDCONRACOR'SDECLARAT10N -Job Description _ 1 bere0y m Net 1 m IkenvN un ons of Chaper 9(mmmeming - p i wSce YYYYY of DivWon3af h= rca Pm fusimueede.aMmylke�4 - <<� mfuufom�ameG �/o2'IB4 WINDOW UPGRADE . . 3 Dam Con er fAs.s /,k1AOSr/g/E A' ARCHIIECT'SO R TION (r ndenund my plena shell be wed as pu recnNa �'` '' (/(�'• _ ._ c Licensed Prufessimul OWNER-BUILDER DECLARATION � I hereby affirm that I em exempt form the Contractors License Law for ftii: o o following rest n.(Section 70315,Business and Professions Code:Any city or county - $ which requires a pump to common,alter.improve,demolish,Of.par any anmwre /ill`/+(`N F y prior as its issuance,alw requires to applicant foraush permit write a signed moment C that he is licensed pumranun we provisions of the Contractor's license Law(Chapter 9 Sq.FI.Floor Area v�j,(vJ,��,,15, /l Valuation _ (commencing with Section 7000)of Division 3 of the BusincataM Pmfeasiam Code)or 4 BB$ that he is models therefrom and wviolation e basis for the alleged exemption:Any of t Secdm 7031.5 by any applicant for a permit wbjem the applicant in a civil penalty or _ _ e - .:.'?^:, :Occupancy Type- not more than five hundred dollars(ML 01,ue ofwepmpmy.wmyempleyeuwithmr-swo,vwle—pemacn, -. willdothewakandthe,w mBnoti.t.&d.roRmdf.uk(SW.7044,Busites and Profession Code:The Conuuwel Li.Law does ma apply in an owner of -. Required Inspections - property who Intriguer i moms thereon.and who doeasuch work himself or through his own employes,provided that such improsemenuam maintended reoffered insists.If, -- however,the building.,improvement is wld within..y...f companion,the own.. _ builder will have the burden of proving Nat he did not build.improve for purporc of sale.). ❑1.as owner of the property am exclusively convMing with licensed conmclws to - contract de project(See 7044.Business and Pmfesa ass Code:)The Conmeters U- -. come law does or apply In an.vxr of property who builds or Improv then m,and, , who contract,for such prejem with a mnoacter(s)licensed pursuant in the Canwasmrs License Law. ❑Iamuemptunde,Sw. .B&PCforwBmuon net' Date WORKERS COMPENSATION DECLARATION - 1hereby affirm orderpenaltyofperjury meofthefollowing declmdoor ' ❑I haw and will maintain •Cenificam of Consent to self-insure fm Workers Comeen. aalon,u provided for by Seeded 3]00 of do,tabor Code,for the performance of the .~ work for which this permit is issued. ❑1 have and will maintain Workers Compensation Imurwce,as renewed by Section .. - -. .. 3] of Nc labor Calc,for we peaomianttaf Nc work for hi lith permit is name. - ... My ork a CamI.=on wsurance cam.and 11'ea number m: Carie,. policyNe.: 1p678 -2W3 CERTIFICATED EmXEMPnONWORKERS ' COMPENSATION INSrx 17j5AI CE (Thbwetim need em becompleted Kthe permit is form=hundred dollm(SIM) - .. or Icsa.) 1 certify that In dte performance of the work for which this permit is issued.I shall net - empwyanype..In any manner w as.became subject o det Worker CompemNen _ -..--- ---- -- Laws of Cahlomla.Date ... Applicant NOTICE TO APPLICANT:IC after making this Ceniftcate of Exemption,you should .. become wb)ect to the Wmk s Comperm loo provisions of the Lanni Code,you muss ,J 0 fonAwith comply with such provisions or this permit shall be deemed minted. (-z rye., CONSTRUCTION LENDING AGENCY t I hereby affirm wet were B a conarvctino lending agency for the performance of pi > the work for which this permit H Issued(Sec.3097,Civ.C.) - - - QLender's Nme - .7 z Lenders Address U 0 1«Afy that I have read this application and sum this we above Information is IL ce m 1 agree to comply with all city and county endurances and sum laws misting to 0 Wildingmwmcaion,and hereby audwrim Momenudves of this city to enter upon we W shove-enentimmil property far inspection purposes. All (We)agree in save,indemnify and keep harmless we City of Cupertino against jj Ilabllidea,judgmenu,costs and expenses which may In any way worm against said Clay _ U 7 In co micamce of the flowing of this permit. Fry APPLICANT U STANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Dat IRCsic5 orfs � 12/tA� Re-roofs Sign ppltcan ..noes, IDam HAZARDOUg MATERIALS OIScLDS E Type of Roof Will we applicant.f building occupant store orhandle limardous material . u unlined by the Consoled Mind Code,Chapter 9.13.Rod the Health sed Safety .de.Section 25532(.)7 ❑Yes - All roofs shall be inspected prior to any roofing material being installed. Win doe applicant future 'Iding occomom saw equipment m devices which If a roof is installed without first obtaining an inspection,I agree to remove emit na'rardnes air cm nano fined by we Bay Area Air Quality Management all new materials for inspection. District? ❑Yea u IhavemWthehar iusmewriakmquimmcmunderChapter6.95.fthc Califon nice Hcalth&SafetyC .Seed..25505,25533ud25334.1undcmtWwairthebuildin9 does not eortendy tenant.that it as my mspomihlllty,to notify the aaupwt of we acuimmenuwdel/plbt`ria,miasuwtt.f.Cerdn.awora w.y. SignatureofApplicant Date g/ /u° All roof coverings to be Class'B"or better GwnFf6r a thori rA agent Dam CITY OF CUPERTI 0 "s-k '' ' BUILDING DIVISION PER T 4CONTRAGTOR INFOR ION & -- — " BuaDIN ADDREss: CRW INDUSTRIES PERMIT N004120142 204 POTTERS HATCH ER'S NAME: PERMITLSSUEDATE MARGARET CHEW 1157 DELL AVE . PHONE: - SANITARY NO. CONTROL NO. (408) 378-2477 ARC HITECrfENGINEER: BUILDING PERMITINFO BIAG ELECT PLUMB MECH p 0 0 0 0 J00LICENSED CONTRACTOR'S DECLARATION Job DeSCTIpL100 ' .w p[Dam I hendl yr m IMt 1 am li¢Iacd un mvisioM of Chapter Y(commencing - :5z ceImaj,JY )nf Division3orthe Busi dprofeaiuns Code,and or Her ram is "omarn aandercer,y g/02YBrl WINDOW UPGRADE 5 n m des 6 Lk.p n F pTECTSECtARi \( ARC111TECTS D RATIONn; I ndersland my plans shall be usedas&records u%O`~" sed Pnsfeai.tml W OWNER-BUILDER DECLARATION [[D l•� aJ005 < I hereby xltlrm that I am exempt form the Contractor's License Law for the FEB } LO Oing mama.(Section IID I.S.Business and Pmfecdons Code:Any city or county %m w which acquires a pcono M consumer,eller.Improv',denlolu h.nr repair any ammone w"^ prior,m its Waanee.alsu mquince lbeapplicam for such permiuo file.signed statement rbar ceuliccusedpare uanu.Useprovisions ofthe Comracmr'sU...law(Charm,9 Sq.F[.Floor Area "Valu3tlon asIZ-$ (commencing with Section 7000)of Division 3 of Nes e Business and Prefectural Code)or ' y 5 9 that he H exempt therefrom and IM bases for the alleged exemption.Any violation of -- Section 7031.5 by any applicant for.permit subjects the applicant to a civil penalty of Occupancy Type nut more Nan Bae hundred dollars($500). I,as ownm of the property.or my cmployces with wages as their sole compensation, will dm she work.and lheswclure is not intended aroffered for sale(Sec.7(l64,Business and Professions Code:The Contractafs Liana es Law donot apply be an owner of - Required Inspections p:apart who builds or i m pmvu dm mon,end who does such.,it himsel f or thmugb his own employees.provided that such improvements are not intended mo0ered forsam.If. however,the building or improvement is said within one year of completion.Ne owar- buildu will have the burden of proving Nat be did our build or improve for purpex of sale.). I,as owner of the propcny.am exclusively contracting with licensed contractors to construct Ne project(Sec.7044.Business and Pmfrssiou Code:)The Contrxemr's V- x hw docs mot apply to an owner of is apeny who builds or improves Ihemon,and. who contracts for such projects with a eanamemr(s)licensed pursuant as the Contractor's License Law. I em eacmpt under Sec. .B&P C fm This moon race Dam WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty.(perjury ora of the following deshourb ss ❑1 haw and will maintain aCunificataof Conant or self-insure for Worker'sComper- sation,as pamided for by Section 3700 of she Isbor Code.for the performance of dte work for which this permit is issued.. 1 have and will maintain Weaker's Compensation Insurance,m required by Section 37 of - Code,fm the pcRormance mf the work for which Nu permit u issued. My mkce Compensation hoormce carrier and Policy number a : Camcr J.SIN7'��1//1H P.IkyNo.: /0678 —2008 CERTIFlCATE OF E%EMPI'ION tROFj W ORKERS' COMPENSATION INS ACE Crisis section need not W completed if the permit is for one hundred dollar(5 100) ar:¢ss7 1 Cenify that in the perfarm occ of the work for which this permit is issued.I shall not employ any person m Toy mdrour, he Werra.sobjuamthe Workeri Compensation Laws of California-Dam -' Applicant NOTICE TO APPLICANT:If.after making this Ccnificam of Exemption,you should become subject to the Workers Compensation pmvisiom of are Labor Code,you most Z rmMwith comply with such Provisions or this permit shall N domed marked. zCONSTRUCTION LENDING AGENCY 1 hereby arnno that Here is a conswerom lending agency,far the Performance of LYi the walk fur which this permit is issued(Sec.3097.Ci,C.) W Q Lender's Name a Z lender's Address U Q 1 nearly that 1 haw mad this application and sum that the above information is ly P emmet.I agree to comply with all city and county ordinances and state taws relating to 0U building construction.and hereby mthlded mpresematives Cr this city to enter upon the a W shove-mentioned property for inspection proposes. (we)agree to saw,indemnify and keep harmless the City or Cupenina against root ra'q Iiabilitiu,judgm.na,costs andcxpcnscs which may in anyway acerae egeinnxid City U Z in consequence of the granting of that Permit. /� U ^ APPLICANT U STANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE LOX— '�ZO/� // ��am/ Re-roofs Sign pplmaHAZARDO Dam HAZARDOUS MATERIALS Dslam or hfge Type of Roof Willthc aptll c" rurr rebuilding oaupem more or handlchvardous material defined by the Cupenin.M Itlpal Code.Chapter 9.11,and Be,Health and Safety Poor,Sccton 25533(.)? All roofs shall be inspected prior to any roofing material being installed. 0y. Will the apPlicam mom (ding muupant esu cyvipmcm ordcvias which If a roof is installed without first obtaining an inspection,I agree to remove Coit hazaNuus air corm battle efired by dm Bay Area Air Quality Management all new materials for inspection. Disuim? ❑Yes � No I how mad the bar on mammals requirements under Chapter 6.95 of lac Califs ria Heald&SafctyC .Sectors 25505.25533 and 25534.1 undersmnL that Box Wilding does amt currently h tenant,dem it u my mspoasibft mm ility he.61, cup. of dm myuimmcnew Ix I'-pn-.�r�wiavalmeor.Cardficamoraae�yr�aney Signature of Applicant Date /zlzw� All roof coverings [o be Class"B"or better liar:ads" '.,_'Dow - • CITY F CUPERT O INP • CUCITY OF O PERMIT APPLICATION FORMPERT APN # Date: 3 Z 3so� 12.1 Lo /?goo q Building Address: I Mailing Address (if different from building address): (02o4 FaTms kATc44 CorWoH Owner's Name: Phone #: C.KEy I MAA(iAAey, (qoq) Contractor: CLicense #:CAW INDJStri.lES i4OZ`IH-4 Contact: Phone(goq) .lzt,-DaZ6 Cupertino Business License#: ?*WKr MunPuy Fax: 23525 Building Permit Info: 'Bldg ® Elect ❑ Plumb ❑ Mech ❑ Job Description: .Residential Y1 omm cial Sq.Ft. Floor Area: /$/Sq.F .: Cost of Project: Occupancy Group: Type of construction: Please check this box ' he ro' is a WWO00 2Z-T%ACEF1EW LIKE FOIL .LIKE second-stor addition: Project Size: Standard ❑ Large ❑ Major ❑ 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 <= 1000A ELECTRICAL BELEC1001 Elee 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 7 1 of3 Cf 7�. z� City of Cupertino ;�: Plan Check Transmittal Permit# 04120142 Control# Project WINDOW UPGRADE Plancheck# 1 Address 10204 POTTER HATCH FileDate 12/20/2004 COMMON Owner CRW INDUSTRIES Description RES. WINDOW UPGRADE Plan Check Status (attach comments and return to Building with pian set) Plan Dept check# -Date Due Date Staff Comment Date Approval? Building 1 1 2/20/200 1/3/2005 POH 12/20/2004 W Assessor 1 1 2/20/200 1/3/2005 1 SENT 1 12/20/2004 C7 • i j� Additional Plan Check Fee ❑ Hours Planning Fees Housing Mitigation Fee Amount Heart of the City Specific Plan Fee Amount T v M ,O V1 r 1 LP) D r W u �wxr ,e x ,m 0 z E ' D � o Kr m oo r% o .. c 0 Z a ,e • � � _ c a °a�c E� m rn �gi � � 'To'V.no = o ZCY o ' QCV p N tO n tt• m r4 K d O N ITS �J � � C j Q�� '� 7 11•Y a1 T �. • �� "^"111 m G iL p H W Z Z N n Y T E N a $ w L T. c C ,ct s