04020075 CI TY OFCUPERTINO b - x �• x>3y 'px '���. +.
BUILDING DIVISION PERMIT"
ERMIT sxCON"lRAC';fIbR, TN, U A'CTUN';k
BUILDING ADDRESS: THE WINDOW BROKER P "fIT"x04020075
Has NAME: PERMIT ISSUE DATE
HUG
ONE: SANITARY 0 CONTROL NO.
800) 639-4927 1
ARCHIT"ECTiBIOGINEER; BUILDING PERMfr INFO
BLDG ELECT PLUMB MECH
0 0 0 0
'Ido LICENSED CONTRACTOR'S DECLARATION
I EY i 1 herohy amrm mal 1 am licensed under providom of Chapter Y(commcttdng Job Description
with Sero )or Division 3 ohne Businraeand Prolesslom @,and my license is
In full f cad ones. •,/� C
t,p ole�naa I l�Cc"om^r 74,7.;g2 WINDOW REPLACEMENT r'����` +'
n —d ARCHITECTS ON
I understand my plans eball be used As public record APR - 6 2004
�
i. Licensed Pmfc iond BUILDING
OWNER-BUILDER DECLARATION
I hcrchy slam mm 1 am exempt from the Connector's License Law for the
E:03 following reuon.ts.xiiftp 1.5,Business and Profession Code:Any city or county
which myulots A permit m consumer,alter,improw,demolish,car mid,any smeum
poor in issuance.aim requires the applicant forsuch Permit to file a signed statement
�Q
that he is licensed pursuant to the pmvisiomof the Couracmri License Law(chapter 9 Sq. Ft. Floor Area Valuation
FC$ (commencing with Section TOM)of Division 3 of the Business and Protestations Code)or
3 Nat he B exempt Mercfmm and Be lash for the dlc[cd exemption.My violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of
not 3 BI`I4Il�ltieir�O Occupancy Typ
mom dun five hundred dollars(5500). e
I,uowarofal propcnyemywployoeswithwgeuuhetrmic lm nudon,
will do the.,k...d the amcmrt is not intanded oro@red foreele(See.7044,Busimss
and Promuimu Code:The Canucamr's Lkarve Lew does not apply m an owner of Required Inspections
pmpmy who build art Improves maroon,and who dots such work himself or through his
awn employee,provided Net such improvements are not intended oraRered forsale.If,
however.me building or improvement issold within ane year of completion,the owner.
builder will lu m de Wrden of proving met he did not bid or improve for purpose of
tale.).
❑1,As owner of the property,am exclusively contracting with liaised ronvecton m
consume me project(Sec.7044,Businw and Professions,Code:)The Convector's U.
across law dots not apply m an nwmer of pmpmy who builds or improve Merton.and
who mntmats for such pmjeets with A concur(s)licensed pursa nl in the Conmctor's
case law.
ameaarnptundar Sec ,BkPClmthhmas.n
at Data
Data
WORKER'S COMPENSATION DECLARATION
I hereby Man under plurality of perjury one of me fallowing decelerations: .
I have and will maintain a Cenifi ate of Caucm m self-Insem for worker's Compere
wi...u provided for by Section 37M of the Labor Code.for me perfmmamm of the
work for which this Permit is Issued.
❑1 ban and will mdnWn Workees Compensation Insurance,As required by Section
3700.(the labor Code.for the pcolc r nano of Mc amrk for which Mi.Permit is issued.
My Worker's Compemauon Im..na artier dPolicy
Cal Wr �� Q/
rtier. I Ul �a 'icy No.:
CERnR TE 'XEMMON FROM WORKERS'
COMPENSATION INSURANCE
(This ttrm need not be completed if the permit is foronc hundred dollars(SIM)
or les)
1 certify mat in the Performance of me work for which this Permit is iuued,I shell not
employ any person in any manner so As m become subject o the Worker'Compensation
Laws of California.Data
Applicant
NOTICE TO APPUCANT.Ir,after making this CcniBau of Exemption,you should
become subject m the Worker's Compensation provisions of the Latae Code.you most
.J O forthwith comply with such provisions at this permit hall he deemed eiaked.
Z �--' CONSTRUCTION LENDING AGENCY
ti
[—i I for
mthat is a Ch,a[cttry lmtheperfurmana of
ai the work fur which this permit is iuued(Sm.3097.Civ.CJ
G0 lenders Name
i7. z
Lender's Address
t.)Q I certify Met I ban mad this application and mute that me above information is
t[. cumcL 1 Agra to comply with all city and county ondinenas and Bats laws mledng to
0building construction,end hereby mahmim representatives of this city to envy upon me
,A above-notatkowdticsjudgm propertyst I.inspection purposes
(y (We)agree m saw,Indemnify ad keep haanlep the city or Cupeftino against
y fladlinconsel tedgmenW c granting
this Permit. may in anyway accrue agdnO said City
C)z in canxgmnee of the ynming oI this permits.
in
(CANT UNDERSTANDS AND WILL COMP Y W ALL NON-POINT Issued by: Date
RCE EGULATI NS./hy --
�E Z-((7`06 Re-roofs
SignalmssofAppliaaDam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will da appellant or for.Wilding occupant store or handle haurdom mucnai
fined by the Cupertino Municipal Cade.Chapter 9.13,and the Health and Safely
.Section 355334? /
pm 1C7Nn All roofs shall be inspected prior to any roofing material being installed.
Wilt the applicant or future building occupom use equipment art devices which If a roof is installed without first obtaining an inspection,I agree to remove
h hanamoue a it omen imns u dcOncd by site Bay Arca Air Quality Management all new materials for inspection.
District?
Yes
�Nu
1 hon mal the huaNmsmamriah mquimments under Chapter 6.95 o(thc Glifon
ria Heal"SectyCode,Sermu35505.25533 and 35530.1 understand thalifthe Wilding
does not cu muly haw a tenant,that it is my responsibility m notify the occupant Of me
Ulm ntswhehm.atb me do tssnanaoncn0eeorOapmg SignatureofApplicant Date
OL - / All roof coverings to be Class"B"or better
Owncrm aolveroragcnt ' pass
CITYOFCUPERTINO
BUILDING DIVISION PER
x4n, „tsp4}s4e. A>w r- C{hr 4P.., Y.:
BUILDING ADDRESS: THE WINDOW BROKER PERMIT NO 04020075
OWNERS NAME: PERMIT ISSUE DATE
H
NE: SANITARY NO. CONTROL NO.
800
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BO O PLUMB MOFCH
_op LICENSED CONTRACTOR'S DECLARATION Job Description
I 1 bounty after se
that 1 am limntl under pmviunns of Chapter 9(commencing
with smdun Ofe))or Division 3 of lh Business fand Imitations gods,and my license la
� 1r a� LC
u3 :7. WINDOW REPLACEMENT
coa7F.. Data send as public
�e Q ARCHITF.C'SD ON
Y tyl 1 understood my plana shall he u+td u puhRe mcnrda
3
Uccruatl Pmfeaaionel
OWNER-BUILDER morDER DE CLARATION
i I hereby.ewer that 11. eampl from die Contrecto'.e:Any c law tum the /
O O fallowing muga•permit
t 7031.5.I.3,Business aM Improve.
de oli Code Any[Wry s county
$ which its Inco.permit also reuirswel,aper,ogormh Permit to
.nywuctum
t-Za pdoroitscensed moment
th aision rs,of the Cor prime o f.n.I..(Cha meal
< (that he I.mommucintwidpwaummdmpmviumut3of C,Busu mr'andProl lAw(Chaplv9 Sq.Ft.Floor Area D Valuation
sC� cool
Wa he 6 unmoral
Section 7000)of the basiim3 ortheege ournpaem.Anynu Code)err
3$ sial he p ewnpt Ne¢from and the basis for the alleged cumpdan.Any=of
Section 7031.5 by any eppllu"t for a permit subjects the applicant to a civil penally of 3 21 N?ft1Qr0 0 Occupancy Type
not mom than floe bmuamd dollars(SSW).
❑L u owner ordist property,or my employee with wagon a their sole compensation,
will do the work.and the smnum is not intended or anerW formic(Sm.7044,Business Required Inspections
and Pmn re udtuCode:The Comncmes Limmen law does not apply o e ns an owner of - fl p
property who bullae or improves themon,end who does such work himse Ir or through his.
own employees,provided shot such Improvememsem notimended oroane t forum.If.
however,the building or improvement is sold within an year of completion.tht nume-
Wllde"r will have the burden of proving that he did net build or improw for purpose of
sale.).
❑1,u owner of the property,am tachoduely contracting with luxated cam ecors to
construe she project(Sec.7044.Business and profession Cade:)The Cormacutes U.
ctw:law dors but apply m an owner of property won Wilds at impmve Nemon.and,
who cmmm fm such pmjcm wish acmwuor(s)IIe,n ed pursuant o the Contracts'.
License law.
❑Iameemptuntle Sea .B&PCfor Ni.muon
Owner Data,
WORKERS COMPENSATION DECLARATION
1 hreby affirm under Penalty of perjury oro of the fallowing aenarWma
❑I have end will maintain aCe dlOcats of Consent to self-Ins rm for Worker"Compan-
sallm,u prorldetl for by Secdtun 3700 of site Labor Code,for the Performance of the
work for which this permit is issued.
❑1 haw and will maintain Worker's Compensation Insurance,u required by Section
3700 of the labor Coat,For the performance of due work for which this permit is Wood.
My Work((t7/r!'e��C��o��mp//en'��udon Inaurana nlcr d Pollry nu bcr C
Carkr.+Jy(�(yd'/}3A I U s' Hey No.: I �l ��
j CERTIFI TE XEMPr10N FROM WORKERS'
COMPENSATION INSURANCE
(This section bend not hcdmpleod if the permit Is fortune hunamd dollars(110h)
or Ire)
employ ceni(y shat er thein my mance of the work for which this Permit u iumd.I shall rat
Lawso any perkob in any mannerse u o bcmmesubjacl o UM WMmn CampenWm
LawsofCtlifamia Dam
AppliNOTICE
NOnCE TO APPUGNT.IL atom making N4 Certificatess of Exemption.you ahaW
.JObmhwi ibsubjecacomp y the Wuch Pr Compensation Provisions N W later Cade,you mea
fmthwiNmmply with web Provisions or this Permit ahailWdeunW related.
z a CONSTRUCTION LENDING AGENCY
[r I hemhy ofirm that them lona comrroctinn lending agency for the pcoformanm of
fx> the were,for which this permit ts issued(ser 3007.Cl,Ca -
W�Q Lenders Nano
zLender'Addmv
V 0 1 cenify shot 1 hew mad this application and sum that the salve Information is
IL t mount.I agree o comply with all city and county ordin erns and slam laws misting to
0 building construction,and hereby authorim representatives of this city to cmcr upon the
W above-mentioned properly for Inspection purports -
(We)agree o save,indemnify and keep harmless the City of Cupolas against
t:y W Ilabillde.,judgments,core and expenses which may to any way ammo against said City
U 7 In conuspear m of the gaming of this pemit.
F7 AP (CANT UNDERSTANDS AND WILL COMPLY WIJN ALL NON-POINT Issued by: Date
MOURCE EGUfATI Ns.hh 0� %�^ _«`��
�-f; l� Re-roofs
Signature of AppncanVC.manor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will do applicant or future Wilding occupant am or handle hazardous material
as defined by the Cupertino Municipal Cade.Chapter,9.1 7,and the Health and Safety
Coca.section 2553z(.)7 / All roofs shall be inspected prior to any roofing material being installed.
Yu AI N.
Will the applicant or future building mcupent use equipment or dcvim.which If a roof is installed without first obtaining an inspection,I agree to remove
emit hararaous air contaminants as dcfined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes XNu
I have rota the haaardow materials requ ire marts under Chapter 6.95 of the Cslifor-
ria Health&3afetyCode.Swoons 35505,25533 and 25534.1 undcrsland that if the Wilding
does not currently how a tumor,dial It is my responsibility to notify the occupant or the
elm nu whichrentW do Its.mmarmctmBele"roemp.ncy. Signature of Applicant Date
t
Owner err authorivnd agent All roof coverings to be Class"B"or better
�� Date
,S
ca
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' • • Community Development
10300 Torre Avenue
Cupertino CA 95014
-f'aTelephone(408)777-3228
fTY Fax(408)777-3333
�UPEkTINO
Building De artment
JOB ADDRESS: 92 PERMIT # ® p
�o l 85 sfiA
OWNER'S NAME: PHONE # 9W b 5f 2
GENERAL CONTRACTOR: Tk W�fv AY11&' FAX # S( , Z
5-0 Lf-
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following ' ormation:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
• Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
10/28/03
®rMI CITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPEkTINO Q gibzoo
N# Date: 2 _ 1 o - 0�
Building Address: Mailing Address (if different from building address):
1019-5, SPo 1
Owner's Name: N / Phone #:
Contractor: U✓�t�o7� �/ License#: �4 if 3�z
Contact: ( ,oPhone: gG{I 63q Cupertino Business License#:
�( Fax: lO q.2 3 So 6
Building Permit Info:
BI Elect ❑ Plumb ❑ Mech ❑
Jo escript'on:
Residential �� ` Commercial ❑
Sq.Ft. Floor Area: $/Sq.Ft.:
Cost of Project: 3 ;7,t Occupancy Group:
Type of Construction: Please check this box if th❑e project is a
second-storyaddition:
QuantityFee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBLDGFEE Bldg Permits . foot BUILDING
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 Incl/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 I BUILDING
•
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Lu> � a .
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x 5 k t
s
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O k
X
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00
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v `TY OF CUPERTINO
CUPEf�PER
TINO PERMIT APPLICATION FORM
Quantity Fee ID Fee Description Fee Group
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BOVERTDAE Inspection Overtime BUILDING
BPBACKFLOW Atmospheric Vacuum PLUMBING
BPCESSPOOL Cess ool PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPFIXTURE Pblg Fixture PLUMBING
BPGAS Gas Pipihg 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
BREMAIRHHAN A/C Units <= 10,000 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Fumace MECHANICAL
BREMFURNOV Relo Fumace> I 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
BREMSIGNAD Rmdl Sips Add Branch ELECTRICAL
BREMSIGNS Remodel Si az s, Marquee ELECTRICAL
2 of 3
?ITY OF CUPERTINO
acro 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
vl� BSPECIAL Special Ins Inspection BUILDING
BSWIM Swimmin Pool BUILDING
BTEMP Tem ora Power ELECTRICAL
BTEMPPERM Temporary Bld Permit BUILDING
BTEMPSVCS WSvcsist Svcs ELECTRICAL
BUSLIC License BUILDING
ELECTRIC l s foot ELECTRICAL
EPERMITFEE it Issuance ELECTRICAL
MPERMFEE al s . foot MECHANICAL
MPERMITFEE it Issuance MECHANICAL
PPERMITFEE ermit Issue PLUMBING
PPLBG Fees foot PLUMBING
ZADDCHG I Address Chane BUILDING
3 of 3