04120071 CITY OF CUPERTINO - "� ' } '` a � j
BUILDING DIVISION PE `'CONTRACTOR INFOR ION'p,
BUILDINGADDRESS: THE WINDOW BROKER PERMIT Nd.V 4120071
968 TWILIGHT CT
ER'S NAME: PERMIT ISSUE DATE
SUE & RANDY CARROLL 2385 LINCOLN AVE 12 /10/2004
PHONE: SANITARY NO. CONTROL NO.
(800) 639-4527
ARCHITEMENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
u0c LICENSED CONTRACTOR'S DECLARATION lob De D
1 hereby afrom 0.11 am licensed under provisions of Chapter 9(commencing
with Section 7")of Division 3 of den Rustiness and pretensions Coda,and my license is
"Moo mmnmreeandeR 2i WINDOW REPLACEMENT
SR? Lkenm Cles Lk.9 f 7
= D.e t J T Contractor < -, t� 0 9 2005
ARCHITECTS DECLARA ON '':�
I undcrsunJ my plena shall he used as public records f
012
0x Licensed hembyProfessionel
OWNER-BOLDER DECLARATION IILII^, Illlll\V\'wV111
0 0 I hmoso .mean that 11. exempt from the C Professions
a License Lew for the
p o following reoma(Section]11314,Busine4a and Improve.
dem li Cole:Any city or county
$
which requiun n permit m ams the eller,improve,de ermit t or e a sig any structure
813512
r^ priorb its issuanec,alwrthrthe prevision nt oftimsoh Permit to Li es Law(ed Chapter
(c eisingwit pSection7 h)prodsionanithe Connector's Llanm law(Chapmr9 Sq.F[.Floor Area Valuation
y+ $
(crearmingexe pt Section ID00)of hadion3 of the Business
xemton.Anynvi Code)m ,
.. Nat he u exempt them(mm and the buts for tiro dlegctl exemption.Any violation of
Section 7031.3 by any applicant for a pemdt subjacu the eppllcanuo a civil penalty of 3 J&jPNbA*dI0 0 Occupancy Type -
rot mom data fns hundred della.($501)).
01L as owner or the property,or my employees with wage,as their role compensation,
will do the work.and the strorture is not intended or offered for set,(Sea.7W.Business
and Prohsaimu Code:The Contrsetori Lice. n ro
,Law does apply to an owner of Required Inspections
property who bulldsorimprovethero n.and whodosesuch work htmsellar through his
ownemploycn,provided Nauuch improwmmor arc notinlended.offered formle.If. - -
hoAever,the building or improvement is mid within one year of completion,the owner.
Wilder will haw the burden of proving that Ise did not Mid or improve for purpose of
sale.).
❑1,u Owner of the Property,am exclusively contracting with licensed contractors to
construct the project(Sec.7644,Business and Professions Code:)The Contractors U,
cense Law does not apply to an owner of property who builds or improve dtereon,and,
who contracts for such pmjem with a conuator(s)licerssed pursuant to the Contractor'.
ve 4w.
am nempl under Sec ,BA PC fm thio reason '
net Data
WORKER'S COMPENSATION DECLARATION
I thereby sf irm under penalty of perjury one of the following Mclaatiov: -
❑1 haw and will maintain aCerdin a e of Ceventta self-insure for Worker'sCompen-
sadon,as provided For by Section 3700 of the Labor Code.for the performatee of the
week for which this permit is issued.
❑1 haw and will maintain Worker's Compensation Iruurance,as required by Section
3700 of the labor Code,per the performance of the work for which this permit is is a6
My Workda Cypmpensalion Insurance as an
nid Polity number am:
Cartier.C 1° Policy No.:
CERTIFIG OF EKEMPION PROM WORKERS'
COMPENSATION INSURANCE
pats section need not be completed if the Permit Isfnroa hundred dollars(3100)
or less.)
I certify that In the performance of the work for which this permit Is issued,)shall not
cmploy my person in my manner m as in become mbjauo lM Wmkcrs'Compcmatlan
Lbws of Cdi6mb.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Ccnifinno of Exemption,you should
become subject to the Workers Compensation previsions of me LaWr Code,you mot
.JO foMwith comply with.uch provide.or this permiuhsll be deemed ranked.
CONSTRUCTION LENDING AGENCY
(•w I hereby aRrm that them is a Construction lending agency for IN Performance of
fY. the work for which this permit I.issued(Ser.3039,Co.Q
0.U Q Lenders Name i /J
.� Lender's Addms.
fJ Q 1 aNry that 1 have mad this application std sine that the above information Mania m
Fbonding Lyra m comply with sit city and county ordinances and cute laws relating to
QV abovengcnioned pro and hembymmon prpose& tivn of aniscity mcnmrupon IN
4L7 show mentioned propene for inspection keep l s
G (We)agree to mw,indemnify and hap harmless the City ru &S.inino id City
try Ilabtlltiu,judgments.crauand espe.uwhich may in any way acme agsi.tsdO City
t.7'� A APPLICANT
of UNDERSTANDS
inC SA permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:9 Date
SO RCFREGQJATIONS,
4t ._:1 t Z ty G t I Re-roofs
Sigvmre of ApplicamrConnecsor Date
HAZARDOUS MATERIALS DISCLOSURE Type Of Roof
WIII the applicant or probe Wilding Occupam store or handle henaral manorial
coned by the Cupertino Municipal Cade.Chapter 9.12.and the Health and Safety
dC,Section 25532(4)7 All roofs shall be inspected prior to any roofing material being installed.
— ❑Yes iA
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove -
emit haradnus sit conmmivnu as defined by the Bay Arc,Air Qualify Management all new materials for inspection.
District? I '
❑Yes as
I haw mad the hnardous mmarialsm,olooner u under Chapar15.95 of the Califon
nia HcalmA Safety COdc,Sccdo.5505,25333 mJ 25534.1 understood thmif the building
does not currently haw a wadnl mu It is my respo.ibiliry to notify the occupant of an,
reguiremenuwhlehnollametpdormiaaa.dar,CaniRae(Occupancy. Signature of Applicant Date
Ori) 1�-1 - 12' Iv — ��
Owncrorauthonzed.gem Dane All roof coverings to be Class ��B��or better
FINAL MEASURE
• Dealer Name: e 11'12wtoJ �ke✓
t
Address: aTt CA DATE
JOB#
CA LICENSE# R
OWNERS: Sue '+ aA,` "t Cay-4�-Oj� RES PHONE:-A '• �'� DATE:
STREET. 1996 n W BUS PHONE: "
�+ ll N
CITY: STATE: ` � ZIP CODE: 95014
y Window
❑ Single story: ❑Wood siding: ❑Wood windows ❑ Patio door handle(s)s E �j' c (in.)
12 Two story: ❑ Vinyl siding: ❑Aluminum windows: ❑Wh' "" ❑ s Enclosed
❑ ❑ Stucco: ❑ Steel windows: Insid ❑ Slope
Security bars - Re-install: ❑ Yes ❑ No ❑ Stain grade �1t grad Angle: ID 30 ❑45
No. days ❑ Retrofit ❑ Pull frames ❑ Lawn sign okaynt Ajr� �J White ❑Almond
NO. LOCATION TYPE APPROXIMATE SIZE TEMP e2 GLASS GRI eft
WIDTH HEIGHT OPTIONS
IT
'' F l oo v
F
3 �it�l� IlfUt�
2 r
ivS ✓' -
D,•,- D;�e Fe - 0.,,,,,R . - .
5
S E �F?�n•H 11tE CC fav,S
Q' ' �U'ti . p rpDF•
9
n
10 at 911 u;,.- fASTitu1,•
a this ,,c 1.ob,, chaa&cs 4c;�10ct flex
MIA.� thout �; CoPe! �hicaBOns
12 v �e�v ,nQ bulld'm1 e of this Fla na[mi�°t tD h pies
1 . .anm01°� , _%A in r ncoVk
13 ;NASI Nps C.a XO'- ° 01mta tall.
14aAre t �v,# �,ta9°'q tyR/u•"..
15
15 C tiz
n
Special Instructions: Total U.I.
Windows:
Doors:
The type and operation of each window have been fully explained and I accept the windows identified on this Bays:
measure sheet as being the windows I am ordering.
Customer signature: Measured by:
Mey 1004
•
CITY OF CUPERTIN#
•CUPEI�TINO PERMIT APPLICATION FORM 0-F642 `071
APN# -I i , J.� CD Z
Building Address: Mailing Address (if different from building address):
Owner' Name: P one#:
� Cw�r�ll C3 Z.-
Contractor: License#:. `� Z
Cont ct: Phone:(5)0r'1 -5321 Cupertino Business License#:
H( c aws�t, Fax: 5160)12 - C..r
Buildhig Pe it Info:
Bldg �' Elect ❑ Plumb ❑ Mech ❑
Job Description: L;j,,,ck o w i ve� a+v'
Residential V Commercial ❑
Sq.Ft. Floor Area: - $/Sq.Ft.: ) ,
Cost of Project: a- _ . _.- OccupancycYGroup:5� 2
_.
ype of Construction: - Please check this 11 the r ' is a
second-sto .addition:
Project Size: Standard ❑ Lar e ❑ IViajor ❑
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL.
BBOILER1 Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 100K to 500K Btu MECHANICAL ;
BBOILER3 Boiler> 500K to 1M Btu . MECHANICAL
BBOILER4 Boiler> 1M to 1.75 M Btu . MECHANICAL
BBOILER5 Boiler> 1.75M Btu MECHANICAL .
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/Off/Comm/Quasi'-
BCONSTAXBQ Con. Tax for BQ Zone BUILDING,
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Constax—Resi/Mobile BUILDING
BELEC1000 Elec 600V <= 1000A ELECTRICAL
- BELEC1001 Elec 600V> 1000A ELECTRICAL .
BELEC200 Elec Svcs 600V <=200A ELECTRICAL.
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING.
BINVESTIGA Investigation fee BUILDING
I of
' CITY OF CUPERTINO '" ' - :r+ya�7rw,v s +g *�,++" '" Rem- `�"y /�
BUILDING'DIVISION PERMIT -.. ' 401\=1 7 R PWOAM� s u i- '" - -•
I ,b 3�b . .. Ya""::,dM .w ?. lS CFa...,�ry..l.`$
EmwINGADOREss: THE WINDOW BROKER - p�'T"IRNG04120071
19968 TWILIGHT T
1 IER'S NAME: - FERMITISSUEDATE
SUE & RANDY -CARROLL . 2385 LINCOLN AVE _
NE: SANITARY NO. CONTROL NO.
(800) 639-4527
ARCHRECTIENOINEER: d - BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
-100 "�' ',LICENSED CONTRACTOR'S DECLARATION :•, - - O-t. ,., O
118 I hamliy affIrmi that I am Licensed under prevision.of Chaply 9(rnmmcncing icicle +., -. Job Description _
with seed..7"),d Division 3 ofNo Businua and Professions Coda.and my lice.¢is -
mfuRrnreaandefrenC 1.7 -? 2.t "2 WINDOW REPLACEMENT
Z
Data i."d Ib -u7`s Cpndnnor
ARCHmfcrS DECLARA N -
'yq 1 undemssnd my plans shall W used u public meorN -
3icicle.
sed
Licensed P."mak e" y/
OWNER-BUILDER DECLARATION s
<Y 1 hereby.(Orth o n I nm exempt from aid
Ne Condncura License Law.r the -
O o .Sowing..on.(Section 7fOLS Bualte, area pre.amoll t.ac:Any city or roomy
$ which requires a permit u cenaWLL tlur,improve.dem.lts6.m repNr any structure
prim he its issuance.also requirei Ne applicant for such permit in file a signed suumend - .
gg < Nn he is licensed purematto de,provisions of ftCoreactori Dame Taw(Chapter9 Sq.Ft.Floor Area Valuation .
(commencing with Saudi.7W)of Divislbn 3 of Ne Busincssand Professions Coda)m
that he is exempt Nemfrem and the huii for du alleged exemption.Any violation of
Section 7031:5 by any applicant for a permit subjecs the applicant in a civil penalty,of -3 JAWNi"410 0 - .. ^ Occupancy Type --- - _
not some Nur five bunared dollars(ML
' ❑i,uewnerofthepmpmyamynnploymwlthwagesufth wlemmpenution:
will do the work.aid Nestructure isunintended oroResedfonale(Sm.7044.Business Required Inspections
and Prefmlom Code:The Contractor's License Law deadu nod apply an ownCer or " _ - q .. .
pmpenywht buildsor(mprevea Naeon.andwhodoessuch workh(nuelfdr through his - - -
uwnsmployres,provddedthsssuehimpnovicen. erotintendedmoQcrtd fm Well - - icicle - icicle___ ,
hawnsr,Neddldingorimpmwmentls=Idwlshinonywarofmmpiedom theowmer-
builder will low Ne burden of proving that M did an,Wild or improve for purpose of
❑1,u Owner of de,Property,un exclusively c.nuaning wide licensed cenuumn to -
construct the Project(Sec.70th.Business and Professions Code:)The Conuacd.M1 U- .- .... ....
e m law does not apply in an owner of property who hill&or bri mes Nemo.,and
who contracts
aNfor such prejettswithaeonirxetora)Ilamdpunm
pursuant WConvacmr'a -- - --- -- ---.-- -
1 son
Law.
,
Lam exempt under See .B&PC for this reason - . .
i
er Doc .. '__11.7-.
�
� WORKER'S COMPENSATION DECLARATION,-„.•,,,vJr-, .' _ icicle. _. -
I hemby affirm under penalty of perjury one of the following declarations: .
I have and will mainWn a Certificate W Covent to self-imam for Worimes Campers-
ssdion,u provided fee by Section 37W of the Labor Code,for the performance of the
work.rwhichthis armitisissucd.
❑1 haw and will maintain Wmkees Compensation Imuran,u acquired by Section - . . -
My W.rk a labor Code.(m Ne perfonnance of Us wmk lm which Nu permit LL iuveA
My WorkefA CyVmpemtion Inwnna canim end Polity number art:n�
Cartier:f -' `° Polity NO.: 151 G I.Sll _
CERTIFICA F EXEMPTION FROM WORKERS'
CO ENSATION INSURANCE
fThls auction read nothecomplesd iftis permit is furore hundred do0an(gIW) _
or less)
1 retify that In the perrmmanee Of the work forwhich this permit is issued,l shall not
employ any person in any summer an sat in become subject to One WorlxrV Compcmdon
Laws of C1Iifomia.Data - - --- -
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
become subject in Ne Worker's Campemadon previsions of Ne Labor Code,you must
v7. z forthwith comply with such maintains or Its permit hall W emoted rooked.
Z ryN.tCONSTRUCTION LENDING AGENCY -
(r I hereby affirm Nn Nen is mmuation lending agency fm theperformsnce of
lYi ti the work fur which this permit is issued(Sec.3097,Civ,C.) -
Q Lender's Name
.7 z Leader'sAddrm
U0 I turfy that I haw mad this application and state that Use salve information is
it, f'•�. conal.I agree u comply with all city and county ordinances and Aute laws relating to
0 Wilding construction,and hereby author=representatives of this tidy to enter upon the
is .hove-memimud property for inspection purposes
gL (We)agme in sew,indemnify and kap hnmla the City Of C9Pl ninO agajmd
fn liabilides,judgments.eros and exitmu which may in any way acme&gaunt tend City
U 7 in consequence of the swung of this permit. - 1/
'7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by; Date
SO Rc�REGULATIONS,
4� �1 �� t Z_ 10, 0 4 Re-roofs
Sigttare of ApplicetwOmuanor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building eecupanumre orhandle havndous material
defined by Ne Cupail Municipal Code,Chapter 9.11,and the Health and Safety
.Section 25531(a)T All roofs shall be inspected prior to any roofing material being installed.
❑Yue bAo
Will the applicant or future building Occupant use equipment or&vim which If a roof is installed without first obtaining an inspection,I agree to remove
it heracdoes air contain=s at dc0.od by the Bay Area Air Quality Management all new materials for Inspection.
Disu.tT
❑Yea a.
I hew mad the hanrdousmaterals requimmcns unacr Chapter6.95 aide Califor.
nu Health&Safety C.ae,SMU=25505,25533 and 25534.1undernond Onlfthe Wilding
does Out cureendly haw A ten=L that It u my rmpomlblllty u notify tis occupant of the
mpuinyuns which mu .met priormwu.n ofacmirmmofatup.ney. Signature of Applicant Date
1122” , r. +Z- (O 2 �, All roof coverings to be Class"B"or better
OWAcr 01 nthon=d agent Date