06120074 CITY OF CUPERTINO
• BUILDING DIVISION PERMI CONTRACTOR INFORMATION` '
BUILDING ADDRESS: PELLA WINDOW & DOOR CO. PERMIT NO.06120074
91 r77 VTT.T.A MAPTA (-T
OWNER'S NAME: PERMIT ISSUE DATE
TINA WOO 9JT14FPnmT PT) a ) 11
NE: SANITARY NO, CONTROL NO.
925 245-447
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
tap LICENSED CONTRACTOR'S DECLARATION Job Description
w 1 hereby affirm this,1 am licensed under provisions of Chapter 9(Commencing p
�i� with Section 7")of Division 3 drum Budrcssand Pr°fessiusu Cade.aM my licensee
A. Lora"faro°a^°°fr"' 8 �-) REPLACE WINDOW LIVING RM ONLY-LIKE FOR LIKE
,q? Lisnx Crus Lie.If
,^ DaleG'dn"xbr
ARCHITECTS DE TION
i e 1 undorsund e used az p tic cords my plans shall b
ryU
G t7, Licensed Professional
5 Oat I am exempt formDECLARATION
CLC I hereby alum Nm I I.S.exempt van the Contractor's a e:ense Any
for the
p a following mean.(Scudo 7113 LBusiness and Pmfessiom Code:Any city or county
fi which acquires a Permit to comoun ct.alar,improve,dcmMuh,or repair MY structure
prior to its issuance.sin mquima the applicant for such Permit in rile a signed summer,
< Oat heislicensed PanitothcprovebmdithnContrxxrLaw Sq.Ft.Floor Area Valuation
CFumn
C (commencing with Section 7000)or Division 3 of On Business and Bofessions Code)or
2 that W Is exempt therefrom and On basis far Or alleged exemption.My violation of
Section 7031.5 by any applicant for a permit subjects the Applicant o a civil penalty of 3AW Nurhb6v 0 0 Occupancy Type
tat mase man five hundred dollars(MLP Y YP
❑I,u owner of Ute propcny,r my emPloyces Wim wage u their ale campevation.
will do On worL and the stuctum a not intended of offered for sale(Sec.70X4.BusinessRe aired Inspections
and Proressmm Cade:The Conommes License law COCA oat apply m m ow.of q p
propcny who builds or improves demon.and who d°essuch work himself or Omagh his
ownemplayca,provided that such improvements are not inteaWW aroQered forsale IL
however,the Wilding or improvemem is mid within ane year of completion.We owner,
builder will have de Widen of proving mat Im did non build in improve fa purpose of
sale.). .....
Q 1,as owner of the property,am eaclie ivehy...Coning with licensed conmcmrs to
comment On pmlea(Sec.7064,Business and Pmfnemon Cade:)The Coomemrs ti
cense Law docs not apply to an owner of property who Wilds m improves thereon,and
who contracts for such projects with a canna ers(s)li=ed pursuer in the Contractors
License Law.
El 1 am axempl under Sec B d P C for this mason
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 hereby in.under penalty of perjury nom of the following tlalan hn.:
I have and will maintain a Certifiax of Convent to self-m ure far WorkersCompen-
noon,m Sadprovided far by o 37M of the Inbar,Code,far the pcommosinx of the
work for which this permit is issued.
❑1 have and will mainain Workers Compessiam Imunre,u required by section
37M of On labor Code,f".performance of Use work far which this permit Is issuer, '
My Wo f ees Compensation Insunna artics and Folic,number am:
Carrier, tN'Oa'Slmv Policy Na.: W C wT 1
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thesecoon need rho Wcamplcted if the permit is frons hundred Cuban;(SIM)
m less.) -
1 cenifv mat in the performance of the work for which this permit is issued.1 shall Trot
CMPloy any person in my random u As to became subject in the Workare Compensauo^
Lave of California.Data
Applied,
NOTICE TO APPLICANT:If,after making this Cemileate of Exemption,you should
became subject in the Workers Compemauon provisions of On labor Code,you most
., .Z forthwith comply with tech Provisions or this M mit.Nal1 W deemed mwkod.
zCONSTRUCTION LENDING AGENCY
f-' Ihereby AM.that dcrn iso construction lendingagcne,l'nr the perfamarwc of
(Ythe work fur which dos Permitis issued(Sec.3097,Civ.C.)
WLenders Name
�A
Z Isnders Address
U O 1 Certify that I have read this application and sox mat the move inforrom.is
ryCrmct.1 agree to comply with all city and county ordinances and sate laws misting to
.J V Wilding Construction,and hereby duOOAnC MPracnutives of this city to enter upon the
r G abuvcmcmidncdpropcny for Caperto;purpwhich es
may
(We)agree to save.indemnify and loop harmless the City of Cupertino against
F+ Z in
sequnce of ueaosuaoOf Ob Permit.
APPLICANT
Cody in anyway accrvc against said City
O z APPLI ANT of due Sde permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUCE R�EGU•a 7QlS./� A
Re-roofs
Signuu of AppiicmUConuacmr Dam
xnznRDouS MATERIALS DISCLOSURE Type of Roof
ill the applicant or factum Wilding occupant store or handle WaNaos material
as defined by sere Cupertino Municipal Code,Chapter 9.11.and the Health and Safety
code.Soman lss3zca)7 All roofs shall be inspected nor to an roofing material being❑rte t7+� P P � Y g g installed.
Will dm applicant or future Wilding Occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
mit ha uhdom air contaminants As defined by the Bay AMA Air Quality Management all new materials for inspection.
Gimlet? �
QYes ❑Nu
I have read sex huaNramaxnals mggimmcnssundcr Chmuo6.95 aide Calif.,.
nine Health h Saresy Code,Seeman 15505,15533 ante 15536.1 understand thrif the building
dos not anenuY ham a sen that it a my responsibility to goofy the acupmt of Use
mwimm awnmh tglM tra;as aor,cerdreatnora<a icy SignatureofApplicant Date
I
gk
0cr All roof coverings to be Class "B"or better
or am omed agent pax'
s Community Development
10300 Torre Avenue
/" Cupertino CA 95014
" Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building Department
JOB ADDRESS: ( PERMIT #
21 7? KAP CT 06 (2 a 0-7 `=t
OWNER'S NAME: 1 IF1.} W oa PHONE # fog 964 87047-
GENERAL CONTRACTOR a Ww tptw FAX #
I am not using any subcontractors: 1 Z IJ V (o
Signature Date
Please check applicable subcontractors and complete the following information:
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
•
er/Contractor Signature Date
CITY OF CUPERTINO
•m 1 of 1 PERMIT RECEIPT OPERATOR: suem
COPY # 2
Sec: Twp: Rng: Sub: Elk: Lot:
APN . . . . . . . . : 35623059.00
DATE ISSUED. . . . . . . : 12/15/2006
RECEIPT #. . . . . . . . . : 37059
REFERENCE ID # . . . : 06120074
SITE ADDRESS . . . . . : 21577 VILLA MARIA CT
SUBDIVISION . . . . . . :
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : TINA WOO
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4800
RECEIVED FROM . . . . : JAMES ANDERSON
CONTRACTOR . . . . . . . : MATT LONG LIC # 25744
COMPANY . . . . . . . . . . : PELLA WINDOW E DOOR CO.
ADDRESS . . . . . . . . . . : 6999 SOUTHFRONT RD.
CITY/STATE/ZIP . . . : LIVERMORE, CA •94550
TELEPHONE . . . . . . . . : (925) 245-4470
OE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW SAL
______ _____________ __________ __________ __________ __________ __________
BENERGY PERMIT FEE 126.36 60.65 0.00 60.65 0.00
BPERMFEE VALUATION 5,517.00 126.36 0.00 126.36 0.00
BSEISMICRE VALUATION 5, 517.00 0.60 0.00 0.60 0.00
BPLANCHK PERMIT FEE 126.36 168.63 0.00 168.63 0.00
__________ __________ __________ ----------
TOTAL PERMIT 356.24 0.00 356.24 0.00
METHOD OF PAYMENT AMOUNT NUMBER
_________________ ------------ __________-____-__
OTHER 356.24 VISA
TOTAL RECEIPT 356.24
•
r ( CITY OF CU�PERTINO
CUPEF�r PERMIT APPLICATION FORM
APN # 3 5 a 65-7 Date:
Building Address: M1lpiling Address (if different from building address):
2- S tlL1 �'cIIZ�c�GJ
Owner's Name: .�\ Phone #: "S q�
t W W `-t
Contractor: Pella Window and Door License#: 835718
Contact: Brent Anderson 408 313-2238 Phone: Cupertino Business License#:
L L
Fax:
Building Permit Info: 2CQ q Le— 1. r I. Uw L\,;Pj6 O/JL y Lite (c<Q
Bld Elect ❑ Plumb ❑ Mecb ❑
Job escription:
Residential ❑x Window and door replacement per contract Commercial ❑
Sq.Ft. Floor Area: Sq.Ft.:
no added square footage
Cost of Project: SSS Occupancy oup-
Type of Construction: `a I Please check this boa if the project is a
second-story addition: ❑
• Pro'ect 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 SOUK Btu MECHANICAL
BBOTLER3 Boiler> 500K to 1 M Btu MECHANICAL
BBOTLER4 Boiler> IM to 1.75 M Btu MECHANICAL
BBOILERS Boiler> 1.75M Btu MECHANICAL
BCONSTAX Construction Tax BUILDING j
BCONSTAX Ind/Off/Conlm/ nasi BUILDING i
BCONSTA-XBQ Con. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING j
BCONSTAXR Constax — Resi/Mobile BUILDING j
BELEC1000 Elec 600V <= 1000A ELECTRICAL j
BELEC1001 Elec 600V > IOOOA ELECTRICAL
BELEC200 Elec Svcs 600V <= 200A ELECTRICAL
BENERGY j Energy BUILDING
BENERGYADD Energy Add Multi BUILDLVG
BTNVESTIGA j Investigation fei
PBUILDI�'G
t3 QIc� Chk
13 S-e ;Sm ,-Cr-,-- I of3