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04010113 (2)
111111111 IRTINO '+"�''�°a ^ 4`' aU1LDING DIVISI ON PERM yCiQ �AClQR IN �,D�•�M"A ,,,, ^,y BUILDING ADDRESS: THE WINDOW BROKER 2c;1 RTXPV DR PERMIT"04010113 NER'SNAME: - - FERMITI.SSUEDATE Y ONE: SANITARY NO. CODA OL NO. (600) 639-4F)27 AR'HITECTIENGINEE 0 9- ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MEGH 0 0 0 0 X00 LICENSED CONTRACTOR'S DECLARATION w 1 hereby affirm that 1 am licensed under visions of Chapter 9(commencing Job Description �iu, withSp etl°g?OhTof Division 7af the Buva Prafessium Cotle. d ylimme is incfallll.,�.�f and effecter 7 ;ti Llansc Clicr /'7 Lie,. 7S 9 3 � WINDOW REPLACEMENT (9 '42� '�/��U DOWN) Fp Date, U/- 7_i— oS Carol 111.1 7W / ARCHITECCSD ION U 1 untlexl�e�s my plans shall he used to famous "L FEB `� } �k +e.o�^ Licensed Professional B • g ��Ol g 3 OWNER-BUILDER DECLARATION 4 a$ I hereby affirm that I am exempt room Ne Contractor's License Law for the p d following reason.(Section 7031.3,Business and Profession Code:Any city m countyBUILIDING K m which teyuires a permit to construct,alter.improv,demolish,Or repair any structure poor it)its issuance.also requires the applicant for such permit to Glc a signed statement < That W is licensed pursuant to the provisions of the Contractor's Littnsc Law(Chapter 9 Sq. Ft.Floor Area Valuation yl=—c (commencing with Section 7")of Division)of the Business and Professions Cnde)ur y that he is exempt therefrom and the buts for the alleged cacmp(ios Any violation of Saad6m 7071.5 by arty applicant for a permit subjects the applicanuo a civil penally of 3 61�1cS0rID�erO 0 Occupancy not more than fvehundred donane an(SSW). P Y Type ❑1,as owner of the property,or my emplayces with wages as their sale compensation, will do the work,and the structure is not intended or offered for sale(See.7 d ,Business and Rmfeuions Cade:The Contractor's Liamn,Law donot apply to an owner of Required Inspections property who builds or improves thereon,aha who docs such work himself or through his own employees,pmvided donation improvements are not intended oroffered for sale.If, however,the building or improvement is sold within oro year of completion,the owner- Wildcf will have dm burden of proving that he did not Wild or improve for purpose,of .1.J. ❑I.as owner of the propcny,am exclusively contracting with licensed contractors to commuc(the project(sec.700x,Business and Pmfessians Code:)The Contractor's Li. ccnw law docs not apply in an owner of property,who Wilds or improves thereoe,and who contracts for such projects with a comar ctogs)licensed pursuant to the Contractor's License law. ❑I am exempt under See .B&PCfarthi.mason . Data WORKER'S COMPENSATION DECLARATION 1 hereby afnrm under penalty of perjury one of the following declarations: ❑1 Consent and will maintain a CcniOcate of Cocnl to self-imum for Worker's Compcn- sation,u provided for by Section 7]00 of the IaWtanthe r Code.for the perfomce of work for which this permit is issued. ❑1 haw and will maintain Worker's Compensation Insurance,as required by Section ?Ora'f the labor Code,for the performance of One work for which Nu permit is issui orkds moottion Insurance c and Policy numbcram: airier. j5 ear. palicy,d.: /r/E 330 FICA PITON FROM WORKERS' COMPENSATION INSURANCE mth o ctino aed mm W completed iftW permit m foronc l undyed dollars(SIDO) buss) I'ceniry that in the performance of the work for which this permit 0 issued,I shall not employ any person in any manner so as In become subject to the Workers'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:IL after making this Ccniffcatc of Exemption,you should .become subject to the Worker's Compcmation provisions of the labor Code,you in" .J O forthwith comply with such provisions or this permit shall be deemed revnkcd. Z y CONSTRUCTION LENDING AGENCY 'rt Ibomby affirm that there is a commotion lending agency l'n,the pcoromorom of G' ti the work for which this permit is issued(Sec.7091,CO,C,) W A Lcndch Name 5 z Isnder's Address U O 1 certify that I haw read this application end state that the above information is IL mneCL I agree to comply with all city and county ordinances and state laws relating to OV Wilding construction.and hereby authorial representatives of this city to enter upon the aboveties Pioned property for inspection which.. �. W (Wo)agree to save,indemnify and keep harmless the City of Cupcnino against h in of o,coming of this Permit. may in eny way¢trot againslsaid City V z in consequence of the granting of this permit. r. A (CANT UNDERSTANDS AND WILL COMPLY W_aErALL NON-POINT Issued by: Date URCE Rr�,AT�NS, p//2305 Re-roofs Mgnmdre I'Appli� aMCu—sono I DO6 HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or handle havartlous material u defined by the Cupertino Municipal Code,Chapter 9.12.and the Health and Safety Code,section 25572(x)? p p y g being installed. ❑Yea 'd1'Na All roofs shall be inspected ober to an roofing material bein Will the applicant or m(ure banding occupant use equipment ar devices whim If a roof is installed without first obtaining an inspection,I agree to remove emit ha>arthus sir contaminants as darned by the Bay Arta Air Quality Management all new materials for inspection. OisviaT . ❑Yes Pu I have read the ha-mous materials requirements under Chapur6.95 of Ne Califon .in Health&Safety Cm ,Socias,25%5.25511 and25554.1 undcrsund thatif the Wilding docs no vrtently how a¢nam,that it is my ms nohilit�y!sadly the acupm(of the re mamaw hmunWme(pri talar"^r"7a-L�to atoccuaney Signature of Applicant Date o / 230 Owner IjKlirltooicdaga,, Ditto All roof coverings to be Class "B" or better *CITY OF CUPERTINOP CU CITY OF NO PERMIT APPLICATION FORM APN# 36-1©9Oy9 Date: Building Address: /1 -7,57-/ y 1JQ Owner's Name: Phony#: of Sy,9ieo v A�✓� ('ioBJ (?;7 3 - 76 8Z. Contractor: License #: Contact: Cupertino Business License#: BuildFit Info: Bld Elect ❑ Plumb ❑ Mech ❑ Job Description: 9 wr:vDoNS Ae740Fi`T wT .00,;U 1/ Residential / o/AWOkf /1rCti icz:Ufy�yC Commercial ❑ Sq.Ft. Floor Area- S/Sq.Ft.: Cost of Pro'ect: ZS� Occupancy Gr p: Type of Co truction: Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> I OOK to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> IM to 1.75 M Btu MECHANICAL BBOILERS 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 <= IOOOA ELECTRICAL BELEC1001 Elec 600V > IOOOA ELECTRICAL BELEC200 Elec Svcs 600V <=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING Z 03� 1 of Smv- SCITY OF CUPERTINOO CITY OF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group 77 BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi-Family Res MECHANICAL BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL BNEWMULTI Multifamily Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMULTI New Multifamily Res PLUMBING BOVERTEVIE Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping 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 HeaterNent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN 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 Furnace> l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Lkppliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL 2 of 3 L��\` OCITY OF CUPERTIN(* CUP TY OF O PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Sips, Marquee ELECTRICAL 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 BSPECIAL Special Insection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING BMISCELL Building Misc Fees BUILDING • 3of3 , N ¢ eo aouewp+0An a11S mea � ,uo!sinojd Rue 10 uo!1e101n 04110 Ppid Zd� C a Je aq o1 10 1!wiad o1 Plaq eq lON 11tlN ` a suogeogloads pue veld sip110 8ucdwels a41 ou!}jaAn3 10 A!3 "1da, Aulp!!nq e4' X Q — uolss!waad ua11!+M 1n0u1!:., aures uG wojj ew n1 lnpnel Lsu suogeialle �0 sa8ue4oe�eI au,1 uo idol 20 un s!1! pue sawn 1 1 sued l0 Jos s.41 x LS su0geo!cads P Q3NNS U S33NtlN1G841l0 (1Ntl S3003 0NUMd(1'3 �0 A113 3M N11M 33WG8033tl Nl k = ® cfl r K v - fl !Q -::c , Alf E� • xo x o X a X O �zX9� zax9h CITY OF CUPEWI'INO �%`f BUILDING DIVISION PERMIT "CONTRACTOR INFORMATION �°. w BUILDING ADDRESS; THE WINDOW4 BROKER PERMIT"04010113 OWNER'S NAME: PERMITLSSUEDATE NE: SANITARY NO. CONTROL NO. 0 6 ARCf11TECT/[NCINEER: 27 BUILDING PERMIT INFO BLDG ELECT PLUMB MECH iOp LICENSED I am ONTAd under SDECLARATION Lw IW¢byaffrmNetlamfiaoeaunxryyy¢¢¢Profes¢orcWper9 my license is Job Description SZ W whh iia ]sOMI)of Division Sof Non usi eProfcuiun¢C d dmylicensc is ^<o, in full and erten. ✓ 7 N2 WINDOW REPLACEMENT 9 ROTROFIT 1 CUT DOWN D t2_ Liceni. Lk.R J �' a�p Datc V/- 'i oS Convacur _ undewJ/ ION �•�.s a I � my plans shall he used ARCHITECTSO is records V goy Licensed Pmfessomal or S OWNER-BUILDER DECLARATION q 1 hereby affirm that I am exempt from the Contractor's License Law for the p O following moon.(Section 7031.5,Business and Professions Code:Any city or county _ �m which require•permit m com mica.alter,improve,demolish,or repair any structure Zs priorto its ioomm.also mquines the applicant forsuch permil to fileasigned statement < that he is licensed purstram to the previsions or the Contractors Licerim Law(Chapter 9 Sq.Ft. Floor Area Valuation y1- (commencing with Section 7")of Division 3 M the Business and Professions Code)of y 3 Nat he is exempt thcrtf er,and the basis for dm alleged exemption.Any violation of rsrw.rrMs�w Section)031.5 by arty,applicant for A permit subjects the nppliont to A civil penalty of 3V9 Y113 Wu�erOO Occupancy Type not more than five hundred dollars(S500b P Y yP Lasawneroande scctu myotinm cowithw.df. .le(Sm.7044,enmiom, will Professions and theawctmeixnoms LMctlorowredsonicpply to an wnerof and Professions Code:The Camerons License Law aces not apply to an owner of Required Inspections property who builds or ed Oat sch impound who does such work himself or through his awn a however. th eo,provided that such improved wit arc not mended movend for sola B, builder the building or improvement ishaltlwithinane year of improve tar the owes builder will have the burden of proving that he did not Wild or improve fur puryo¢e of sal.). ❑L as twee of the properly,,B exclusively contracting with licensed,,convenors i. '�^Le couvnct the project(Sec.?an Business and property who Cade:)Thew;Oct on,Lid !� come Law coca not applyje An owner of pruptdy wce Wilds or improvss Cotton,and who comment for projects wiNaennvacmr(s)Iicenmd pursuant the Contractor's �sr� Li"m`Law. H 2004 ❑I Am exempt under See. B 6 P C for Nis noon Owner Date WORKER'S COMPENSATION DECORATION I hereby affirm under Penalty of perjury OM of Ric following declarations: ,�I have and will maintain a Ccoifimm of Consent to elf insure for WorketsCompcn- ation,u provided for by Section 37M of the Labor Code,for Ne perfmmanm of the weak for which Nis permit is issued. 1 haw and will maintain Workces Compensation Insurance,as ro uimd by Section 100 fthe Labor Code.for the Performance ofthe work for which Nis Permit is issued. mkcr's C_.'Knoll in Insurance c and Poli,r bar am.: artier. �r. ,CRI �� Polity No.: f.r 330 FICA MON FROM WORKERS' COMPENSATION INSURANCE (ITU aret..need not W completed if t e pewit is forune hundred dollars(31009) or leu) 1 comfy Nat in the Performa..of the work for which Nis Mrmi,is issued,I shall not employ any person in any manner so as At become subject m tW Worker!Compeumion Laws of C.3iforno.Date Applicant NOTICE TO APPLICANT:If,after making this Cie ifcatc or Esemption,you should become subject to the Workers Compensation provisions of the Labor Code,you must .J ,z forthwith comply with such provisions Of this permit shall W deemed mwikcd. zO CONSTRUCTION LENDING AGENCY I-. I hereby affirm that there is A couvucdnn lending agency for the Performance of R' the work for which this permit is issued(Sec.3091,Co,C.) aQ Lendses Name z Under's Address U C) I certify this I have rod this application and sere that tW aW w information is Fcored.1 agree t0 comply with all city And county ordinances and some laws relating to O V Wilding construction.and hereby amhoimrepruenlaives of this City to error upon the HIS7 above-m[mhmedpmpCrtts Addepenion Purposes. My (We)agree to save,indemnify and keep harmless the City or Cupertino against z liamose,,judgmentsecaseantl ea pestsesnnit. tory in any way accrue against said City U z in consequence of UNDERSTANDS of this permit. /7 ^ A (CANT UNDERSTANDS AND WILL COMPLY W LL NON-POINT Issued by: Date URCER A N / /�G _ <� O/ 2 1 Re-roofs Stgnm fAPPImanUCanvacm, . p HAZARDOUS MATERIALS DISCLOSURE Type Of ROOF - Will are applicant or future building Occupant store or handle huardous material As mimed by oat Cupenino Municipal Code.Chapter 9.12,and tW Health and Safety Care.Section 25532(a)? t]Yc¢ to All roofs shall be inspected prior to any roofing material being installed. Wits the applicant or/future Wilding Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove I air contaminants As defined by Rho Bay Area Air Quality Managcmcm all new materials for inspection. ❑Ycs �Nu I have mad the Isoodemsmaturials requirements uulcr Chapwr 6.95 ofom Califor- nia Health A Sarney Cods.seaboard 25505.25533 md25534.I undemond that iftM Wilding does no vwnoy how a repent Nnt it u my ms nsihilit nodly IM.cupant of the re mcmaw' h kMetpri toiss.a.em eaw.roc. o zs oti m,. . Signature of Applicant Date Owner (him.edag.t oto I All roof coverings to be Class"B"or better