02030040 (4) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATIO'
BUILDINGADDRESS: PERMITNO.
11110 SANTA TERESA DR MILOJKOVIC DRAGAN AND T TJANA 02030040
OWNER'S NAME: APPLICATION SUB DATE
MILOJKOVIC DRAGAN AND TATJAN 03/11/2002
/ HONE: SANITARY NO. CONTROL NO.
00 ARCHITECT/ENGINEER: BUILDMG PERMIT INFO
BLDG ELECT PLUMB MECH
i ur LJ U LJ L_J
LICENSED CONTRACTOR'S DECLARATION
Lz 1 hcmbv mrOrm that 1 am licensed mine r Ch.,lm 9(commencingJob Descr] tion
L prmECLAR per
„t
with 5.ion1000)cimmsinn3mnheBuamessand PrcmssromCmae.and myhanse REPLACEMENT OF WINDOWS .
as E--s is in full foes and effe,.
a i U License Class Lic.a
Data Convector
a.a.a G ARCHITECT'5 DECLARATION �� AN ��®
OA
m.5 1 undersand my plans shall be used as public mc.Ns
p O Licensed Professional as
Oar IER-BUILDER DECLARATION MAY 0 b 2002
1 hereby maso.(Tent ohm 1 1 exempt from the Cocoons Co License Law for the
C z a following moon.(Section 1onstr Business and Profusions Code:Any cloy of county $7722
FO
which requires<permit remrsw0.alter,improve,tlemouch initt ore a signed
any
ormentrr
3$ Priorooits issua¢e,also
umat zoite the mitiocso for Contrator a Licenseaw(Cha mem
that be is lice ud punuam m the pAvisiom of the Contractor License Law(Chapter 9Valuation
lcommencierg with Section 7000)of Division 3 of the Busmen add Professions Code) 1 j.3 a Z O':-V-V fi,'-L�I i !•. s
or that he id exempt therefrom and the basis for the alleged exemption.Any violation
of Section]031.5 by any applicant for Si permit subjects the applicom tom civil penalty
of no,mora than five hundred dollars(S5W), 10 CPN DATION Occupancy Type
O 1,as ow.,of the pmped,mr my employ.with wages as their We compcna,ion,
Will do the woand structure,is not intended or offered for sale(Sec.]014; -
a ' work:and
and Professions Code:The Contractor's License law docs not apply to an 103 - UFER Required Inspections '
owner or property Who builds or improve thereon.and who does such work himself 104 - REBAR
or through his own employees.provided that such improvements art not intended or
ofrined for sale.IL however,the Wilding or improve m is Sold within one year or 10 5 - ANCHOR BOLTS
completion,the owner-Wilder will have the burden of proving that he did not build or
aim,tm
proverpurposeofsale.), 106 - SEWER & WATER
pyLns cwner.ftme,m ."y.arieclmivciy comraeingwith licensed Cono actors to 202 — UNDERFLOOR PLUMBING
construe,the project(Sec.Nod,Business and Professions Code:)The Contractor':
203 - UNDERFLOOR MECHANICAL: '
License Law does not apply to an owner of property who Wilds or improve thereon,
are who connate mf such p.ojeca,with a eunmaeads)licensed puauaa,an the 204 " - UNDERFLOOR FRAME' _.
Cesmadi License Law.
l un exempt oder ec. - B R P C for This reason 205 — UNDERFLOOR 'INSULATION
woes dtk;�e Dan, 301 — ROUGH PLUMBING
WOR R'S COMPENSATION DECLARATION 302 — TUB & OR SHOWER
Inereby affirm anger penalty afp=duty one of the runowing declarations: 303 - ROUGH MECHANICAL
1 have and win maintain a C<rdficaie of Consent to self-insure for Worker's 304 — ROUGH ELECTRICAL
!' Compensafi... a .,..sided for by Section 3100 of ,he Labor Code, for the
manc
perfoe of the woh fw which this per.ni,is issued.
305 — FRAME
r D1neveandwiBmaintainworker'sCompcnationInsurance,uregainedbySecnon 306 — HOLDOWNS
3700 of the Vbor Code,for the perfomnance of the work for which this per mil is 307 - INSULATION
:- r issued.My Workcls Compenation Insurance Iarrier and Policy Tomberam:
_ . . 30,8`" t,SIJEETROCK ..
Gartree r ' C' '. ^:i j L•"Policy No. '-
::'
CERTIFICATIONOFE%EMNWSURAOMWORgER3";', •� 1 t'309 =`"EXTERIOR'•LATH
,,........._ "'COMPENSATION MSURANCE' ''.
Tied
— 3'1'0 ' IN;TERIOR...LATH'..
" (ii::arnnnba'nntb Inmpmeainn<p mniafor one hundredamlan 311 - SCRATCH COAT
(sllq)w1esJ . . � '
...... . ^ .. .313 ="ROOF "NAI-L
I ceNfy wt in Ne petrormance.f the wwk for which this p=mut is Issued.I t. - .. . . .
Shall not employ any person in any manner so as,to become subject to the W?no.' 501 — FINAL ELECTR I CAL"ENERGY
C.mp<nsmion laws of Cahfomia.Date .. '
Applicant_ ' " 502 — FINAL PLUMBING ENERGY.. .
NoneETDAPPue,wr.¢ane��,.k;ngmiscertineaenfExempdon,youshoma 503 — FINAL MECHANICAL 'ENERGY '
become subject a rhe Worker's Compcmamon pdwid ors of die bobor Code,you moa
zfoMwihcomplywihsm<npo :inn:ormisprtnit nonWd«mdre.nk a. 504. — . FINAL BUILDING ENERGY,,.
CONSTRUCTION LENDiNG'AGENCY' - SOS — FINAL ELECTRICAL
,hertby alEr.n that them is a construction lens ing agency for thepto odomi
W l"' of Ne wwkfor which Nis pemtit is issueE lScc l09Z Civ. ncc 506 - GAS TEST
.� A l�rder'a Name.. h .-e.... .. . ..... . . t
p Lend«s.AdaRas' 507 — FINAL PLUMBING
(.7.0 �-I Certify that I have mad this applicmion'and state that above information is 508 — FINAL MECHANICAL
I+a:'E. correct.1 agree to comply with all city and county ordinances and state laws.elating 5 0 9 — FINAL GRADE
Oep to Wilding camination,arta hent authoriie repoolmadves.fthis city m Inter upon
{r] 0e above-mamioncd.maty for.inspection puryous. 510 - FINAL PLANNING
h` liabilitie�jua mei s.`Costs and hick may in ess any way raperdnn.g aid 514 - F INA PU I C WORKS
r..).z Cit g prises w may any way accrue against
City in consequence of the granting of this permit'
APP CANT UNDERSTAI�S'AN boa. COMPLYwmi ALLNO -POINT" Issued by: Date
s E ]TONS " .,. ,.Ili r' 3. J
.. irature.r BtanoContritemr..', .• :,.. . .. .' RRe-roofs
HAZARDOUS MA ERIAIS DISCLOSURE Rare, "
F:•.'F.1: ,y uneLppGeantnrua building oc'uµbtSt..rhandle nzaaosmaerm _,Type of Roof
:i
IS 1 c mad by We Cupe�roo Municipal Code,Chap,ar 9.)2,and the Health and Safety L
Cade.Section 255J2(a)1 r ., 1. - '••, 1 i ; • _t y' ''
❑ver'-. _•: Ir.' No _ gginstalled:-..
All roofs shall be Insperted,pnor to any roofin material bei"
Z111theappzq ant or None Wildingoccupant equipment o devices which If a roof is installed without first obtaining an inspection,I'agree to remove
it h rdo in contaminants ss defined by the Bay Area Air Qualify Management
:miry " ., 1 _ ply with
I'r�✓. oven jdN.. all non-point source regulations.
I h vi read the hazard i m tions x 05ircm<n9 un255 Chapter h.9S.f the
CtliI buil Health s Safety Code,Sections arm;dd 25533 and 25534,1 understand that
Ne building des not contently have atenangthat it iv my asponsibilioy to notify,he'
upw of the requiten u wh'Is must be it pdpd.,to issuance of a Cent of
2 Signature of Applicant Date
t
-��
her or thorimdagentDetm.- d All roof coverings [o be Class "B"or better
' ,, :.t
T'.
-OFFICE— . . . .._ ._.___. ._. . _.. . . _. . .
OFFEE COPS K-f o 1 (, o d ZoaZ
PPROVED
/
4 i 4 .�cP JR IANCE WITH THE CITY OF,
ij
CUPERTIKOC4EN ORDINANCES
— �1 BATE 7/ —
SIGNED_
IThis set oend specifications MUST� — _ _ I kept oc: ad times and itis un
awful to . y c .n�cs or alterations
CK� n same with.u, n pc:m ssion from 1 n
` lJ jic hui dlnO C.,•" C t, i Cupertino. V
^ , The s'.amp.n^ '' n ^ perifications .
v 3Hr t'_ NOl o: d r 1.) he an
ppro%:l of the v.'iO rnv provision
n^n r $
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IN
Contract
The W=Ldow I�Xo® �� S7i�
DOUBLE PANE INSULATED THERMAL wS
l/ L 30502 San Antonio Street, Hayward,CA 94544 Phone(51 429-5040
I LICENSED&INSUR CONTRACTORS. . . CA LICE SEN 749382
OWNERS RES.PHONE DATE
f/ �� Fe',U/ BUS. PHONE /.:2 _ir
STREET L EXISITING WINDOW
OWOOD LUMINU ❑STEEL D OTHER
CITY,STATE AND ZIP CODE�r' FRAME BRA ' GLASS
C U%�K,,e, No C�1 : �i ��l a� 1 . �l/IH
JOB LOCATION X ST. REPERRE15 BY
. . -. Cl YP DM DH :HS RO,.NP.
APPROXIMATE SIZECOMMENTL}
Ory. WIDTH HEIGHT. S '• LOCATION COLOR GLASS' GRIDS' . _ (PAI LD
��U L
V /,
DiN V10 oz
Oeell
U F Thi �yTTRAA
4oTKoVIC
GYM 21�F u. z. N
jJ�iCe :J. L,; 7. b �C
G )0 1�d 61E7. /V Z !L AUl l- /G
�.. 21 . U' ` TU.
fir; N7>3 L40&:22-
A' ENr7/14
!.` "
c 27InJ
ALARMS: Alarm connections are the responsibility of the home owla4"Zld,54 >z • L:'/� ��GIF�' GvULy
W� He eb OLlt�B t to�the manufactur and ins Ilatio f th/gabevep(pecifi replacement wmtl s,/doors for
W l �� % / i ly�,5i(n/ /
(THIS PRICE DOES NOT INCLUDE PAINTING)
Payment to be as follows:
o Cash down payment$ Measurelproduction /`//,ilk /-� l")kJ
Balance due installer on completion $
Installation to commence on or about —/0 Wk-:5 ! Approximate completion 7-
�P AI I Irs�
All material is guaranteed to be as specified.All work to be om eted in a wo anlik manner according to standard practices.Any alteration or deviation
from ahnvo cnncificatinnc nr.mfnrncewn renaim due to local huildino codec invoMna extra costs will he executed only uoon written orders.and w71 become iP