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04070172 (2)
CITY OF CUPERTINO & BUILDING DIVISION PER @ITRACTc��t=r '� � n1 BUILDING ADDRESS: THE WINDOW BROKER PERMIT NO 04070172 PERMIT IS5UE DATE ER'S NAME: KATHY STANI H SANITARY NO. CONTROL NO. NE: (800) 639-4527 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH u o o LICENSED CONTRACTOR'S DECLARATION Job Description w 1 hereby affirm that.1 am licensed under previsions of Chapter 9(mmmencing O with Section 101X7)of Divison 3 of the Bus;ass d Professions Codgandmylicenacis acad ;mm��e eerrt. WINDOW REPLACEMENT —�? LicensoC ct.ta Lie: ni-Q Data -4=zy-O2, Coal. II ARCHITECTS DEC L�gR TI N ' kj�rmand my plans shall he used as public records OyU ;a� Licensed Professional g OWNER-BUILDER DECLARATION Counselor. oun ON 1 hereby off.(Erre that 1 1. exempt from she Cssions o e:Artyc Law for the p O following reason.(Section vanuu Business antl Professions Cole:Any city or county Which its ham n permit re quite.the almm improve,dcamilish permit U or repair any someonemars r i m,11wIss;amempamsorequires the applieam for such permit 0leesigneJ aummem Valuation That he isliccnseJ porsuanun the pmvisloru of the Conlescmr's License law lChap¢r9 Sq.Ft.Floor Area S that as Is exempt Section 10nd of basis f r Mus alleged ..s and.m.Any vi Cnee7 or Nal io Is exempt fang applicant li and or basis fur bj alleged apeman to Any violation of So,nom 7031.5 by any for 501).Permit subjects Ne applicant acivil penally or 3 @I8ai�@16er00 Occupancy Type •nor more Nen five hundred dollar(g5o07. . ❑1,as owner of the property,a my employees wish wages as their sole compensation, will do Ne work.and Ne structure is not intended or offered far salc(Sec.1044,Business Required Inspections and Professions Code:The Conuamm'x List.Law does not apply to an owner or q p Property who bui Ids or improvise thereon,and who does such work himself or through his own employees,provided Net such improvements tie net intended oraffered forsels.IL however,the building or improvement is said within one ysm of completion.the owner builder will have the burden of proving that he did not build or improve for purpose of / sere.). ❑I,as owner of the property.,B exclusively confessions wile:)Theed contractors t. construct the project(Sec.o an Business and Professions Code:)Theves u ansa nd cense Law dacsnot r suchplmjecm with a cafpropcny who sedpds or;mpro Me Contra ors !1 whence Lacts for such projects wish a canlesetoKa)licensed pursuant m the Contractors License Lew. IM, em exempt under Sec. ,B&PC(or this reason \/�( er Doe WORKER'S COMPENSATION DECLARATION I hereby strum under penally of a jury one of the following decloetimme have and Will mmmutin aCmdEtodeof Consent to selr-Iname far Workers Cempem n,as provided for by Section 37M of the labor Code,far Ne performance of the k for which this permit is issued. have and will maintain Worker's Compensation Insurance,as required by Section 0 of the Labor Code,for the performance of the work for which this Permit is issued. Worker's Compesmahm Imumar s carrier and Pp ITicE/pWabe,..: - Oarjer:s IgiG RTIFI, r—EXEMPTION ✓v/ CERTIFI ATEOF FROM WORKERS' COMPENSATION INSURANCE (ITB section need not becompleard if the permit is foronc hundred dollars($I00) or less.) I certify that in the performance or the work for which this permit is issued,l shall not employ any person in any manner so w to become subject to the Workers'Compensation Laws of California.Out Applicam NOTICE TO APPLICANT:If.after making this Ceniftcafe of Exemption,you should become subject to the Worker's Compensation previsions of Ne Labor Code,you must �Z forthwith comply with such prnviOme;or this permit shall he deemed revoked. z Ch CONSTRUCTION LENDING AGENCY [-. I hereby affirm Nat there is a construction lending agency for the performance of fYa 7 the work(a,which Nis permit is issued(Sec.3097,Civ.C.) . is,A Lender's Name gL ,t Lender's Address U I certify Nat I have read this application and sure that Ne above information is LL f" correct 1 agree to comply with all City and county ordinances and smm laws Elaling to V building construction,and hereby andamin representatives of this city m enter upon the W ahove.menlioned properly far inspection purpoxe. (We)agree to save,indemnify and keep harmless We City of Cupertino against +� ' rn liabilities,Judgments,costs and expenses which may in any way accmcagamsl said City U in consequence or Me granting of this permit in'th PLI UNDERSTAND�AND WILL COMPLY WITH ALL NON-POINT Issuedby:S4�� Da e cu�oNs ?. Re-roofs ure of ApplicanUConuacmr Dale HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will she applicant or future building smulsoustare or handle barardous mocrial dermad by the Cupertino Municipal Code,Chapter 9.13,and the Health and Safety de,Section 25532(a? All roofs shall be inspected prior to any roofing material being installed. ❑YesW;II the applicant or future building occupant use eyuipmenl or Devices whichIf a roof is installed without first obtaining an inspection,I agree to remove arardnua air conmminants as JcOncd by she Bay Arca Air Quality Managcmcm all new materials for inspection. District? - ❑Yes I hove mad the haaaNnus s 25505,2553lrmd 255 under dcm=6 alof the building n;asmo &Safety Codc,Sections255o5,25533andnxah EIIundemamee ifthebulking Jws not currcnti]]''haw a tenant than it's my responsihility tu notify the mcupanl of Nc oulan. cnI, chum et poor ismarm O(aCemremearcl aney. Signature of Applicant - Date •mob. .,l-L,. 0 7�-'2 a All roof coverings to be Class"B"or better fur uthaixctlagmt Gibe— 'A rr p JUL 27 2094 o` CITV OF CUPERTINO po _NG X c C�k o �JLJ 'EI��LJVL� >-c�� v.. APPROVEL) 's IN ACCORDANCE WITH THE U Y W CUP C .S Ad. 0P' +NANG€.6 x DAT SIGNED This set be kep on the jo II times anrf It 1§ 9 , lawful to make any-Rnges oralt§P§t18r� k o on same without written permisalan free Z✓S x the building Dept., gy of Cupertino, stamping of this pian and specificafl© 1 h Id til nermit or to bar `JfIMLL 1r approval of the violation of any prove , at ally Oily_Ordinance or gate Lew k CIO C k L CITY OF CUPERTINO* 0 7vl Z �CUPERTINO PERMIT APPLICATION FORM APN # ?Z 6 Date: Building Address: �O Mailing Address (if different from building address): 10550 5toLC' 95rU 4 Owner's Name: Phone#: Ko. I 0O 25�1i - 573 I Contractor: License#: T�, UQ ro -7 y 9382 . Contact: Phone: Cupertino Business License#: 2385 ;Hcoh v CA Fax: 1k)63q-4521 Building Permit Info: Bldg ❑ Elect ❑ Plumb ❑ Mech ❑ Job Description: w 1 N nJ s ren m e �$ d� ter✓ v mo �w,,, Residential l� �`��^ �au�le a�e lass 'f�^ 2 nn L ornmercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: o Occupancy ro e of Construction: Please ch a project is a second-story addition: ❑ Project 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 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 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 BELE 200 Elec Svcs 600V<=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investi ation fee BUILDING 1of3 y/ 3 � ZI WITY OF CUPERTINOO CUPEI�F PERMIT APPLICATION, FORM QuantityFee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME 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 Heater/Vent 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 Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BRE LOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 WITY OF CUPERTINC* CUPE(I;TINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Grou BREMSIGNAD Rmdl Signs Add Branch , ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING a BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECLU 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 Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING 3of3 i