05010072 (2) CITY OF CUPERTINO rS N. r ;ru,; x c �¢-�•,
BUILDING DIVISION PER C NiAC�#T.OYt INktO IgNn
11m,s 7-m +c+muw :art zx.F'
BUILDING ADDRESS: ARGONAUT WINDOW & DOOR PERMIT"005010072
7 i _
WATRRPORD DR
ER'S NAME: PERMIT ISSUE DATE
FRANKLIN NISHIURA 10624 S DEANZA BLVD 01/11/2005
PHONE: SANITARY NO. CONTROL NO.
(408) 996-9670
ARCHITECT/EfJGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
1 0 0 0 0
o LICENSED CONTRACTOR'S DECLARATION- Job DOSCrIpI10n
1 tensity affirm
that 1 am licensed under provisions of Chapter 9(commencing
with Section 7")of Division 3.(the Bulinus end Professions Code,and my license is
+ mfull Come And effect. WINDOW REPLACEMENT
j
M'6 License Class Lin.At
3` DateContractoTSDECr
e u(lSa ARCHITECTS DECLARATION
C 1 understand my plans shall be used as public«cords
y6
5 G Licensed Profcssianal
OWNER-BUILDER exempt
DECLARATION
0 f 1 hereby.(Sem that 11. exempt from the Contractors License Law for Nc
p O following moon.permit
t ]IDIS,Business and ere.de ons Code:Any tiny or caunre,
$ which its iogao.mh reconstrue,alms improv,dcermitt orerepair gany tatu.ure 10781
prionoit issuance.also requires the applicant for such Permit 0leasigneJ statement
E that he is licensed pursuant to the provisions of the Conl«clahLicense Law(Cho pler9 Sq.FL Floor Area Valuation
� $ (commencing with Section 7000)of Division S of the Business and Professions Codc)or
that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjccu the applicant to a civil Penalty of - er 0 . Occupancy Type
not mo«Nan five hundred dolls..($500).
❑1,As own.or the property,An my employees with wag.As their sol.compensation,
will do tim work,and the structure is not intended or offered r...1.(Sec.7044,Bulinus Required Inspections
and Professions Code:Tho Conusctor's Liceense law does not apply to an owner of q p
property wymes,provided
mpmwg thereon,and who docssuin work himaelfor through his
own employe.,p ing or i Nat such improwmenu ase not intended mpledoA for owner.
however.the building u improvement Is sold within on yesr of completion,the oven
builder will have the burden of proving that he did not build or Improve for purpose of
1,as owner of Jre propeny,am exclusively contracting wish licensed rums c mn to
uucuhe pre, (5..7044,Busin.a and Professions Code:)The Centocors Li.
ccnu law ......
cs not apply m an owner of property who build.or improv.thereon,end /
who contract for such pmjeet with a commends)licensed pursuant to the Contractor's Q�
License Law. a�
❑lame pi oder Se � . .B&PC rNl mason
�S
WORKER'S COMPENSATION DECLA N
I hereby affirm under Penalty of perjury one of d«following declarations:
l have and will maintain aCtoolm not COnsml no ser insure fm Workcea Compere
gallon,as provided for by Smion 7700 of than labor Code,for the Performance of the
work for which this Permit is issued.
❑I have std will maintain Workers Camperuadma Wursn..as required by Section
3700 of the labor Coda,for Ne performance of the work for which this Permit is Issued.
My Workers Compemaniau Insurance carrier and Policy number am:
Cari., Policy No.:
CERTIFICATE OF EK EMPTION FROM WORKERS'
COMPENSATION INSURANCE _
(Thu section need not be completed if the Permit is forone hundred dollars($I00)
car less.)
I certify lost in the performance of Ne work for which this Permit is issued.l shall not
employ any person in any mender an as no become subject to the Worlmos Companudon
Laws of California.Doc
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
.become subject 10 the Worker's Compensation provisions of the Lahnr Code,ynu most
�Z forthwith comply with such provisions or this permit shall k deemed mvoked.
ZO CONSTRUCTION LENDING AGENCY
I Woby alitrm Nn there is.construction lending gency for the Perfurmane of
Ys
the work for which this Permit Is issued(Sec.7097.Civ.C.)
31 Q lenders Name
3.z lender's Address
7
J-t 1 certify No I hese with
this and tiun and Bute that Ne shove Information to
y f- .arcing I ag«e to comply with all airy and county nNinaes of and talc[am«lacing e
'U abovengcnnoncolpm,endho«by auNonprporesenutiruof Niscity reenterupon the /
W ahovc(We)are Property for inspection an keep ha
(We)l gm no save,indemnify and kith harmless the City of Cupertino id City
ti f/1 liabiliti.,judgment,tases and expenses which may In any way acerae against said City
J F^7j in consequence of Ne Sooting of this permit.
APPLICANT NDERSTANDS N n1L COMPLY WITH ALL N N POINT Issued by:qjta� Dat
SOU E ULATIO�'
t' Re-roofs
..1'Applicam/Odiorgetto Data
HAZARDOUS MATERIALS DISCLOSUR Type of Roof
Will the applicant or forum building occupant atom car handl a'ruduua material
defined by the CuNnim Municipal Code.Chapter 9.13.and the Health and Safety
c,Section 25531(x)7 All roofs shall be inspected prior to any roofing material being installed.
[:]Y. u
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 hvardnue air conmminant as defined by the Bay Arca Air Quality Management all new materials for inspection.
District? -
❑Yes
I he.mailthe haaNrusmaterials«quimou nu under ChapmrA95 of the Calif.,.
nit Hca W A Sufey Codc,Studons 25505,255]3 and25534.I undentnd Noiflhc building
Jou not cumen I y how a¢nark a old respomihility m nndfy 1M occuPmt of Nc
�yai«myAy+ m must lotFoNCcrupo oroccuP,fry'/ Signature of Applicant Date
� �
! � C'
Owner or authorized agcm Date All roof coverings to be Class"B" or better
wit
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(t CITY OF CUPERTIN(P S—v ( c�) -072
CI YOF PERMIT APPLICATION FORM
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CU
PERTINO
APN # / 17
D 2� Date:
Building (S re Is: Mailing Address (if i r t from bui ing address):
�4 t.-A-"?dt-�'Z1z�'
Owner's Name: Phone #:
�a Neu 1J 1U c s ( e�
Contractor License#:
EjON19.c ('
Contact: Phoqq'e:�4? o-�� Cupertino Business License#:
w IIJL 0—Fa. 5ro `%,56
Building Permit Info:
Bldg Elect ❑ j Plumb El Mech ❑
Job D scrition: /
ResidentialCt)CNDCte>5, e �❑ ;
Sq.Ft. Floor Area: �j / Sq.
Cost of Projept: e//Oc roup-
Type of Construction: Pleaseck this b e project is a
second to addition: ❑
Project Size: Standa Large/[:]?'
ar e ❑ Major ❑
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> IOOK 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/OfUComm/ uasi BUILDING
BCONSTAXBQ Con. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Constax —Resi/Mobile BUILDING
BELEC1000 Elec 600V <= 1000A ELECTRICAL
BELEC1001 Elee 600V> 1000A ELECTRICAL
BELEC200 Elec Svcs 600V <= 200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
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• CITY OF CUPERTIN#
I OF
. CUPERTINO PERMIT APPLICATION FORM
uanti Fee 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 rinklerBackflo 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 Fumace> l OK btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISC Mise Apparatus ELECTRICAL
BREEMNRAPP Rem Non-Res Appliance ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
BREMPOWER Power Device/Apparatus ELECTRICAL
BREMRECEPT Rc tl Switch & Outlets ELECTRICAL
Ask BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT Repair/Alter Heating MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
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4PITY OF CUPERTINO '*
CIT 0 PERMIT APPLICATION FORM
CUPEkTINO
Quantity Fee ID Fee Description Fee Group
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 lnsection 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
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