08120105 CITY OF CUPERTINO ora x" Maxgxbaa 4� If �' >
BUILDING DIVISION PERMITCiINTRA '0RANFQRMATIQN
BUILDINGADDRESS: PERMIT NO.
10571 _—QUALITY WINDOW Ar DOOR ngi ?njo,
OWNER'S NAME: PERMIT ISSUE DATE
FED RE)O S CONTROL NO.
408) 777-9090
ARCIUTECT/ GINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
0 0 0
O p LICENSED CONTRACTOR'S DECLARATION
U 1 hereby afRrm Mut I am licensed timer provisions of Chapter 9(commencing Job Description
with Section 7M)of DiWsion Sof sine Business and Professions Code.and my license is
^oH imm�roseanaerrea pp CHNG OUT 9 WNDWS & 1 PATIO DOOR TO DOUBLE PANED
j Z Licence Clsss D Lk.g h I 7
=k-p Da¢h. t,0.r_(� Con—a" Rd(SPI\
vvvyuuu ARCHf1EC1-S DECLARATION
rj.< 1 undersand my plans¢lull be used as public rtsoNa
a
Lo
Licensed Professional
cnt� OWNER-BUILDER DECLARATION
i E I hereby.171.Nat 1 am exempt from Ne Convamoes Lima.law for the
E no following mason.(Section 7031 S,Business and prefectures;Cade:Any city or county
3$ which ncquims a permit on cnnamcL glut,improve,demullsh,nr repair any swtture
prior to its issuance,also rcquiros Ne applicant for such permit to rile a signed statement
p < that he is licensed pursuant oMepmvisionsofbeComacturiU.MmLaw(Chap.9 Sq.Ft.Floor Area Valuation
y�O (mmmcacing with Section 7000)of Division T of Ne Business and Professions Code)or
y Mut he is exempt memfrom and Mu thou far the at cacmp4ion.Any violation or
Seadem 7031.5 by airy applicant for.permit subjects the applicant m a civil penalty of APN Number - Occupancy Type
set mom man r hundred dollars(Stam. Pane Y YP
❑I,sownerof Miepmperty,amyemploCMwimwagesu Lmkwlccompmuon, 31630042 . 00
will do Mawork,and daswcmm is natinknded midleted forsaae(Sec.7044,Business
and Professions Cade:The Conui cors Liana law arms ant appy to an owner of Required Inspections
property who wiles or im prom¢aeon,and w ho does such work himsel f or duaugb his
own employ=,provided Mut such improvement are n otinunded woRerW forsale If,
harem,me building or improvement is said within mu year of completion,me owmr-
builder will have the Entries of pmving mat he did not build or improve for purpose of
sale.).
❑1.a awns of me property am exclusively conuacting wish licensed cenaannou to
comm uct Me project(Sec.7044.Business am Professions Cade:)The Coeuaaors U.
cense law rias not apply to an owner of property who builds or improm meson.and.
who conuacu for such projects with a conuaeeKs)Recruiter pursuant an me Common's
License Law.
❑I an exempt under See ,B&PC for this msson
0. Dam
WORKER'S COMPENSATION DECLARATION
1 hemby afEmh under penalty of perjury one of the following declarations:
1 ham and will maintain a Cenifiate of Consent to felbinsum for Workars Compen-
On.as provided for by Section 7700 of We labor Code.fm me performance of Mae
wart for which this Permit is issued.
❑1 base and will maintain Workers Compensation Insurance,as required by Section
3700 of Mu labor Code,far me performance ofthe wart for which this permit is issued. '
My Worker's Compensation Imma c Maier and policy number a¢:
Cartier. SI'&+C I-�4 Policy NO.; 1314
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This mctern need cot be complcud if Me permit is for once hundred dollars($100)
or Ins)
I cati(v met in me performance of Mc work for which this permit u issued.l local nm
employ any person in any mannerso as in become subject to the Warkcrr Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:IL after making this CcniOae of Exemption,you should
become subject u Iw Workers Compensation provision;Of the labor Cade.you must
O10"wim comply with such provisions 0,this permit shall be domed ked.
Z CONSTRUCTION LENDING AGENCY
'r+^ Ihcreby affirm mat then is a commction lending agency for Me,Mrrormarm of
a> Mu work for which This permit is issued(Sec.7097.Civ.C.)
t[7 Q Lenders Name
5 Z lenders Add"•.. -
f J C) I cenify mat 1 have mad this application and state mu me above u[i m ation is
correct.I agree to comply with all city and county ordinances and sum laws relating u
0 building construction.and hereby aushoim mpmemom,ef ofthls city in Order upon Me,
W above-merdumed property for inspection purposes
' f1 (Wc)agree to an,indemnify and keep harmless tae City of Cupertino against
fn liabilitie,Judgmenu..oss andexpcacs which may in any any accme against said City
(„)Z m consequence or me granting of this Permit. q
ti APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date �{ �
SO CE REGUL TIONS.
�� 1111 Re-roofs
Signuu Applicaor Dae
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIII she applicant or fume building e.Chapter
or handle Health
material
C deflnedSac by Me Cupenina Municipal Code.Chapter 9.13,and she Hvalth anJ Safety
Cods. us3x(g7 NbNo roofs shall be inspected nor to an roofing material being❑lice y,)Na P P � Y g g installed.
Will the applicant or idiom wilding amoloot an,equipment or darner which If a roof is installed without first obtaining an inspection,I agree to remove
R hardous air contaminants as defined by she Bay Arta Air Quality Management all new materials for inspection.
v ctva]
❑Ys `(7f No
I have mail me haarshna materiae requirements under Chapter 6.95 of the Califor-
nia HcAIM&safety Code.Scctiom 25505,25577 and 35534.1 discounted this ifthc wilding
does oat t y have a mrd L mat it is my=Wmihility a notify Mu mcupmt of the
myuirem wichmuubc tpriarmiavan¢aracenir, artxcupaney. Signature of Applicant Date
ri 1(L
owner cora nnrise ages Dae All roof coverings to be Class'%T'or better
CITY OF CUPERTINO
• 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 31630042 . 00
DATE ISSUED. . . . . . . : 12/16/2008
RECEIPT # . . . . . . . . . : BS000006830
REFERENCE ID # . . . : 08120105
SITE ADDRESS . . . . . : 10571 DEODARA DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : MORAN DIANE/RICHARD MCGRATH
ADDRESS . . . . . . . . . . : 10571 EODARA DR
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2430
RECEIVED FROM . . . . : RUSSELL MAHZOON
CONTRACTOR . . . . . . . : RUSSELL MAHZOON LIC # 24101
COMPANY . . . . . . . . . . : QUALITY WINDOW & DOOR
ADDRESS . . . . . . . . . . : 3597 HOMESTEAD RD
CITY/STATE/ZIP . . . : SANTA CLARA, CA 95051
TELEPHONE . . . . . . . . : (408) 777-9090
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
----- ---------- ---------- -------
1BSEISMICR VALUATION 3 , 800 . 00 0 . 50 0 . 00 0 . 50 0 . 00
1WINREP EACH 8 2 . 00 734 . 00 0 . 00 734 . 00 0 . 00
TOTAL PERMIT 734. 50 0 . 00 734 . 50 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- ----- -
CREDIT CARD 734 . 50 MC
---------------
TOTAL RECEIPT 734 . 50
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APPROVEU
GUpgMN0 CODES AND ORDINANCES ;
.2-q1 °x3°
Acnm
This .......... .no specificationsMUS t
Oe kept on the job al ail times and it is un
lawful to make any changes or alteration,
)n same withou� w Iden permission fron. j L
he building DeplCupertino. 6 ,
C�a�A4F
the stamPing of
HALL NOT be he d 6; Pr mit or w'CgNx`J
nproval Of the violation of any 16 200
DEC
BY: 20
o
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/els
�--����� � CITY OF CUPERTINO
CITY OF
O CUPERTINO GENERAL BUILDING
PERMIT APPLICATION FORM
APN # 2 On
Date: 17-
Building Address:.) Y/
105 -11 Deaolotra Dr CvPr-4 M eA I S'c I L,
Mailing Address (if different from building address): A S R.g o VI-7
Owner's Name: Phone#:
D1,An� MORAn1 �� 6 3a-7 - 9v5- 6
Contractor: Phone: •77
Fax:
Contractor License#: 6 _ 6.�I1 3-7
Cupertino Business License#:
Contact: /'?d SS e I I M C, Z o o tj �Phone: - 7 _ g o c� o
� a
• Jo2 oSSe+. Fax:
Residential Commercial
Job Description:
Ow i,M a(ojS a-a) PAO mor
Building Permit Info:
Bldg E]`_ Elect ❑ Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B ❑- —�
Valuation: Square Footage:
3 �0
Project Size: Ex ress ❑ Standard ®urge ❑ Major ❑
Green Building: Please complete relevant portion of the Green Building/LEED Checklist& attach it
to the application or if applicable, include in plan set & the sheet index.
Points Achieved: V
eFor help, contact Build it Green at www.buflditjZreen.orp
Revised 10/20/08
'"Z�' CITY OF CUPERTINO
CUPERTINO GENERAL BUILDING
PERMIT APPLICATION FORM
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
1BBOILERI For the installation or relocation of ea M
boiler/compressor to & including 3
horsepower, or ea absorption sys to &
incl 100,000 Btu/h (29.3kw
1 BBOILER2 Installation/relocation of ea M
boiler/compressor over 3 horsepower
to & incl 15 horsepower, or ea
absorption sys over 100,000 Btu/h
1 BBOILER3 Installation/relocation of ea M
boiler/compressor over 15 horsepower
to & incl 30 horsepower, or ea
absorption sys over 500,000 Btu/h to
& incl 1,000,000 Btu/h
1 BBOILER4 Installation/relocation of ea M •
boiler/compressor over 30 hosepower
to & incl 50 horsepower, or for ea
absorption sys over 1,000,000 Btu/h to
& incl 1,750,000 Btu/h
1 BBOILER5 Installation/relocation of ea boiler or M
refrigeration compressor over 50
horsepower, or ea absorption sys over
1,750,000 Btu/h
1 BAPPLOTH For ea appliance or piece of equip M
regulated by this Code but not classed
in other appliance categories, or for
which no other fee is listed in this
code.
IELECINSP Other Electrical Inspections (per hour) E
1MECHINSP Other Mechanical Inspections (per M
hour)
1 PLMBINSP Other Plumbing & Gas Inspections P
(per hour)
IMEETING IHR Application Meeting B •