08010103 CITY OF CUPERTLNO
BUILDING DI VISION P>;RD�T `'u>tCO:TRACTOR TNF ORMATTON.E
wa n9^g.;ft(rn sX'i'e�w5i' ngnva`S' a"i'1' ti„vb„;r s, r P;"1t'n
BUILDING ADDRESS: PERMITNO.
23038 CRICKET HILL RD ALLBRAND WINDOWS 08010103
OWNER'S NAME: PERNM ISSUE DATE
PREM MOHAN 23312 CABOT BLVD 01/16/2008
PHONE SANITARY NO. CONTROL NO.
(650) 622-0330
BUILDING FERMrr INFO
A0.CHITER/ENGINEER '
BLDG EIER PLUMB MECH
t� 0
�pQ LICENSED CONTRACTOR'S DECLARATION Job Description
C educhy0)Of Nu Iamli ft Business
Bud
Poir..ofr Code.r9(commencing p
;zm wiNSatwn]000)afOivisioa3ofJrtBusiuressandProfcssiansCode.and mylicensou REPLACE 17 WINDOWS 1 SLIDEDOOR LIKE FOR LIKE
• re„ to full fmce and Susan-j
t�z Llcecsopass
�t:
Dam - ( ARCHFIE I MLARATION
I s 1 uMersund my Plan shall he used as public records
nyU
;06 ,reused Prefrssional OWNER-BUILDER DECLARATON
I hucby Mr..than I..uempt from the Contractors Licve law for the
00 following reason fS.tion]W 13.Busing and Prefcssiom Code:MY city or rounty
m Lei which requires.permit m mnstrueL cent..nnprowe,demolish,m repair anY swnurt
priermiBLssuance.elwrequirestheapplicanlforsochpenmi4mfilcasigu!cJeummal F[. Floor Area Valuation
G that he is licensed pursuant to the Previsions.(the Contiacmfs Li¢nsc law(ChapCs 9 SG $9508
%� (commencing with Section 70)())of Division 3 of the Business and Pmfessions Chde)or
3 9 Nat he u comps Wercfrom and the basis for the alleged uempdm Any violation of
Somem 70313 by arty applicant for a permit subjects the applicant to a Civil penalty ofNumber. Occupancy Type
nm more dun fisc hundred dollars 06500a 34240029! �
❑La saw mu of Ne structure
mY womoded wish waguss Near sole70m4.B Business will do thewons and C Communo's License
do snot apply roan Owner
Required Inspections
and Professions Code The Chooacm rr License law docs not apply m an own.of q p
Owncozy who builds or imprev.this soh,and who sou such work himself ed though Au
how..sh ria.Provided that such improvements is sormats are oat ear ofC.oQered for sale V.
Wilde, .the bei he err improwwcrnusold within oreWordofwmpkdoo,theowe.-
builde wi0 Ease Jen b..n.n of preying that he.did not build.r improve 1'r purpnm of
sale.).
❑1.as owner of ths propt.,am udusiwly ronuaming with licensed re nuaems m
cmm,"M the pmk-a(Sec.7044:Busincce and Rofecsions Code:)The Conoaemr's U.
cense law does at apply in an own.of Property who builds or improv.thereon,and,
who Contracts f.sur,Propels witha conuacmr(s)h.d pursuant he the Condaeors
Lircnse Law .B&P C Ter dJa reason
❑I am uempt uM.Scor
Own. Date
WORKER'S COMPENSATION DECLARATION
1 hereby a01nn under penalty or Perjury ane of the following deelardimn:
Ihs.candu imainwnacetifrmmofco twulf-insumfwwoM1 )Compes,
scion,as Provided for by Section 37M of Ne Lab.Cade.I.the Performance of the
wort for which this permit is issued
1 have and will maintain WmImes Compensation I... required by Section
37M of the lab.Code,for the pc,fom enc of the work for which this permit u issued.
My workcra Cmnpc...6 n bes unee carrier and Policy number am:
camer,._2=yrruT'/:`�•a,PlalieyNa_7/)4' ��1W(
tERTIACATE OF FXFMPnON FROM WORKERS
COMPENSATION INSURANCE
(This sendoureed her he wmplctedBlc pandit I,(.,an.hundred dollars LSIOM -
Orless.)
1 certify Net in the pvform..m of de woh Ire which this permit u issued.l shall not '
crnpmy any person in any an.a,as in become subject to daworkel'Compensation
Laws of Caliromi.Dam
Appliant
NOTICE TO APPLICANT.If.after making this Ccrtificale of Escmption,you should
become subject on the Wader's Compensation provisions of Ne labor Coda you most
D Z foMwith comply with such previsions or this permit shall be deemed revoked.
Z CZ) CONSTRUCTION LENDING AGENCY
Iherthy afOrm Nar dere uamrsvuninn lading agcnq fm the performaut¢of
R% de work for which this permit Is issued(S..3097.Civ,C)
:3 Q Lender's Name ,
L Lcndors Md.
� Z
0 1 certify that 1 have orad this application and sum that me above information Is
rnnca 1 agms re comply with all city and county ordinanm and sum laws relating in
V building comom ion.and Ecreby auNorim mpresceutiKs ofthu city re cote upon tM
„ above-matiotad property far inspection purposes.
(We)agree m save,indemnify and keep harmless the City of Cupmino.gond
, liabilitimJudgments,Coss and opens which may in any way acerx against said City
J Z in consequence of the&ranting of Nu permit.
'—� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGON . _A
Re-roofs
slyw AppOanl]Canuanor Dam Type of Roof
HAZARDOUSMATERIALSOISCL.OSURE yp
Will the applicant m fuuue building occupant ttom a bundle ham itmo mavaial
as deRned by Ne Cupertino Municipal Cod,Chapter 9.11 and the H..IN and Safety
Cade.Scar..25532(87 [ All roofs shall be inspected prior to any roofing material being installed.
❑ya
Will ft Animator or future building occupant use equip^mnt Or devices;which
If a roof Is installed without firs[obtaining an inspection,I agree IO remove
emit hanNon,air coemmimnts as defined by the Bay Area A;,omrity Management all new materials for inspection.
Diarct7
❑Yrs
I haw,mad the hind.maurialsmquirom Dander chmur 6.95.1'the Califor.
nice HaIN&S.fetyC.dc Sc tions 25505.25533 and 25534.Iundrmind thin Wits,building
does rat currently have a Cohan,do,it is my respamdur ly in notify tla oceupent or the
q.;rem pS�Eynme poor mIssuance Of-owraam.f� Pd Signature of Applicant Date
yip /"fie — All roof coverings[o be Class"B"or better
0 ror auNo . engem Dem
CITY OF CUPERTINO
2 ITEMS OF 2 PERMIT,RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 34240029 . 00
DATE ISSUED. . . . . . . : 01/16/2008
RECEIPT # . . . . . . . . . : BS000003714
REFERENCE ID # . . . : 08010103
SITE ADDRESS . . . . . : 23038 CRICKET HILL RD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : PREM MOHAN
ADDRESS . . . . . . . : . . : 23038 CRICKET. HILL RD
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . RICARDO CASTELLANOS
CONTRACTOR . . . . . . . : JACEK PASTERNAK LIC # 24829
COMPANY . . . . . . . . . . : ALLBRAND WINDOWS
ADDRESS . . . . . . . . . . : 23312, CABOT BLVD .
CITY/STATE/ZIP . . . : HAYWARD; CA 94545
TELEPHONE . . . . . . . . : (650) 622-0330
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 9, 508 . 00 1. 00 0 . 00 1 .00 0 . 00
1WINREP EACH 8 1 . 00 367 . 00 0. 00 367 .00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 368. 00 0 . 00 368 . 00 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 368. 00 VISA
---------------
TOTAL RECEIPT 368 . 00
W T�.�a O lam: •- ` '
cCok Xo 9y t9®., UlkE Fc)R Like
UUPERTI ACCRDANCWOH ED
CODES AND 8DINA CES
)A fi c��v�U t Rs4
�1®NE6 f Nl
Phi® sot of /` 1b H.�A.0
Bs kept on a ens ana s
lawful to the job at all flcifications MUSS
Int ho arty changes es and it is un
the este with tyri or al-, ,
rhe ®ehUrn nen (n f," �
m g Dpt•. City of Perrni�ion t.
MAIL NDr be helOf d to o�P and pec a�nfl
iG.7nv of tho violation oI
ar•
t any City Drotnance OC Sta,any Prov onr
�C d (aM. �
y7X SS�i
�r
,/ t 9 t c3 ED Ar•. le CC j�j�
PictvQfi3U�� P JAN18 "
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CITY OF CUPERTINO
OF
CUPERTINO GENERAL BUILDING
PERMIT APPLICATION FORM .
616/0
APN 9
49 _ /66 Q Date:
Building Address::
2 g
Mailing Address (if different from building address):
Owner's Name: Phone#:
l—3
Contractor: Phone:(,i500j YOO — o'y 5k
D Fax: 6 —P-)
ontractor License #: <K9
Cupertino Business License #: G,�, �C n
Contact: Phone: /7C,K- 'g
U S Fax:
Residential Commercial ❑
Job Description:
• � ;F- P)L C1- j W-L UOdw3 S L1.pz�,l,60 oc)2
LsKF 'o k Lafce
Building Permit Info:
Bldg Vr/ 'Elect ❑ Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
I FR, I IFR ❑ 11, 111, V-IHR E] 11, 111, 1V V-N
Valuation: Square Footage:
S O$
Project Size: Standard ❑ Large ❑ Major ❑,