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07030068 CITY OF CUPERTINO BUILDING DIVISION PERMIT PERMIT NO. BUILDING ADDRESS: 20211 SUISUN DR ALLBRAND WINDOWS 07030068 PERMIT ISSUE DATE OWNER'S NAME: RANGWALA JUMANA Z AND ZOAIB 23312 CIBOT BLVD 03/09/2007 SANITARY NO. CONTROL NO. ONE: (6 5 0) 622 —0330 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH p OZ LICENSED CONTRACTOR'S DECLARATION Job Description LU 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing Z with Section 7000)of Division 3 of the Business and Profcssimna Code.andrm license is REPLACE ENTRY DOOR/LIKE FOR LIKE y in full force and effect.C j Z J Z License as L� 1� F w Date Contractor ARCHITECTS DECLARA ION 7 a< 1 understand my plans shall be used as public records )yU U.F Licensed Professional y; OWNER-BUILDER DECLARATION 1 hereby alTtrm that I am exempt from the Contractor's License Law for the 20 following reason.(Section 7031.5•Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure Z r prior m its issuance,also requires the applicant for such permit to rile a signed statement t' .Ft. Floor Area Valuation a that he;s licensed pursuant to the provisions o(Ute Contractor's License Law(Chapter 9 •09 $3090 t-$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or URIL that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of ��i Number Occupancy Type not more than five hundred dollars(5500). 3692801") . 6 9 2 8 01t.-) ❑I,as owner of the property,or my employees with wages as their sole compensation, will do the work.and the structure is not intended or offered for sale(Sec.7044,Business e_uired Inspections and Professions Code:The Contractor's License Law does trot.apply to an owner of property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If. however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon,and. who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. ❑1 am exempt under Seo. Ba P C for this reason - - Owner Date --_ - WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following-declarations: ❑1 have and will maintain a Certificate of Consent to self-insure for Worker's Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑I have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number are: L M Cartier. 2 'VIsL4% •Pofcy No.:?6 - 3_I W l CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Chis section need not be completed if the permit is for one hundred dollars(S 100) or less.) I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must 0 forthwith comply with such provisions or this permit shall be deemed revoked. Z" CONSTRUCTION LENDING AGENCY [~•a►��. 1 hereby affirm that there is a construction lending agency for the performance of > the work for which this permit is issued(Sec.3097,Civ.C.) W A Lender's Name Z Lender's Address U 0 I certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to rJ- U building construction,and hereby authorize representatives of this city to enter upon the W about-mentioned property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against rF"t liabilities,judgments,costs and expenses which may in any way accrue against said City 1 U Z in consequence of the granting of this permit. Date �. APPLICANT UNDERSTAND ND WILL COMPLY WITH ALL NON-POINT Issued by, SO EGUJe�NS. J Re-roofs Signature of Applicant/Contractor Dau Type of Roof HAZARDOUS MATERIALS DISCLOSURE yP < Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roofs ;hall be inspected prior to any roofing material being installed. fi [:]Yes CSNu Will the applicant or future building occupant use equipment or devices which If a roof i;installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? 1 ❑Yes I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&SafctyCodc,Secuons 25505,25533 and 25534.I understand thatif the building does not currently have a tenant,that it is my responsibility to notify the occupant of the reyui is whicb.4pust be in r to issuance of a Certificate of occupancy. Signature Of Applicant Date All roof coverings to be Class "B"or better Owner or authorixcd agent ripic CITY OF -'UPERTINO 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: suew COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36928015. 00 DATE ISSUED. . . . . . . : 03/)9/2007 RECEIPT #. . . . . . . . . : BSO)0000657 REFERENCE ID # . . . : 07030068 SITE ADDRESS . . . . . : 20211 SUISUN DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPEERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : RAN,-WALA JUMANA Z AND ZOAIB ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : CUP.-,RTINO CA, 95014-4427 RECEIVED FROM . . . . : REC:3IPT INTERFACE CONTRACTOR . . . . . . . : JAC:3K PASTERNAK LIC # 24829 COMPANY . . . . . . . . . . : ALL:3RAND WINDOWS ADDRESS . . . . . . . . . . : 233L2 CABOT BLVD CITY/STATE/ZIP . . . : HAYWARD, CA 94545 TELEPHONE . . . . . . . . : (65 )) 622-0330 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- -- -------- ---------- ---------- ---------- BPERMFEE VALUATION 3, 090 .00 104 .76 0 .00 104 .76 0.00 BSEISMICRE VALUATION 3, 090.00 0.50 0.00 0.50 0. 00 -- -------- ---------- ---------- ---------- TOTAL PERMIT 105.26 0 . 00 105 .26 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 105.26 VISA --------------- TOTAL RECEIPT 105.26 Community Development aff 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 f7UPEI�TINO Building Department JOB ADDRESS: PERMIT # OWNER'S NAME: Jg c PHONE # 4 J:P 92F - ) 3 GENERAL CONTRACTOR: 11U ),••,Ao,2s I FAX # C3;U I am not using any subcontractors: I gnature Date Please check applicable subcontractors and cornAete the following information: 60 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Da(e CITY OF CUPERTINO C1 of PERMIT APPLICATION FORM CUPEkT1NO ,-k-PN# �� q Date:J� 0 Building Address: Flailing ddress (if different from building address): 2021 SQ,'suQ Dv. Owner' arae: Ph o e 8 Z9 - Contractor: License#: Contact: 1 Phone: 20D 40D 0770 Cupertino Business Lic2 e#: Si 5 IG Fax: 650 Q_�' 52 na C Building P rmit Info: Bldg V Elect ❑ Plumb ❑ Mech ❑ Job Description: 1 / i� Residential E� & " ��" u I a c��►-►Q�► l Comm' r )al� ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: 3 n�� Occupancy Group 0 Type of Construction: Please check this box if the project is a ✓_ second-story addition: ❑ Project Size: Standard lam' Large ❑ Majc r ❑ 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 lM 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 Ilotel and Motel BUILDING BCONSTAXR Con;tax—Resi/Mobile BUILDING BELEC 1000 Ele; 600V<= l OOOA ELECTRICAL BELEC1001 Elec 600V> 1000A ELECTRICAL BELEC200 Elee Sivcs 600V<= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA I westigation fee BUILDING 1 of 3 CITY OF CUPERTINO CUPERO PERMIT APPLICATION FORM Quantity 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 I:ispection Overtime BUILDING BPBACKFLOW A`mospheric 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 Plain Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE R e 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 A It of Drain &Vent PLUMBING BPWATER Inst all/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 :-ighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Rely) Furnace> l OK btu MECHANICAL BREMHEAT I[eater Installation MECHANICAL BREMINHOOD In itallation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Ren: Non-Res Appliance ELECTRICAL BREMPOLE Po le/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc i:1, Switch & Outlets ELECTRICAL BREMRELOCA R Aocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 :)f 3 CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rnidl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN V,.nt Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL —Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP T emporary 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 Mechanical sq. foot MECHANICAL MPERMITFEE Mf ch Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Plannin ; LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING 3 of 3