06050251 CITY OF CUPERTINO "�"""�' rt�+^� ,g�x g=''�'"'�
BUILDING DIVISION PERMIT Ty o,N rI2AG3iMANI'O ATIQN
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BUILDING ADDRESS: PERMR N0.
FIVE STAR WINDOWS 06050251
O R E: PERMIT LSSTIE DATE
SANITARY N N0.
ARCHIiF.0 fENOINEER: BUIIDBSG PERMIT INFO
'BLDG ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION Nob Description
1 b."am.Lha 1 am li¢rmd uader pmv .or CEepl 9(ammeMn, P
diL with Sombm 1018)dDl0a.3d tht Buu fyZ8S3Cad,, my fxa n
m rwi rort p
a w] a ��! - _ - - _ WINDOW REPLACEMENT & D) OKE
E ARCHITECTS DECLARATION
t 1 UMm my plana dull he urrd u pmNic mmrdt
UliamdPmfeWan.1 JUN !7-' 2006
OWNER-BUILDER DECLARATION
I Mmby aRrm Iba,I am a pt fma Ne CmmW Ws Llcmm In fm the
orail miq rnun.(Sema 18)1.5,8uu and Pmrcuiau Codc:Any chy m coumy
2 which r w.a pmmil b tlmmrm,a-1mia r dcmdLsb a-Pah uy mbntua 141 It
,�' pnabiu lOYYKe.aBr rtgwra dw mppiam fa mrch pmmit wfik asi,ncd tuwmmr
ij IhaKUllccuWpumu^rrowtPam^mbmdWeConuacldtLsucWw(Chapa9 Sq.FL Floor Area
-$ (emwe�nj whb bod 700 ik baals r.tithe Btmmmapl Prar�ieu alf-rr
T_ dui Ee u ammp tM&PN mW We Ws4 ro Wi alk,ed Mt 5m l w Any l Pd y d
Seaim 1051.5 by ap a dalb ra m petolh aDjccu the appOcam w a dWl Paahy d �p��T Occupancy Type
ma mae dam rive bamad adwe(5:50ln. 3'(i"JLU��r 00 ecu ant
❑L o awm{r-(ft popery.a my employta with nies as(heir sok mmPeimrlm.
wLU du Ne work a"rW mm I,a Lc M a dfurd fc&ale(Scc.1Me,Bmrco Required Inspections
"P,11".Code The T,...�...iti.I.fmite Taw dtn ma apply w u nrrmm d q P
Pra ywho bulldso lmpmaa 0veahaW wto dousuch work hvuulfo lhroa,h hla
twm mmplvy2s,pmvwrl tWl wch impmvemrau aw mtinlendW a pQered for sale B, '
baweaer,du buiwlni a htpoaanW u mW whhin arc Yta dmmpkwm,the ower
bwma wiB Wye Ne Gvdcn d pmNni Bur he d'W nor ddld a Imprrne fa poryoe d
ukJ.
❑I,a oyer of de K.P.M.am--W vtly.1'aoln,wish 1I 'coaruclas b
comaaact Ue pro)=(Sec 1061,ll ti amd Pmfusiam Cade)The Cm ru It
vme IAw d.mm apply ban owmm of prripary who bOdm o lmporss Ileum,and.
vin mmaama fa arch pojeeu with•cmuanm(t)Iiamsd puum w Ne Cmhamdm
❑El I—l».
nrspundc yt .B drPCfa tW ream
Owner D.-
WORKERS COMPENSATION DECLARATION
1 busby a)nmm mdcr Petalty (Pm d tk rolbwMt d-�
u+ am.in maialm a cmif orcommn wrr-Imre ra wards cm am.
.tion,as pmlbl d ra by Semlm 3'/(I)d Ne L bar Code.fa me prfarmana d the
wok fa w1bid Thu ptrrmh b;awed.
❑1 here am n'll vuimulm Wo .CamWe Iamraws.as raomtd by Smbm .
51(18 drW Mbar Code.fa drc pafomsrce d Ile work Ra w This pvmit 4'- A
MywV Cirniemudm mann¢ear and Polity n,&M3.s^
Cnria: n✓11(�Al PuBcY Nu: 1r'sNl�-JT I
CERTLnCATE OF EXEMPTION FROM WORKERS_'
COMPENSATION INSURANCE
(Thu tcNm recd as 4 mnpleub R de pmmh u fame hmia,ed dnOm(1180)
mku)
1 ami y bra in the p,,f..d IW wmk fo wbicb wit Permlt Is I..._t,I sball not
cmplmy any pnm w any mamrcr so u n become wbjw w UC Warkme'Cmyemalbn
I dCalummi Due
Applam
NOTICE TO APPLICANT:If.alkr matin,Iles Cm ntat of Eumpom.ymr should
- tr c ambjta w Iht Wmrkds C=mPe a prwlaam d Ibt Luba Cade.ym mtm
,O fmWviNWi
comply with arch pmmu o wu Nal
Permit l Ix Marcel rtrakN.
CONSfRUCT10N LENDING AGENCY
.�. IhmeLy air.IhV Gere u a camtwiw Im"-Fm fa Ne pufammmd .
7 drt work fa which 0W pemta is Wu (Sec 3091,Civ.C)
QlmtleYt Num
I ft Aft.
t 0 1 c rY dm I have reW thin aDpncabm aM sue Om Ne.hose wfomudom u
�� coma 1 a,i{Y w comply wiN W ciry arm minty adlmrcea corm sue Ian rt Wim,b
bu8din,ctmrtnetim,arm Wtby mahorim rtp arml .m dcay ay m w w IsLi e
W ab9 -memarod papcny ra mspeeum pia=
!1 (We)airs w uw:.Imdtmnirr w Ymp n,rmkss tk Cay d Cuprnim.,.icor
V) WMll6mjW,mema.coatamlupemsu whkh may w a,aima Wd Cry
lZ M casagtmce d drt Lamin,d dha parch �6
PLICANT U ST DS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
U ONS
Re-roofs
Si'
c ornppiamocw..cta Due
xnzARDous MA AIS DIsa.osuRE Type of Roof
NII Nc appkwr a fvwrt bulldim,maupenr stort a W W k Wnvdans mamrial
u de etl by Nt Cu mi.Mu pal Co .maper 9.12,aM the HW w and Safay
cam• Ya 25532(a)1 ,'Z� All roofs shall be inspected prior to any roofing material being installed.
WIII tat,applin.r a W.bWldln,oupaw um cquipmmr a Mwim wh¢b
Will
If a roof is installed without first obtaining an inspection,I agree to remove
ardmu air conuminaou u&fire by tx Ray Arta Air Qualhy Mau,cmcnt all new materials for inspection.
Di L?
❑Ya No
1 hno rtd de IuzxdmsmamrlaUrtgalrcmws u WmCluprr G95 of tle Ulifm
maria W k WaYCadc,5swaru25505.25511 aW25531.1 urmamrm I/m Jde Wilduq
ror cartmly w a ba h is my rcrpm lliy m miry de arupam d we
Immema It t b" d,Cv,;Bamd Signature of Applicant Date
All roof coverings to be Class "B"or better
Owner N w lb vtd a,ck e