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03120096e2 dyoc R`D icy? CI'u SOL IiC I r.pt �opC LmY -Z> FFA 02 z CITY OF CUPER'I'INO ,,��g.sksr� Anif.i'i'g+�a�`?'& - BUILDING DIVISION PIi'R s3iC®k�TI�VZQRIF®RMftNC BUILDINcnoDREss: CRYSTAL CLEAR WINDOWS & DO Kf§71TND03120096 OWNER'S NAME: PERMIT LSSUE DATE U] 212003 NE: NO. SANITARY CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION I hereby affirm the I am licensee under provisions or shaper 9 (commencing Job DE1SCr1pI100 J of the Business and Professions Codc, and my license is wishil to. tIXX) pec,. ;n full forte and effect WINDOW REPLACEM ane cine Da Do: om Co.,.,ALE® ARCHITECTS DECLARATION - Ianecrsundmyplansshallheasedasp.hire scorch JAN 2 2 2004 Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the (��'�®'�� following reason.(Section 7031.5. Business and Pon(mrions Code: Any city or county (B which requiresa Permit or construct, eller. improve, demolish, or repto any structure prior In its issuance. also requires the applicant for such permit to file a signed statement that he is licenvd pursuant to the provisions of the Contractor's Liana Law (Chapter9 Sq. Ft. Floor Area Valuation (commeeing with Section 7") of Division J of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of " any applicant for a f r a Per. subjects the applicant e a civil penally of Section 703than 3 0 Occupancy Type not mot than five hundred deltscant n 0s)). _WIdB`�51$el0 1, ss owncrof the pmpcny, or my employees with wages u truth sale compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Cade: The Commceri License Law does not apply to an owner of Required Inspections property who builds or improve themon.and who does such work himself or through his tun employers, provided that such imtimnumnts arc not amended or offered Torsed. If, however. the building of improvement is sold within one yes of compledon, Ne owner - builder will haw Idea burden of proving that he did not build or improve for purpose of salt.). 1. as owner of the amptny, em exclusively contracting with licensed contractors to contract the project (Sec. 7044. Business and Professions Cade:) The Contractors Li. arae Law does not apply to an owner or property who Wilds or improves themon, and who contracts for such packets with a coetrach r(s) licensed pursuant to the Contractor's License Law. ❑ I em cnin,l under Sea. , B & P C far this moon er - "s Date �Ow >' 00.K� ICOM � A 4DE/ELATION ' I hereby affirm under penalty of perjury one orlim following declarations: haw and will maintain a Certificate of Consent to self inure far Workers Compcm ' ion, as provided for by Section 3700 of the Labor Code. for the performena of the ' work for which this permit is issued. ❑ 1 have and will maintain Worker's Compensation Insurance, u required by Section 37M of the labor Code, for the Perfamaoee of the work for which this permit is issued. My Worker's Compensation Insurance artier and Policy number aa: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (nor.6. raced nal W campleed if be permit is for ane hundred dollars IS 100) or less.) 1 certify the in the performance of the work for which this permit is issued, 1 shall nut employ any peso. in any manner so u to Wcume subject to the Workers Compensation Laws of C.I f.rAi.. Data Applicant NOTICE TO APPLICANT: If, Arlo making this Ccropma, of Exemption. you aboard become subject m Ne Works Compcazdon provision of the IxWr Cstle, you muse ' forthwith comply with such Provision or this permil shall W deemed evoked. CONSTRUCTION LENDING AGENCY I hereby affirm that Vert is a construction lending agency for the performaneo of the work for which this pcnnit is issued (Sec. 3097, Civ. C.) Lender's Name Lender's Address 1 certify that 1 have read this application and sole that the above infomnauon is "mmct. I agree to comply with all city and county ordinances and that, laws ¢lasing to building convection, and hereby authonre ropmsenseins of this city to color upon the ahr.c-memiunce PmPc for inspection pcNan phimoses (We) agree to saw, indemnify and keep harmless the City of Cupertino again, tet j ncoabi isegjnceof o training cxprnsesmit. may in any way action againnseid Ciry inof thegaming ser this permit. A"PLICA T APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINTIssued by: I �� SOURCE Dale TGULATIONS. nn /u -- ����d/�n Re -roofs Sgn arc Adphc Contrlclor Da �� AZARDOUS MATERIALS DISCLOSU REr / Type of Roof will the applicant or future Wilding occupant lore of handle haaardoa material u defined by IM Cupertino Municipal Code. Chapter 9.12, and IW Health and Safely Code. El es ns3z(,)7 Yes No All roofs shall be inspected prior to any roofing material being installed. win thea ticnm or seem buildin ecu ant ase a u; nn s p q proem or JMana which If a roof is installed without first obtaining an inspection, I agree to remove g II hmardnus air contaminants u Jcfincd by the Bay Arca Air Qualify Management solo) all new materials for inspection. ❑Ye0 1 hrvcs mad the haaandoEerials requirements under Charter 6.95 of the Califor- niaHcalth& Safety Coda. Sern25 mo505.25533 and 25534.1 undesoM the if the Wild;mg dors not Currently have a anent that it is my resprnibilily a notify IM decupant or The 2Nuirtmc which muss he met prior a issuance of a Ccnifcae of @"upon Signature of Applicant Date 3 All roof coverings to be Class "B" or better anthrn' des cal D,c E APPROVED N AqG~cE WITH THE CITY OB pgtgNO CO ES AND. ORDINANCES sic 4 yn �z_ Th set of p- and specifications MUST he rept on the job at all times and it is UK, few ul to make any changes or, alterations fan Mme without written permission from ha building Dept., City of Cupertino. Thr stamping of this plan and specifications 3" LL NOT be held to permit or to be ar rpproval of the violation of any prcvisione d enV City Ordinance of State LGW- VQ,,-ter 1 [s��r I, 13 �e> l 3 [304 Ar ro ce *CITY OF CUPERTINO* CATV Or PERMIT APPLICATION FORM CUPERTINO 03l a o09� FN�N# 3 s^d l 6 OS -3 Date: / l Building Address: BAPPLOTHER Owner's Name: Phone #: k, 1z 44401 — Jai' Contractor: License #: Boiler <= 100,000 Btu MECHANICAL Cupertino Business License#: Contact: P mm� ,P�W-2/ BBOILER3 ildi g P rmit tnfo: 1 Bld Elect ❑ Plumb ❑ Mech ❑ Description: 2 ro /% /0/j K do w/ WI t o Residential EJ Comm cial Sq.Ft. Floor Area: $/Sq. t.: Boiler > 1.75M Btu MECHANICAL Cost of Project: 3000 Occupancy Group: 2� BUILDING Type of Construction: :YK: BUILDING 40 Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > I OOK to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler > 1 M 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 Hotel and Motel BUILDING BCONSTAXR Constax - Resi/Mobile BUILDING BELEC1000 Elec 600V <= IOOOA ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING 1 of 3 «�, i CITY OF CUPERTINO *ITY OF CUPERTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi -Family Res MECHANICAL BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL BNEWMULTI Multifamily Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMULTI New Multifamily Res PLUMBING BNUSFD New Single Family Res BUILDING BOVERTWE 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 rinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER Install/Alter Water Pipe PLUMBING BPWHEATER Water HeaterNent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 ctm MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BRENUURNOV Relo Fumace > l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non -Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL • 2of3 CITY of CUPERTINO OTY OF CUPERTINO 0 PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL BREMSIGNAD Rmd] Sips 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 Inection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Tcmp 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 Issuance PLUMBING PPLBG Plumbin Fee sq foot PLUMBING ZADDCHG Address Change BUILDING • 3 of 3 0 6ER-BUILDER VERIFICATJJN 1. (Check one) I or my immediate family (parent, spouse or child) will perform: A. -X All the work authorized by flus permit • B. _ A portion of the work C. None of the work f RF If B or C is checked, complete 2 or 2003 2. A state licensed contractor will be hired to do: A. All of the work T�. B. _ A portion of the work (complete section below) Contractor Address/City Phone # State License # Type of work to be performed 3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or • portions of the authorized work. I understand that I may be an employer (see reverse side). A Certificate of Insurance covering workers' compensation must be on file at the City of Cupertino Building Department office. PersorVFrrm Address/City. Phone Number Type of work to be _performed I declare under penalty of perjury that the above is true and correct. I have read and understand the Owner -Builder Information (reverse side). Property Owner's SignatureI�=Tl —��3 L BL t??2-'1 / �n /0 3 Job Address: -�Z // d g 3 gp 1 AM. (f Permit # Department. • City of Cupertino Building Department CITY OF 10300 Torre Avenue Phone: (408) 77-32CUPE�TINO -W Dear Property Owner. An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements spedfied. For your protection you should be aware that as owner -builder you are the responsible party of record on such a permit. Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to havg a business license from the city or county. They are also required by law to put their license number on all permits for which they apply. ' If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be aware of the following information for your benefit and protection If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $200 or more for the entire project, and such persons are not licensed as contractors or subcontractors, then you may be an employer. If you are an employer, you must register with the state and federal government as an employer and you are subject to several obligations including state and federal income tax withholding, federal social security taxes, workers compensation insurance, disability insurance costs, and unemployment compensation contributions.' not carry out these obligations, and these risks are There may be financial risks for you if you do especially serious with respect to workers compensation insurance. For more specific information about your obligations under federal law, contact the Internal Revenue Service (and, if you wish, the US. Small Business Administration). For more specific information about your obligations under state law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an owner-bujlder building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors State License y, Board in your community or at 1020 N Street, Sacramento, California 95814. Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. Very truly yours, Building Department, City of Cupertino • Printed on Recycled Paper 00 Z r N P >_ 4 C] ZDz U_0 OF U F� �z CITY OF CUPEWHNO $, BUILDING DIVISION PERMIT CONTRACTOWINFORMATIQN RUH.DING ADDRESS: CRYSTAL CLEAR WINDOWS & DO I4�1T"°03120096 OWNER'S NAME: PERM TT LSSUE DATE NE: SANITARY NO, CONTROL NO. 1 ARCHTTECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONIRACnderp DECLARATION Job Description I hcrchy affirm ivis 1 am licensed under provisions of 9 (commencing - p with Section sCode, Division 3 of d¢ Rosiness and Pmfcssioa Calc, and my liccnx isiiihil ud of ec effect. ,p WINDOW REPLACEMENT FINALE® Licenlx Claim Loc. g Date Contractor ARCHITECTS DECLARATION I understand my plana shall he used as public mcoma JAN 2 2 2004 Licensed Professional DECLARATION DECLARATION Oat 1 hereby affirm than I am exempt Gum the cors License Lew for IW I on exempt from following reason. (Section ]In I.S. Business and Professions Code: Any city or county Brr0��Yrra®'�� which requires a permit to construct, alter, improve, demolish, or repair any structure Prior m its issuance. also RGuirea the applicant for such Permit to file a signed statement that he is licensed pursuant o the provisions of the Contractor a License Law (Chapter 9 Sq. Ft. Floor Area Valuation (commencing with Section 7M) of Division 3 of the Business and Professions Code)or Nat he is exempt thcmfrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicanuo a civil penalty of 7ai �a 31 NOO 3 +P .Apa,�9eF0� QccU anC -Type not mom than fire hundred delta. (5500). VVI• H P Y YP I] 1, u owner of the property, or my employees with wages ax their sale comparison.. will do the work. and the swdme is not amended or offered for sale (Sec. 70W, Business and Profession Code: The Cont.emrs Li.. Law does MI apply In an Owner of Required Inspections property who builds or improves thereon, and who does such work himself or through his own employees. provided that such improvements sure not intended or offered for sale. If. however, the building or improvement is sold within one year of completion. be owner - builder will bars the burden of proving Nal he did not Wild or improae for purpose of sale.). G_l h as owner of da, property, am exclusively contracting wit licensed contractors to eoruwct Ne pounced (Sec. 7044, Business and Prefesimms Code:) The Contracmr's Li. cense law does not apply to an owner of Oro,a ny who Wilds or improves dremon, and who contracts for such projects with a eomralor(s) licensed pursuant to has Contractor's License taw. ❑ 1 an exempt under Sec. , B At P C for Nis mann Q D Owr�cr�� Data ORK S COM N A DECO Aata 1 hereby affirm under penalty of perjury one oPfhe following declarations: Cj I ban and will maintain a Cenifcam of Conserv to ulGirtsurt for Worker's Comper, sation. as provided for by Section 37M of die Labor Code. for the performance of IW work for which Nis permit is issued. ❑ 1 have and will maintain Worker's Compensation Insurance. his required by Section 3700 of the Labor Code. for the performance of the work for which this permit is isined. My Workers Cnm penaation Insurance carrier and Policy number art: Carrier: Polity No.: _ CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE (rhis xenon need not W completed if the permit is for one hundred dollars (S 100) or less.) 1 minify that in the performance of the work for which this permit is issued. 1 shall not employ any person in any manner so as to become subject to the Wtomia COurromaion lawn of California. Data Applicant NOTICE TO APPLICANT: If, after maki n6 this Cenifeahe of Exemption, you should became suhjcet m the Worker's Compensation provisions of the IaWr Code, you must mMwith comply with such provivnu or this Permit shall W deemed .wk.d, CONSTRUCTION LENDING AGENCY 1 hereby affirm Na there is a construction lending agency for me performance of the work fur which Nis permit is issued (Soc. 3(1 Civ. C.) ' Landers Name Lender's Add.ss 1 certify Lha 1 pave rad thio application and sui¢ than the aWve information is conn. I some to comply with all city and county on irdsoms and suite laws relating to building construction, and hereby authorise.prcsentaives of this city to ender upon the alwvnmemidgin rimpeny for inspection pintmwhich (We) agree m ars, indemnify and keep harmless the City of Cupertino against ms liabilmultrence o n¢cramantl ex Peacsmit. may in any way accmc against said City in nmxyucncc of the graining of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOURCE TGULATIONS. rt Re -roofs Sqn ore Adphc sena rep Dat AZARDOUS MATERIALS DISC Type of Roof Will the applicant or future building Occupant store or handle hazardous material or de0ned by the Cupertino Municipal Code, Chapter 9. 12, and the Health and Safcty Cale. Section 23512(a)? ❑Yes Nu All roofs shall be inspected prior to any roofing material being installed. Wilt mea applicant or tit building Occupant uce a np s p equipment or whim If a roof is installed without first obtainingan inspection, I agree to remove P g o oar conuimimnts a defined by IM Bay Area Air Quality Management Mara all new for inspection. District? materials ❑Ycx No 1 have reml the hvallonssmaxrials.quim anisunderChapter695oftheCalier- maHcelth&SafciyCnde. Sections 25505.25533 and 25534.1 understand thdif the Wilding does not currently haw a ¢pant that it is my responsihility to notify the Occupant of the r i.mc which must W mal mior to issuance of a Ccrurcon i f Occupan /7 Signature of Applicant Dale -3 All roof coverings to be Class "B" or better aulhori d ag m m