04110008 CITY OF CUPERTINO
BUILDING DIVISION PER ��CSN 'ntAG�TnRINF�OI2M„ ;,., N
BUILDING ADDRESS: ALLBRAND WINDOWS PERMITNp,,4110008
111 E0.'S NAME: PERMIT I5SUE DATE
GEORGE MOUSTAKEAS 2004551 INDUSIRTAT. RT) 11 /02 /
PHONE: SANITARY NO. _CONTROL NO. 1
(650) 622-0330
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
pm
?,IOp LICENSED CONTRACTOR'S DECLARATION
I Mrcby afOsm that 1 am licensed under provisiam of Chapter 9(commencing
xnNSap'6n]q�1alDlvidon3of Ne BusinwWP (caVua Codc,odes license is
lull foe�n1 cffnct
z .mac CT" C 13 Ue•g ✓�,�27- ��- REPLACE WINDOWS/
,__ Data t`Y—o�c�Commuter P�t' h 7 OQ
y ARCHITECTS DECLARATION
Y lunticrsup�J-my plans Wall he used—addija�orJs H u
yN'I+(
_"d Professional �U�LY� V
Y5 OWNER-BUILDER DECLARATION tpjl
4 1 bunchy affirm that I am exempt firm she ContrecloYa License Law for the
1:00 following romon.(Section 7031.5,Business and Pm!tion Cam:Any city W county
$ which requires a permit to construct alter,improve,demolish,or repair any structure
Fly prior in its issuance.also requires the applicant forsuch permit to rile a signed summand
F0 that he isliccnsedpursuant tothe Provisions of the Contractors License Law(Chapter 9 Sq.Ft. Floor Area Valuation
50 (commencing with Section 7")of Division 3 of Lou Business and Profealous Code)or
$ Net he is exempt t ercfrore and the basis for the alleged exemption.Any vi.l.don of
Section 7031.5 by any applicant fa a purmli subjects Use applical to a civil penally ofe10 0 Occupancy Type
nal mart Nan five hundred dollar,(SSW).
0^I,u ownu of the propemy,a my cmploycea with wegee m their wle campenudon,
will dothework,end : ah Contractor's
Law do Tante(See.]Oma,Business
and Profession Code:The Canveror.Ucuve Law does or apply m rt owner of Required Inspections
property who Wilda orimpraws Merton.andwhadoesavch workhimsel(orthmugb his
w•�emplayen,,provided dim such imprommats art not Intended oreffered ferule.If.
however.the building or improwmenl is alit within one year of completion,the owner- `
Wilder MR have din burden of proving Nal las did wt build or Improve fa purpose of '
ole).
0 1,as owner of the property,am exclusively convecting wish licensed concurs to
coattpcl the projen(See.7044,Business and Profession,Cade:)The Contractor's Li-
cense Law don not apply to an owner of property who builder or improm themon.ad
who contracts for such projects wish a eonlnaorp)licensed pursuant in the Convatofa
Lie'.Law,
0 1 am em rpt under Sec. .B&P C for this meson
Wer Dau
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury aro of the follawing declarations:
0 1 have and will maintains Certificates ofConsenuo elf-insure far Workers,Compcn-
utian,u provided for by Section 3700 of the Labor Code.(a the performance of the
work for which this permit is issued.
0 I bow and will maintain Worker's Compensation Insurance,u required by Section
3700 of to labor Code,far the performam of she work far which this permh is Issued.
My Workers CdmPa $edr�qt lmursn<e anion and Policy number am: ��� �
Center. -la 1 ort (N3_CO. Paliry No.:iY WaG z Q
CE IFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURAtCE
-� d.ammismdnm becamplemd Rose hisfm ane hundreddollam(Slfp)
or leas) 7
I certify that in Ne performance of Nc work for icb this permh is issued.I atoll at
employ any person in my mawrn um ^me ecus Ne workers m
Compaation '
Laws of calir rrtne
Applicant
NOTICE TO A PT ICANT:IL after making this Continuum of Exemption,you should
become Subject to On Warker'S Compensation prwisiom of Ne lastan Code.you must
.JO tolwith comply wish such provision in this permit shall W deemed revoked.
,Z.rCONSTRUCTION LENDING AGENCY
,4 o-�. I heirohy oRrm Na there is a...str.clinn lending egeary for than performance.(
lYi7 the work for which this permit h issued(See.7037,Civ.C.)
CLn74 Lender's Name
a Z Lindersnddress .i
V Q I certify Na 1 hew mad this application And mune Ran the above Information ie
ILO P CemecL I agree to comply with all city and county ordinances and lute laws relating to /
0 U .1anirgeolimuedro and hereby euNodrzrepmacntalivrs of this city toenmr upon dm
fgd shove-menti.gree to ertysin,far lapedianpuoup ha
gL (We)agree to taw,inticmmfy and keep harmless de City of Cupertino against
liabilities.judgments,costs and expenses which may in any way acme again¢saidCity
U 7 In consequence of the Srafing o(Nis permit. /
F7 APPLICANT UNDERSTANDS ANI WILL COMPLY WITH ALL NON-POINT Issued by: Date
S ,Reg REGU NS._Q 34��ea
C w2 i C'\� ' 1I-02-C4Re-roofs
\ ign one ofApPlicaHAZARDOUS MATERIALS DISCLOSURE Dane Type of Roof
Will the applicant or future building occupant store or handle hosrdous mamdal
As defined by the Calamine Municipal Codc,Chapter 9,11,and the Health and Safety
ah.Seoul V1532(.)7 y'' All roofs shall be inspected prior to any roofing material being installed.
❑Yes (yyrso
Will the applicant or future building aocuponl use equipment or Jcvicm which If a roof is installed without first obtaining an inspection,I agree to remove
emll haardous air contaminants as dented by the Bay Area Air Quality Management all new materials for inspection.
Dlxlrict7 11 // '
Oyes V.
Ibacmaltheh,Secd mamrialsnyuimmenuunder Chapmrd.95ofNe Wilding
nits Hat &SafclyCodc,Sectiom25505.25577 aJ255J4.1 unJcrstand Not i(Ne building
dna mol only Ilaw a scram Net it is my mspaalhilhy m notify de aYupat Of Nc
myui c who E£lne rmissua afuCcniricane of Occupancy.
D Z _Utt Signature of Applicant Date
n
Ower lr err amhodvcd agent pale All roof coverings to be Class"B"or better
FINAL MEASURE
Dealer Name: �t 11 V�a+C� `Viv,dO�S-
DATE 11-0t _Oaf
• Address: `� �a�10 5 t CSA 1 a 1
JOB#
CA LICENSE#
OWNERS: �r - Y a .n- aa�fl-rS� RES PHONE: DATE:
1,-� n1-GLI
2
STREET: 05PP7 11 SVtiy'�'s2 Uv- BUS PHONE:
CITY: 'v'1'i_O STATE: C n ZIP CODE:-
15
ALM C)t\; I /' Bay Window
® Single story: ❑Wood siding: ❑Wood windowsa_ tI. I o door handle (s): Eave projection: (in.)
❑Two story: ❑Vinyl siding: ❑Aluminum wi S. --Roof type: ❑ Enclosed
❑ ® Stucco: 12 Steel wtnddGk ®AND it GES A ❑ Slope
Security bars - Re-install: ❑Yes ❑ No OUPUB) It e Angle: ❑ 30 ❑45
No. days ® Retrofit ❑ Pull fram s colc,: 0 White ❑Almond
APPROXIMATE SI
NO. LOCATION TYPE P B2
WIDTH NEIGH , of C8ti �$Z COMMENTS
1 Is art
Th a sec the f b at all fig
as an I
ati
or. alter
z la ful to w thou written ermission
qrge no.
3 , li a buil nuOfArl this plan a d speclii be r
iO1he violation t any probe
5 anY ity Orman
6
7 PD
8
s o � �rea et. D PD
10
v.�
tt (au .y s e V
12 ,
13 X
14 IY.
15
16
17
Qg.ci�l Instructions: Total U.I.
Windows: 1 1J
Doors:
The type and operation of each window have been fully explained and I accept the windows identified on this gays:
measure sheet as being the windows 1 am ordering.
Customer signature: Measured by:
May 2(b4
11/18/2004 15: 07 4087781550 JOHNSON LUMBER ACE PAGE 01
00 /
soave
�y1r rr n .20 ZS_
• � S(,+�vR/sem
a C)
TIFICATE OF
CONFORMANCE
CER
HE UNDERSIGNED MANUFACTURER HEREBY ear&IES
that the products idantHled below And On attached sheets Nos. are marked with
the Collective Mark of the AMERICAN INSTITUTE OF TIMBER CONSTRUCTION.(AITC)and.were
manufactured in conformance with applicable provisions of American National Standard ANSVAITC
Al 80.1-1902, Structural Glued Laminated Timber,and that such manufacture has been at our plant
In , which plant has a quality control system
approved by the Inspection Bureau of the AMERICAN INSTITUTE OF TIMBER CONSTRUCTION
and Inspected periodically by such Bureau.
JOB NAME: '-
JOB LOCATION: Lain i�M�q,{��. ^� ^� 7 ,y
9UBTOMERS ORDER ND.' "10 n DATE S' I L FORA ORWR NO. o2 y 7213[1
• &16NA7UR8
CCM�PAN�Y_71
/
TrTL ADDFteM � 1I1JrL.!—.MTS__S'r 7�f f 5/�
AITC HEREBY CERTIFIES that the said company at Its said plant is Rearmed. by the
AMERICAN INSTITUTE OF TIMBER CONSTRUCTION to use the AITC Collective Markin respect
of products which comp)yy with applicable provisions of said Standard,that the adequacy of the qu*
fly control system In effact at said plant is periodically inspected and verified by the Inspection
Bureau of the AMERICAN INSTITUTE OF TIMBER CONSTRUCTION, and that. In the Judgement
of AITC, said company is capable of complying with applicable manufacturing-and testing pww9lons
of said Standard In respect of products manufactured at said plant Confonhanoe wi h'the Standard
in respect of any spedflo or pardoular product is the sole responsibility of the manufacturer;AIM
guarantee hereunder being that tho oaid comparty'is quallW'tc produce a product meeting the said
Standard and that its plant Is periodically inspected end verUlad by the AITC Inspection Bureau.
ArTc cemrrcate No, 92- X81980
AMERICAN INSTRUTE OF TIMBER CONSTRUCTION
E=EIVED
MAY 1 7 2004
KFILLER LBR SALES
• 1994 AMERICAN IN71TUTE OF TIMBER CONSTRUCTION
Am)FORA IBC
LR/LB 3nad S370S 6E-I 83111 91:66-E4i:-856 90:91 t7aOZ/81111
" •CITY OF CUPERTINO
CUPE(�TINO PERMIT APPLICATION FORM
IIN# Date:lding Address: I Mailing Address (if different from building address):
S7p Surr�5e Dr GA�_oc�ner's Name: Phone#:
co2U% (W2) 25 - 2288.
er�ac�t�r:1 ,� ��J License 8zP .�
#: �1 r
Contact: d . Phone:(5io)333-5$ 2T Cupertino Business License#:
aha b J'awsV\ Fax:
Building Permit Info:
Bld fr7 Elect ❑ Plumb ❑ Mech ❑
JobDescri w os c(,1��,� �� �e.j
Residential He &xs Commercial ❑
9q.Ft. Floor Area: `\ y $/Sq.Ft.:
Cost of Pr 'ect 1 1 a 680 �� Occupancy Grou
-- Type ofnstruction: Please check this b if the roject is a
second-story additiour EJ
Project Size: Standard ❑ Laze ❑ Major ❑
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 1M Btu MECHANICAL
BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL
BBOILERS Boiler> 1.75M Btu MECHANICAL
r 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<= 1000A ELECTRICAL
BELEC1001 Elec 600V> 1000A ELECTRICAL
BELEC200 Elec Svcs 600V<= 200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
1 of
OCITY OF CUPERTINO
CUPE�TiNo PERMIT APPLICATION FORM
QuantityFee ID Fee Description Fee Group
BMISCELL Miscellaneous Fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
BNUCONBM New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BOVERTINM Inspection Overtime BUILDING
BPBACKFLOW Atmospheric Vacuum PLUMBING
BPCESSPOOL Cesspool PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPFIXTURE Pb1g 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 rinklerBackflo PLUMBING
BPSTORM Storm/Rain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
BPVENT Alt of Drain &Vent PLUMBING
BPWATER Install/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
BREM 3USWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL'
f BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Fumace> l OK btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISC Misc Apparatus ELECTRICAL
BREMNR.APP Rem Non-Res Appliance ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
BREMPOWER Power Device/Apparatus ELECTRICAL
BREMRECEPT Rc tl Switch & Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT Repair/Alter Heating MECHANICAL
BREMRESAPP Rembdel'Res Appliance ELECTRICAL
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*ITY OF CUPERTINO�
CUPEI�TINO PERMIT APPLICATION FORM
QuantityFee ID Fee Description Fee Group
BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS Remodel Signs, 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
BSEISNIICRE Seismic Fee Res BUILDING
BSPECIAL Special Inection BUILDING
BSWIM Swinuning Pool BUILDING
BTEMP Temporary 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 . Mechanicals . foot MECHANICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
-- PPERMITFEE Plumbing Permit Issue PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
ZADDCHG Address Chane BUILDING
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