04100116 (2) CITY OI'CUPE12'I'INO
Bml,Dwc Dn'Is1oN PERMIT CONITRAC�,T,OItAINFORMAT=IONS
BUILDING ADDRESS: PERMIT NO41 0 0116
0305 EL PRADO WY
OWNER S NAME: PERMIT ISSUE DATE
Ah ERNA JACKMAN 10/18/2004'
FICHE: SANITARY NO. CONTROL NO.
ARCHITECrlENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
0 0 0 0
a�lOp LICENSED CONTRACTORS DECLARATION Job Description
z U r 1 herchy affide
rm Ihat 1 am licensed unr provisions of Chapter 9(c.aboading P
=?6 with Section 7")of Division 3 of the Business and Professions Conic,and my license is
in min
.x ann effect. REPLACE WINDOWS/SLIDING DOn
Li
O I� Liccnsc Out Liu.x
^Fp Dan—Cunuaea
ce ARCHITECTS DECLARATION
'rest C i 1 understand my plans shall he used as public records
is
'+.o H Licensed Profeninnal
OWNER-BUILDER DECLARATION 3
<i 1 hereby affirm that 1 am exempt from the Contractor's License Law for the /
a O following reasnn.(Section TW 1.5,Business and Prnfessinns Code:Any coy or mumy \
x m ff which requires a permit W construct,than Improve,demolish,or repair any structure �,1 $12910
mom'^ prion.its became,also rtquhu thcapplieanl tortoni permitw fleaoigncJ suamcm
v-' that he is licensed pursuanto the provisions of the Cow mracturs LiccnLaw(Chapter 9 Sq. Ft. Floor Area Valuation
04lt—$ (commencing with Section 7000)of Division 3 ofor,Business and Professions Code)or
y; Nat he it cwmpt thciefrom and the basis for Ne alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of -JqAPNR�I�beyu Occupancy Type
no curno,than fro,hundred dollars(5508).
❑ Las owner tithe property.Or my employees with wages as thelrsole compensation,
will do she work,and Ne swan¢is nor intended or offered for sale(Sec.7D44,Business
and Professions Code The Contractors License Law docs not apply to 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 are not intended or offered for sale.If.
however,Ne building or improvement is sold within one year,ofcomplelion,theowncr-
to Idcr will have the burden of proving that he did not Wild or improve for purpose of
J,as owner of the property,am exclusively contused ng with licensed contractors to
consumer the product(Sec.7044,Business and Profusions Ccdc:)Thc Contractors Li-
cannot Law docs not apply to an owner of pmpcny who Wilds or improves thcmun.and
who contracts for such projects with a enntraelor(s)licensed pursuant to the Contractor's
Liccnsc Law.
❑'lam camg1 under Sec. .B&P C for this mason
0Wna,� Mo:�_LC CI`t_C) _T, Dat" IC) I -u,�
l(/ WORKERS COMPENSKT10N DECLAR�'�/pN
J Ihereby affirm under penalty of perjury one office laid mgdeelarationr
❑I have and will maintain a CenlGcam of Consenuo sclbinsure for Worker's Comp"n-
oation,az provided for by Section 32W of the Libor Code.for the Performance of the
work for which this permit is issued. .
❑1 have and will maintain Worker's Compensation Insurance,az required by Section
3)U)of Ne Labor Code,for the performance of the..,it for which this pdrril is ivued.
My Worker s Compensation Insurance carrier and Policy number arc:
Cartier. Policy No.:
CERTIFICATE OF EX EM MON FROM WORKERS'
COMPENSATION INSURANCE
[This scctinn need not be conarcad if clic Momil is for one hundred dollars(glBtB
m Icor.)
1 aenify lhut in the performance of the work for which this permit is issued.1 shall not
taping any pawn in any manner in 0 W Weome subject to the Workeri Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,alter making this Cenilietle of Exemption,you should
become subject to the Workers Compensation provisions of the Labor Code.you must
.JZ•foMwhh comply with such provisions father Permit shall W deemed rcvnked.
'Z'O CONSTRUCTION LENDING AGENCY
'r. "N—' I hereby alarm that there is aconswainn lending agency for the performanccuf
C 9 the work fur which this permit is issued(Sec.3097.Civ.C.)
D.)C hinders Name
ZLenders Address
za)U C) 1 certify that l have read this application and sum Unit the above information is
LL. Pcoria 1 agree to comply with all city and county ordinances and sum laws relating to /
CJ building construction.and hereby authorise representatives of this city to enter upon the ;Y_as "---��...
GG above mentioned property for inspection purposes.
(We)agree to save.indemnify and keep haemless the City of Cupertino against
F" req liabilities.judgments,costs and expenses which may in any way accrue against said City _
U Z in consequence of the granting of this permit.
'^ APPLICANT NDERsTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE RELATIONS.
-oil
Signa Re-roofs
e fAppcaMConaeor Dara
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant sere or hamlle bas rth us material
as defncd by the Customs,Municipal Code,Chepar 9.13,end the Health and Safety
Code.Si 25532b)? All roofs shall be inspected prior to an roofing material bei. Installed.
❑vee v4 P P Y P> g
Will the applicant ormwm Wilding acceptor use egaipmemordevices which If a roof is installed without first obtaining an inspection,I agree to remove
mit havardout air contaminants as dinned by the Bay Arca Air Quality Management all new materials for inspection.
Distrix?
E]Yes
1 have mad the havaNnus materials requirements under Chapter 6.95 of the Califor.
ria Health&Safety Cral Sections 25505,25533 and 25534.I undcrsund that if the building
docs not cu sly haus a awns.Nath is my res,ortioloy W nutty the Occupant of the -
rcyui a hlehmu he meIprior lniionareeOfaCealramofG"a `y. Signature of Applicant Date
rn r'i .1 >� I0-1
�- `O n oramm�raedagent Daa All roof coverings to be Class "B" or better
RECEI�D
I
Q
W
i
APPROV t✓eLO
WITH THE CITY 00
CUPERTIN D
)ATE
I SIGNED
I This set pians and specificatfons MUST
De kept on the job at all times and it is two
lawful to make any changes or altemdo l
on same without written permission fmM
i the building Dept., City of Cuper iM
The stamping of this plan and sp0
C.� .3HALL NOT be held to permit or to ba: an
+pproval of the violation of any PWAMM
n1nanCP. or 'sram tAw,
L=I
J
iL) f1 PrOCb Jldi o
C��pFr h nc� CJ dCo(S- W'nd O�bS ( 3
i�C� r cc s LU tih ereSS
City of Cupertino
Plan Check Transmittal
Permit# 04100116 Control#
Project WINDOW UPGRADE/EG Plancheck# 1
Address 10305 EL PRADO WAY FileDate 10/18/2004
Owner JACKMAN
Description WINDOW REPLACEMENT
Plan Check Status (attach comments and return to Building with plan set)
Plan
Dept check# Date Due Date Staff Comment Date Approval?
Building 1 1 0/18/200111/1/20041 POH 1 10/18/2004 51/Assessor 1 0/18/200 11/1/2004 SENT 10/18/2004
Additional Plan Check Fee ❑ Hours
Planninq Fees
Housing Mitigation Fee Amount
Heart of the City Specific Plan Fee Amount
CITY OF CUPERTINO
W-m 1 of 1 PERMIT RECEIPT OPERATOR: conniew
COPY # 3
Sec : Twp : Rng : Sub: Blk: Lot :
APN . . . . . . . . : 34230015 . 00
DATE ISSUED. . . . . . . : 10/18/2004
RECEIPT # . . . . . . . . . : 27474
REFERENCE ID # . . . : 04100116
SITE ADDRESS . . . . . : 10305 EL PRADO WY
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : ERNA JACKMAN
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : SARATOGA CA, 95070-6025
RECEIVED FROM . . . . : JOHN KORGES
CONTRACTOR . . . . . . . : LIC #
COMPANY . . . . . . . . . . :
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
TELEPHONE . . . . . . . . :
SFEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
-- - - ------ ------------- - ------- --- --- ------ - - - - --------- - ----
BENERGY PERMIT FEE 201 . 96 96 . 94 0 . 00 96 . 94 0 . 00
BPERMFEE VALUATION 12 , 910 . 00 201 . 96 0 . 00 201 . 96 0 . 00
BSEISMICRE VALUATION 12 , 910 . 00 1 . 30 0 . 00 1 . 30 0 . 00
BPLANCHK PERMIT FEE 201 . 96 269 . 52 0 . 00 269 . 52 0 . 00
-- - --- ------- - - - ----- - - - --
TOTAL PERMIT 569 . 72 0 . 00 569 . 72 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- -------- ---- -- ------- --
CHECK 569 . 72 4886
TOTAL RECEIPT 569 . 72
•
CITY OF CUPERTINO t�
CITY OF PERMIT APPLICATION FORM
CU PEIi`TINO
APN # Date:
3 2 3 � of iv-iS-o•i
Building A'd"dRss: Mailing Address (if different from building address):
IOaoS F_1 R-ado u_-GL C-6,+w_-r L6-)o
Owner's Nana Phone#:
Err)a LAO $'- SLf)5- 133��
Contractor License#:
,LX rd o LOp F re plocc Outlet
Contact: , Phone: S(.0+ %J 9r1 Cupertino Business License#:
llVlr� L rekJ>Fax: 3r - i- 71
Building Permit Info:
Bldg Elect ❑ Plumb ❑ Mech ❑
Job escription: rCploCe-- "p3f Cle eVSt��C,,Oa
Residential b/ r.U�(-dUWS k SIdiC) CknxS Commercial ❑
Sq.Ft. Floor Area: S/Sq.Ft.:
Cost of Project: Occupancy Group
Type of Construction: LPlease check this box if the project is a
second-sto addition: ❑
JProjectSize: Standard ❑ Large ❑ 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
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 <= 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
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s"� �. 72—
(to - CITY OF CUPERTINO
CITY 0 PERMIT APPLICATION FORM
CUPERTINO
Quantity Fee ID Fee Description Fee Grou
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 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 rinkler/Backflo PLUMBING
_ BPSTORM Stonn/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
BREMBUSWAY . Remodel Busways ELECTRICAL
BREMFIXT _ Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Furnace > I 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
BREMPOWER Power Device/Apparatus ELECTRICAL
BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT Repair/Alter Heating MECHANICAL
ISL BREMRESAPP Remodel Res Appliance ELECTRICAL
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{ 1 CITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM '
CUPERTINO
Quantity Fee 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
BSEISMICRE Seismic Fee Res BUILDING
BSPECIAL Special Insection BUILDING
BSWIM Swimming 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
EPERNUTFEE 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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