09120002 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10251 WESTERN DR CONTRACTOR:FIVE STAR WINDOWS PERMIT NO:09120002
OWNER'S NAME: JOSEPH N BABANEZHAD 1450 DELL AVE STE C DATE ISSUED: 12/01/2009
OWNER'S PHONE: 4089962967 CAMPBELL,CA 95008 PHONE NO:(408)370-3331
4 LICENSED CON'TRACTOR'S DECLARATION r r
BUILDING PERMIT INFO: BLDG ELECT PLUMB
license Class 3 C_Iy Lic.q �aZ�778 j1
MECH r RESIDENTIAL'\ COMMERCIAL r
ContractorTn '7e�-+ k�— «a+s Date %Z,/ % /17'1
hereby affirm that t am licensed under the provisions of Chapter 9 JOB DESCRIPTION: REPLACE WINDOWS LIKE FOR LIKE, 12 WINDOWS
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect.
1 hereby affirm under penalty of perjury one of the following two declarations:
1 have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as pmvidod for by Section 3700 of the labor Code,for the
performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:510000
1 have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. APN Number:35911009.00 Occupancy Type:
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
correct.1 agree to comply with all city and county ordinances and state laws relating PERMIT EXPIRES I F WORK IS NOT STARTED
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes, (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR
indemnifyand
nses hairless the City of Cupertino against onsequenceoft encs, IHO DAYS FROMJ�AST CALLED INSPECTION.
costs,and expenses which may accrue against said City in consequence of the (///moi S
granting of this permit. Additionally,the applicant understands and will comply /7 rrtt
with all non-point source regulations per the Cupertino Municipal Code,Section Issued by: /� I ' V Date:
9.18.
Signat Date 0
RE-ROOFS:
❑ OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspection,I agree to remove all new materials for
1 hereby affirm that I am exempt from the Contractor's License Law for one of inspection.
the following two reasons:
1,as owner of the property,or my employees with wages as their sole compensation. Signature of Applicant Date'
will do the work,and the structure is not intended or offered for sale(Sm.7044,
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE
declarations: 1 have read the hazardous materials requirements under Chapter 6.95 of the
1 have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
Compensation,as provided for by Section 3700 of the labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
performance of the work for which this permit is issued. Safety Code,Section 25532(a)should 1 store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should 1 use equipment or devices which emit hazardous air
Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District 1 will
permit is issued, maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Health&Safety Code,Sections 25505,25533,and 25534.
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 Worker's Owner or authorized agent:
Compensation laws of California. If,ager making this certificate of exemption,I Date:
become subject to the Worker's Compensation provisions of the Labor Code,I must
forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY
I hereby aRrm that there is a construction lending agency for the performance of work's
APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C-)
I certify that I have read this application and state that the above information is Lender's Name
correct. I agree to comply with all city and county ordinances and state laws relating
to building construction,and hereby authorize representatives of this city to enter Lender's Address
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
granting of this permit.Additionally,the applicant understands and will comply 1 understand my plans shall be used as public records.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. Licensed Professional
Signature Dale
Community Development
10300 Torre Avenue
Cupertino CA 95014
sl
Telephone(408) 777-3228
CITY Of Fax(408) 777-3333
CUPEkTINO
Building Department
JOB ADDRESS: PERMIT #
\02sl o , a ooC>a
OWNER'S NAME:S 9n PHONE #
GENERAL CONTRACTOR ,�j<9-re -ocr FAX #
I am not using any subcontractors: C2 z/o/AR
Sign Date
Please check applicable subcontractors and complete 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 Date
OF
':Li Lt,101 ()III"Y"VI(II-S
12-
JI
'-I1--W:,MUST
Unlawful 11 ni,o,any
iollenrabon
s
"4. on Sarna without ,tten �' ssafromhO HLdding�7 ' Of� of Cuperim..The stamping p/ plan and
LL NOT ba held to Pe"nd or to be an
approval of the violation of any provisions
--z) any City Ordinance or State Law.
OFMCE COPY
PZFCEjVEj:) X:
DEC 1 2001)
BY:---
C)
,e i t I
I(!i Ali .It
i
CITY OF CUPERTINO
3 ITEMS OF 3 - PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub:-.Blk: Lot :
APN . . . . . . : 35911009.00
DATE ISSUED. . .. . .-. . : 12/01/2009
RECEIPT' #.. . . . . . . . . : BS000009302
REFERENCE :ID .# . . .:x ,09120002
SITE ADDRESS . . . ... : ;10251 WESTERN DR
SUBDIVISION . . .
CITY . . . . . . CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : JOSEPH N' BABANEZHAD
ADDRESS' . .:.. . . . . . . : 10251 WESTERN DR
CITY/STATE/ZIP . . . : .CUPERTINO CA, CA 95014-2944
RECEIVED FROM . . . .': JEFFREY A PICKARD
CONTRACTOR" . .'. . . . . : 'JEFFREY PICKARD LIC # 23690
COMPANY .... . . . . . . . .. FIVE STAR WINDOWS
ADDRESS :.,. . . . : 1450 DELL AVE STE C
CITY/STATE/ZIP . . . :CAMPBELL, CA 95008
TELEPHONE (408) 370-3331
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- '---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION '
_30, 000.00 1 .00 0.00 1 . 00 0 .00
1BSEISMICR VALUATION 70, 000.',00 1.00. 0.00 1 . 00 0.00
1WINREP EACH 8•,, '2.00 760.00 0.00 760 . 00 0 .00
---------- ---------- ---------- ----------
TOTAL PERMIT 762 .00 0.00 762.00 0.00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 762 .00 VISA
---------------
TOTAL RECEIPT 762 .00
,
1€«dam 'rCITY OF CUPERTINO
CITY OF
cuPERTiNo
'GENERAL, BUILDING
'PERMIT-APPLICATION FORM
APN # :` Date:
35
Building Address:
lo7.s 1 `.Jesl-eaves +:�r��e
Mailing Address (if different.from,building.address):-
Are Hazardous Materialsbeing used as,part_of'this.project? Yes El No
HOA: (Exterior work only) Yes;❑• ,No ;❑ t If Yes, provide letter from HOA
Owner's Name: Phone#:
Contractor: „ Phone:
hvc 1 Fax:
Contractor License#:
CnZ lEt3 l
Cupertino Business License#:t
Contact: Phone:
J C� �,Lkar7. Fax: yCft) 370
Residential Commercial'
Job Description:
Building Permit Info:
Bldg Elect ❑. Plumb ❑ Mech ❑
Type of Construction(Usage Class): Occupancy Type:
1-A, 1-B ❑ II/IIIIV-A ❑. II/III B;,IV-HT;.V-B
Valuation: Square Footage:
l O ooh
Project Size: Ex ress ❑' ' §' ihdard ,6 ":Lar e ❑ .!Major ❑
Green Building: Please'complete-r"elevantportiomof the Green Building/LEED Checklist& attach it
to the application or if-applicable, include in plan set& the sheet index.
Points Achieved:
For help, contact Build it'Greewat,www:buildit reen.or
Revised 07/14/09