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08090171- PUB U- y � i U OL y -C O m L ) u- a- Q 2 L)U O cn zVV- Q TO 7 0 CD LO HQ ( LO a B N d' O P7 -� N 94 � H a CD Liz mpq d q J O z F L a LO Vi �tl IL Q i U] 2O LL L O ^� U 0 O -Z L 00 O '9 '4 N U F \ L7 O LO O w r a pq CL- cc cr LOLo m CC O OJ E IL y a w v O a O a a a o O °D El U as H r J c4 W a xv a N1 � LO Q �_•' C - vUi31 6cf l u U- 7 0 CD _� QI J . 2 U CC ll` ai I&I o Idl Idl _OL y OL a OL O OL a� O O O J = II+ Q o O w L u7s O CD ftf I 2 . Idl w2 Z N Q CC O C1 m r ~ �� '� O 1 Q __j 7 O lel LL Q w C -ti Do 00 00 c,7 ~ 2 CL CC O C PJ fr. tea} CD O O w w L�i1 w ,5 � u nJ N Cv ([ CL O 2 m m CL O zz U � N N W (n — — dr F:-: H CL J v - _ 1 1 0 w � � M J O O a 00 O U O p r r CC — — Q Q r U co 3- O D 41 0 T (U Ql Q} a7 ,n .A a} N n [1 y " %a} ip C1 x tf7 y0 o y a a "� y L E N v E a� 2 Z a�IL CLO j w vcz, o 't`-�� CD a _ vii a} N (D CJ ~ U _0 CL 70 v+ -- Z y i0 V iU N 41 Q "' a`} U q] Cl v v U E ro a = U U C .� kn y _0 y —'' .L - al al y a a' fu LO a' w a� ° a a� L L- v 9 a- IL � Q co U IL O IL IL Cr7 z CL d IL U U U CL CITE'OF CUPERTINO BUILDING DIVISION PERMIT C�le1TItGTC1R`INJ� RiVIATIQ1�i. ,, BUILDING ADDRESS: PERMrr NO. 10286 VIRGINIA SWAN PL HOLDER INC DBA ABLE GLASS 08090171 OWNER'S NAME: PEWAH ISSUE DATE MUTTART HARRY C ET AL 1129 RICHARD AVE 09/25/2008 PHONE: SANrrARY NO. CONTROL NO. (408) 496-9960 ARCHITECr/ENGINEER: BUILDING PERMrr INFO BLDG ELECT PLUMB MECH O zp LICENSED CONTRACTOR'S DECLARATION vI hereby affrtn that I am licensed under previsions of Chapter 9(commencing Job Description Z w with Section 7000)of Division 3 of the Business and Professions Code,and my license is RE PLC EXTNG WNDW S& PATIO DR W/NEW LIKE 4 L I KE in full force and cffc i z License Class Lie.p IZ Dale Contractor ,,,h - ARCHMCrSDECLARATION it< I understand my plans shall be used as public records :yu U.y Licensed Professional y OWNER-BUILDER DECLARATION 3 a m: I hereby affirm that 1 am exempt from the Contractors License Law for the :00 following reason.(Section 7031.5,Business and Professions Code:Any city or county $ which requires a permit to construct,alter,improve,demolish,nr repair any structure prior In its issuance,also requires the applicant for such permit to file a signed statement za =o that he is licensed pursuant to the prerac visions of the Contractor's License Law(Chapter 9 Sq.Ft. Floor ea a uatl on (commencing with Section 7000)of Division 3 of the Businrss and Professions Code)or $12500 `i that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of Number Occupancy Type not more than five hundred dollars($500). 3 164 6 0 0 4 �CJ'N ❑1,as owner of the property,or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sale(Sec.7044,Business and Professions Code:The Contractors License Law docs not apply to an owner of Required Inspections property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If, however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li- cense Law dors not apply to an owner of property who builds or improves thereon,and, who contracts for such projects with a contractors)licensed pursuant to the Contractors License Law. ❑I am exempt under Sec ,B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑f hsve and will maintain a Certificate of Consent to self-insum for Workers Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑I have and will maintain Worker's Compensation Insurance,as required by Section 37[10 of the Labor Code,for the performance of the work for which this permit is issued. My Workers Compensation Insurance carrier and Policy number am: �7 Carri= nutG /ro Policy No.:CtJ f? 000 �9 �2 CRE T�IFICATE OF EXEMPI ION FROM WORKERS' COMPENSATION INSURANCE Crhis section need not be completed if the permit is for one hundred dollars($I00) or less.) 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 Workers Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code.you must Z forthwith comply with such provisions or this permit shall be deemed revoked- ® 1 CONSTRUCTION LENDING AGENCY [—+ I hereby affirm that there is a consuvcdnn lending agency for the performance of CL the work for which this permit is issued(See.3097,Civ.C.) Lender's Name 04 .`4 Z Lenders Address U 0 1 cenry that 1 have read this application and state that the above information is LL.'-+ correct I agree to comply with all city and county ordinances and state laws relating to p U building construction,and hereby authorize mlimsentatvcs of this city to enter upon the U above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against bce) liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence or the granting of this permit, J v APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date ✓�� `��- SOURCE ULATIONS. Z�6 Re-roofs Signature of Applicant/Contractor Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code, Dyes o 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yrs �j V Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as fined by the Bay Area Air Quality Managcmenl all new materials for inspection. District? ❑Yes Nu I havc mad the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505.25 533 and 25534.1 understand that if the building dors nly have a tenant,that it is my responsibility to notify the occupant of the reyuiremp7iCy(3d}ich mttst be met prior to issuance of a Certificate of Occupancy. Signature of Applicant Date q, Zr.od Owner or authorized agent Date All roof coverings to be Class". 'or better � 0t CITY OF CUPERTINO CITY OF CUPERJINO GENERAL BUILDING PERMIT APPLICATION FORM APN # Date: Building Address: 5WAA1 P4-(o Mailing Address (if different from building address): Owner's Name. A ,� / Phone #: Y�u�TC-� /"t fK ;�-j Contractor: ��,L r� �3 Phone: J J -9 G Fax: 4 9z Contractor License#: Cupertino Business License#: C0 7 Contact: 'r Phone: �6&) -76 16o-o �ILiG �L4C� Fax: Residential Commercial ❑ Job Description: PC--f 1rtCC Dob 2 7}t IU7o Building Permit Info: Bldg &I—' Elect ❑ Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B _❑ II/III/V-A ❑ II/III B, IV-HT, V-B ❑��- Valuation: Square Footage: Project Size: Express []-Standard ❑ Large ❑ Major ❑ Green Building: Please complete relevant portion of 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 Green at www.builditgreen.org Revised 7/01/08 W CITY OF CUPERTINO CITY OF CUPEKrINO GENERAL BUILDING PERMIT APPLICATION. FORM Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM 1BBOILERI For the installation or relocation of ea M boiler/compressor to & including 3 horsepower, or ea absorption Sys to & incl 100,000 Btu/h (29.3kw) 1 BBOILER2 Installation/relocation of ea M boiler/compressor over 3 horsepower to & incl 15 horsepower, or ea absorption sys over 100,000 Btu/h 1 BBOILER3 Instal lation/relocation of ea M boiler/compressor over 15 horsepower to & incl 30 horsepower, or ea absorption sys over 500,000 Btu/h to &incl 1,000,000 Btu/h 1 BBOILER4 Installation/relocation of ea M boiler/compressor over 30 hosepower to & incl 50 horsepower, or for ea absorption sys over 1•,000,000 Btu/h to & incl 1,750,000 Btu/h 1 BBOILERS Instal lation/relocation of ea boiler or M refrigeration compressor over 50 horsepower, or ea absorption. sys over 1,750,000 Btu/h 1 BAPPLOTH For ea appliance or piece of equip M regulated by this Code but not classed in other appliance categories, or for which no other fee is listed in this code. 1 ELECINSP Other Electrical Inspections (per hour) E 1 MECHINSP Other Mechanical Inspections (per M hour) 1 PLMBINSP Other Plumbing & Gas Inspections P (per hour) 1 MEETING 1 HR Application Meeting B al- cayor Community Development Torre Avenue Cpe0rtino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 CUPEkTINO Building Department JOB ADDRESS: PERMIT# 102Vr(o VFt .�,W PL-aceo�f61?l R' OWNES NAME: hR� ILC. tr04117- 4"D F� �� PHONE # �o� GENERAL CONTRACTOR: FAX# I am not using any subcontractors: 4v 'f o� Signature Date Please check applicable subcontractors and complete the following information: 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