07120260 CITY OF CUPERTINO
BUILDING DIVISION PERMIT11I1TX
BUILDING D ESS: PERMITNO.
11��1� SUTHERLAND AVE AMERICANVISION WINDOWS INC 07120260
W ER
NER'S NAME: PERMIT ISSUE DATE
TANI STEVEN N AND PATRICIA D 1050 E DUANE AVE #H 01/18/2008
PHONE: SANITARY NO. CONTROL NO.
(408) 617-0901
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
9LDGO ELECT PLUM MECH
� 0
300 LICENSED CONTRACTOR'S DECLARATION
uJ 1 hemhy,&Man Nn I am livened under provisions of Chapter 9(rommencing Job Description
with Sccdon 70110)or Division 3 ofine Business and Pmfeaaiov Coda.and my license is REPLACE 1 ENTRY DOOR W/SINGLE ENTRY DOOR
to
fflltome aliveft —7-7ue
5qz ulif s Lk.g -7-7 }/SIDELIGHT
nF- DamCone ^/ d
ARCHITECTS DECLARATION
ee I understand my plan shall newed at public records
yLicensed Profcuionel
m 3 OWNER-BUILDER DECLARATION
Commodes
Z Q 1 hereby.(Sw Net 1 1. exempt from ma Can ons;Co License Lew far the
O O following msson.(Sccdon]831.5,Business and Rvfcssiav Cam:Any city m county
K$ which requires a permit to eamadow.alma improve,demolish,or repair any aumuro
Valuation
prior ne its women,also winner the applicant for such Permit he file a signed,tatemem
< that he k licensed Durward to the provisions ofmc Conwncm/s License Law(Chapter9 Sq.Ft.Floor Area $g550
B (commencing wit Section 7000)of Division 3 of the Business and Profession Code)or
tet he LL e
exempt therefrom and de basis far de alleged emptiom Any violation or
Sccdon 7031.5 by any applicant far a permit subjects to applicant in a civil penalty of ,p7�Number Occupancy Type
not mom than Bra hundred dollars(glom. 3 5 617 0 6 3?tl V
❑L m omen of the propcny,army employees with wegv ws deir ale wmperommt,
wE domewmk..nd
and iobu Code:eTaheumumlnLLcmmYtks enande,Law dowan,
apply.an anowner of
Required Inspectionsections
property who pdaorimpnes andlawo maswhwohhmeBar trough his
awn ems.provided died sushimprovements am not retl for .
ver,the buil or imPrrowmentaptdtnarm your oftempledm,the owner.
Wilderwill low the hard=of goosingmat e did
not build or improve for purpose of
❑1,as ower of the property.am exclusively conaaming with licensed rontnemn m
..net de pmjem(Sec.7014,Business and Profusion,Cade:)The,Ce mat:mrs Lt.
comeslaw dean not apply be an owner of property who builds or Improve daemon.and
who conrraLL for meat projects wpm aconwemr(a)licensed pursuant m the Contractor's
License Law.
❑I am exempt under See .B k P C for dais mason'
Few Dae
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury am of the fallowing dec radon:
❑Ihaw and will mainuinaCeNfiwta afComm�dmself-ivumfarWarker'aCompen-
sation,an provided for by Section 3700 of the Labor Cade.for dm performance of to
work for which dais Farrah is issued.
I haw and will maintain Worktf Compemation Insursnce,as required by Suction
3700 of the labor Code,far to performance of the wmk for which Its permit is issued.
My Worker's Compemedan Tomorrow carrier and Policy number are:
Carrier:J6AmoYe-es Od(gl?vi I -Pollry No.: t&)L—L's"O`(ST— O
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(7bu auction wed not k completed if the Permit Is forms hundreddadats(SIW)
or less.)
1 cattily deal in the performance of to work for which tis Permit Is isswd,I shall not
employ anypermn in any manses as to become mbjwt in to Wormmn Compensation .
Law,of Califomia.Dem
Applicant
NOTICE TO APPLICANT:If,after making this CeniOwm of Exemption.you should
become staff.as to Wohets Conatums lice provisions of the Labor Code,you muss
Z forthwith comply with men provision or thio permit shall k deemed terminal.
tiCONSTRUCTION LENDING AGENCY
[--t I hcmbyafhthi metmert i,awmwclending agency for me performance of
ai work fur which this permit Is issued(Sec.30 3097,Cih,C)
Le
W Q landets Name
.7 z L<ndefs Address
V p 1 certify that 1 have mad this application and some that the have information is
w^', correct 1 agree in comply with all tidy and county onlimmus and sum Iowa relating at
building construction,and hereby mthadm mpmaentadws of this city in caw upon to
F37 ahove-mentionod property run impecdan purposes.
day,,pyt (We)agree to saw.induanify ad keep baseless to City of Cupertino afralmt' _
fq Iimilidw,Judgments,costs and expemv which may in any any aceres against said City
O',Z in consequence of the Stating of dais permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date On 7eC
SOURCE REGULA 1
t \B ° Re-roofs
mayor nu DO Da
AZor Et building
DISCLOSURE Type of Roof
W pCupentar fMuni Municipal
Code.Chaptemaor handle hewItanmaterid
u defined by me Cupertino Municipal Code.Chapter 9.13,and to Huelth and Safety
e,Section 35533(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yue C4?
Will to applicant or future building ocwpeam use equipment or damew which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as defined by tic Bay Am.Air Qwlity Management all new materials for inspection.
Dimict7
❑Yw OL
I hawmud dteh ...mamdalsmquimmenwunderChapw6.95ofineCalifor-
niaHcalt&SafctyCoM,Sx6om35505,35533uud25534.1 urArnmd muifmc Wilding
drew not currently haw•moat,ser It is my responsibility in entry tic awupeal or to
mqulre LL which must kneel prior m issuance ar.Ccliftcate ofOccup Signature of Applicant - Date
Q' All roof coverings to be Class"B"or better
Ow r sat d a arc
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CITY OF CUPERTINO
BUILDING DIVISION PERMIT +C�NTCTQt INFURMtTI01�1;
BUILDING A DRESS: PERMIT NO.
1119 SUTHERLAND AVE AMERICAN VISION WINDOWS INC 07120260
OWNER'S NAME: PERMIT ISSUE DATE
TANI STEVEN N AND PATRICIA D 1050 E DUANE AVE #H 01/18/2008
PHONE: SANITARY NO. CONTROL NO.
(408) 617-0901
ARCHITECI'fENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
o p LICENSED CONTRACTOR'S DECLARATION
V)= I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description
:z with Section 7000)o!Division 3 of the Business and Professions Code,and my license is REPLACE 1 ENTRY DOOR W/SINGLE ENTRY DOOR
t s a in full forceand eft
ti7.ZLicenscCl �7
W/SIDELIGHT
❑ Date O ConlractorApIMCAw1VDt0-J
12m 1 ARCHITECTS DECLARATION
'< I understand my plans shall be used as public records
1yU
'u•�' Licensed Professional
e y
OWNER-BUILDER DECLARATION
I a Z.: 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 Conswct.alter,improve,demolish,or repair any structure
z?y„ prior to its issuance,also requires the applicant for such permit to file a signed statement
< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
t=-❑ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $9550
that he it 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 penalty ofNumber Occupancy
not more than rive hundred dollars(5500). 35617063 Aff p y Type
❑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 Contractor's License Law does 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.).
❑1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractors Li.
cense Law does not apply to an owner of property who builds or improves thereon,and
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's
License Law.
❑I am exempt under Sec ,B&P C for this mason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations.
❑I have and will maintain a Certificate of Consent to self-insure for Workers Compen-
sation,as provided for by Section 3700 of the Labor Cade,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
3700 of the Labor Code,for the performance of the work for which this permit is issued. '
My Workers Compensation Insurance carrier and Policy number are:
L�-
Carrier.'tAMPt.OYt'JGS
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not he completed if the permit is for one hundred dollars is 100)
or less.)
1 cenify 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 Workers'Compensadon
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 Codc,you must
Z forthwith comply with such provisions or this permit shall be deemed revoked.
O CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance of
1i > the work for which this permit is issued(Sec.3097,Civ.C.)
QLender's Name ,
z Lender's Address
0 1 certify that I have read this application and state that the above information is -
7r ..r correct.I agree to comply with all city and county ordinances and state laws relating to
Ubuilding construction,and hereby authorize representatives of this city to enter upon the
W above-mentioned property for inspection purposes
y G1w (We)agree to save,indemnify and keep harmless the City of Cupertino against
:.t Co) liabilides,judgments,costs and expenses which may in any way accrue against said City
Z in consequence of the granting of this Permit /
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULA .--
18 ° Re-roofs G�
Signator rf c nractor Da
AZARDOUS MATERIALS DISCLOSURE Type of Roof
pplicant or future building occupant atom or handle hm2rdous material
as derincd by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Codc,Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes C4
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,.1 agree to remove
emit ha72rdous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
District?
E]Yes lu
1 have read the ha72rdous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Codc,Sections 25505,25533 and 25534.1 understand that if the building
does not currently have a tenant that it is my responsibility to notify the occupant of the
require nts which must be met prior to issuance ora Certificate of Occupan y. Signature Of Applicant Date
Q'
Owr auth '.d a All roof coverings to be Class"B"or better
arc- �
� _ - CITY OF CUPERTINO
0 OF
CUPEI�TINO GENERAL BUILDING
PERMIT APPLICATION FORM
APN# Date:
56t 1-7 t (03 , 0 0
Building Address:
Mailing Address (if different from building address):
Owner's Name: Phone#:
AN —S�Ooq
Contractor: Phone: 6( 7— O(O/
/`gym Z��1 li��► C Oak)-C 1 YA C-1 Fax: �0
Contractor License#:
Cupertino Business License#: ( (} (9 [
Contact: `D j� Phone: G'/ ? Oq d/
Fax:
Residential ❑ Commercial ❑
Job Description:
Building Permit Info:
Bldg 91--' Elect ❑ Plumb ❑ Mech ❑
Type of Construction(Usage Class): Occupancy Type:
1 FR, 11FR ❑ 11, 111,V-1HR ❑ 11, 111, 1V V-N'q— �-
Valuation: Square Footage:
VT
Project Size: Standard ❑ Large ❑ Major ❑
3'
CITY OF CUPERTINO
CITY OF
CUPEKFINO GENERAL ]BUILDING
PERMIT APPLICATION FORM
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
113130ILERI 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)
113BOILER2 Installation/relocation of ea M
boiler/compressor over 3 horsepower
to & incl 15 horsepower, or ea
absorption sys over 100,000 Btu/h
11313OILER3 Installation/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
11313OILER4 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
11313OILER5 Installation/relocation of ea boiler or M
refrigeration compressor over 50
horsepower, or ea absorption sys over
1,750,000 Btu/h
1BAPPLOTH 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
IMECHINSP Other Mechanical Inspections (per M
hour)
1PLMBINSP Other Plumbing & Gas Inspections P
(per hour)
1MEETI]vG1HR Application Meeting B
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
C1TY OF Fax(408) 777-3333
CUPEkTINO
Building Department
JOB ADDRESS: PERMIT #
///2q �� �� � 6 Z �
OWNER'S NAME: PHONE # (`� — d Sa
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors:
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