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04100059 'CITY O'r CUPERTINO ` '' BUILDING DIVISION PERMCONTRACTOR"IINFORMA�IN „ - 4 +4, .nx z BUILDING ADDRESS: FIVE STAR WINDOWS PERMITNO.04100059 11140 CHADWICK 2L PERMIT LSSUEDATE OWNER'S NAME: STEVE & LAURA PETERS 1490 DELL AVE AWN E. SANITARY N0. CONTROL N0. 408 370- ARCHITECTfENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH Lo =oo LICENSED CONTRACTOR'SDECLARATION Sob Description �, I I L I I ) D I_ 1 hereby affirm,hal I am licensed under provisions of Chapter 9(commencing D iW❑ with Section]WB.fD1visi Sarum Business and Professions Cnda,and my licrom is - — inmurorteanderrect �_I' jpy�3�ji / ELECT. CANLIT. /SWITCH Loo ( LiSN amp Do¢ "'�- I - Vat Cmmncmr I,J[f Z� 2Otf4 ABC](]=- TS DELL RAT19N a'a I undcrs,and my plans shall M used as Public me.,Ja `LLU ���pppI�I��1�1()7 1p� Ips II Ip1 0 Licensed Professional V U 11�'! S OWNER-BUILDER DECLARATION 111111 lam. LJILJJ I hemhy adient Nal 1 em exempt from the Contractors License Law for the C a o following reason.ISecuum]1131.5.Business and Professions Cale:Any city ar county C $ which.quires a peemit u,eomxwn,cher,imp.e,demolish,or repair any amctun prior to its issuance.also outdoes,the applicant for such Permit Ola a signed stammer, ValDatlOD < than he is licensed purshom to the provisions Of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area x�S (commencing with Section 7000)of Division 3 of thecs e B usinand Professions Code?ser ca _ that he is exempt therefrom and the bass for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects dm applicant to a civil penalty of 39&N7,0"er00 Occupancy Type not more than rive hundred dollars(SSW). ❑I,as owner aline propcny,or my employees with wages as their sole compensation, will do lie work,and the swnuin is not intended or offered for safe(See.]Oaa,Business Required Inspections and Profession Cade:The Conmcmrs License Law does not apply,o an owner of tl p progeny who thaWsorimprovrs thereon.and whodecasuchwork himxlf ortlmugh his Own employers,provided that such improvements are no,intended oroRered for safe.If. however,the building or improvement is sold within one year of completion.the owner- builder will have the burden of proving Nal he did not build or improve for purpose of sato.). ❑I,as owner or Ne property,am exclusively contracting with licensed contractors m corslruel este project(Sec.704a,Business and profassion Coley The Contractor's U. axe Law dace not apply b an owner of property who builds or improves Merton,and who contracts for such projecm with a eontr tercels)licensed pursuant o the Comradors License Law. ❑I am exempt under Sec. .B&P C far this mason caner Data WORKER'S COMPENSATION DECLARATION I hereby dRnn under penalty of perjury one of the following okoh room: ❑I have and will maintain eCcni3am of me"h to selfe,fort for Worker's Compmr sa,ion,es provided for by Section 37W of the Labor Cade,for the performance of the Zwo k for which this permit is issued. I add d will maintain Workers Compensation lM1SunnCC.as required by Section ] of the labor Code.for the beformanceafthewort forwhich this pumitis issued. My Worker's Cnmlmnsauon Insurance canner and PolicyA,number am::I q_ Cartier. VC(YI'Yk:-lr`� Policy No.:/3OI-) f Il CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thu section need not W completed if the Permit is for one hundred dollars(3100) nr IcssJ ' 1 ratify that in the performance of the work for which this permit is issued.I shall or employ any person in any manner so M e become subject to the Workers'Compensation Laws of California.Dale Applicant NOTICE TO APPLICANT:If,after making this Cenificam of Exemption,you should become suhjecl,o the Worker'a Care cr s onion provisions of the Labor Code,you most .J O fonbwith comply with such provisions or this permit shall W deemed invoked. z CONSTRUCTION LENDING AGENCY PIherehyaffirm that them is a construction lending agency for the Performance of C > the wurs fur which this permit is issued(S5 3097,Civ.C.) [I]Q Lenders Name Lender's Addrtss V HOZ-. 1 certify Thal I have read Nis application and state that the above infaanaliun is Q W - correct.1 agree to comply with all city and county ordinances and state laws relating to O V building moswction.and hereby iuthome rcpresenlalives of this city to enter upon the r Lkl about-memiuncO Pmpcny for inspection purposes (•^ G (We)agate to save,indemnify and Meg harmless the City or Cupertino against / rn liabilities,judgments,costs and expenses«:hich may in any way atone against said City („),'� in ucnccyf the g tingEV—_1 ermit. 11 APPLI NT'UNDER OMPLY WITH ALL NON,POIr�r Issued by: Date. s� - l'U-II- U�j Re-roofs Sign.sere df AAcanuCon000 Data A2ARD0 S MATERIALS DISCLOSURE Type of Roof Will the appli ant or fusu c building neCtopam store or handle havardous material as defined,by the C coir Municipal Code.Chapter 9.12,and the Health and Safoy Code,SCNun 255S2(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Y ❑X Will thea secant or gra building Occupant axe e ,Ofdevires which If a roof is installed without first obtaining an inspection,I agree to remove applicant g o vmipmrn emit ha'rardoux air contaminants at defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes Nu I have mad the haaardous mattedulsrequircments under Chapter 6.95 of the Califon. ria Hcallh&Sa(cty Cade,Seeumm 8505.25533 and 853x.1 understand flthe Willing docs mol curtcndy.hmc.aman nL.Nal ikixmy responsibility Occupant notify the upant of d¢ requiromeaswhich Must he met poor toismanceoraComficaeofCocupamey. Signature of ApplicantDate owner ter amthariaca again Data All roof coverings to be Class "B" or better e • CITY OF CUPERTINO I 1 of 1 PERMIT RECEIPT OPERATOR: conniew COPY # 3 Sec : Twp : Rng: Sub: Blk: Lot : APN . . . . . . . . : 35617080 . 00 DATE ISSUED. . . . . . . : 10/11/2004 RECEIPT # . . . . . . . . . : 27372 REFERENCE ID # . . . : 04100059 SITE ADDRESS . . . . . : 11140 CHADWICK PL SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER STEVE & LAURA PETERS ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4705 RECEIVED FROM . . . . : FIVE STAR WINDOWS CONTRACTOR . . . . . . . : JEFFREY PICKARD LIC # 23690 COMPANY . . . . . . . . . . : FIVE STAR WINDOWS ADDRESS . . . . . . . . . . : 1450 DELL AVE CITY/STATE/ZIP . . . : CAMPBELLO, CA 95008 TELEPHONE . . . . . . . . : (408) 370-3331 • FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL -- -- - - -- -- ------------- - - - - ----- - - - -- ------ - - -- - - BREMFIXT NO. FIXTURES 1 . 00 1 . 20 0 . 00 1 . 20 0 . 00 BENERGY PERMIT FEE 83 . 16 39 . 92 0 . 00 39 . 92 0 . 00 BREMPOWER POWER UNITS 1 . 00 47 . 96 0 . 00 47 . 96 0 . 00 EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 BREMRECEPT NO. OUTLETS 1 . 00 1 . 20 0 . 00 1 . 20 0 . 00 BSEISMICRE VALUATION 200 . 00 0 . 50 0 . 00 0 . 50 0 . 00 ------- - -- ---------- ---- --------- - TOTAL PERMIT 129 . 15 0 . 00 129 . 15 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ------------ ----- ------------ - - ------- - - - CHECK 129 . 15 10257 TOTAL RECEIPT 129 . 15 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 103 UFER 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL • A- *CITY OF CUPERTINO* cITYOF PERMIT APPLICATION FORM ( tea 5 CUPERTINO / APN # Date: ,O " WO Building Address:-114o �(�& ��Mailing Address (if different from building address): Owner's Name: Phone#: Lk"m Pews 409- 2. S- Contractpr:- 1 License#: 67-193% 1 Contact: /�f 10VXVT- Fax: Building Cupertino Business License#: �` Fax: 'NO Building Permit nfo: Bldg ❑ Elect Plumb ❑ Mech Job Descrip Residentia Com rcial 47 / Sq.Ft. Floor Areh: $/Sq.Ft.: Cost of Project: Occupancy Group: Type of Construction: Please check this box if the project is a W(/I tGt.11lV C Q,r� second-story addition: ❑ lO o Project Size: 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 BELE 200 Elec Svcs 600V <=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3 �4' � 7�1 Z CITY OF CUPERTINO - - 'n" a• "' " BUILDING DIVISION PER CONTRACTORNF.ORMA`IIO N, _ BUILDING ADDRESS: FIVE STAR WINDOWS PEILMIT N0.04100059 1114 OWNER'S NAME: PERMTT LgUE DATE STEVE & LAURA NE: SANITARY N . CONTROL NO. 408 37 - ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH app LICENSED CONTRACTOR'S DECLARATION JIMED w❑ I hereby afOrm IMI 1 am li0c ucd under provisins of Clo p cT 9(commencingiWwithSection701X1)efDiHsi3ofthcBusilestandPforessinnxCode.andmYlicenxisinmuforeeand maI• �_i7bJ ELECT . CANLIT. /SW nz Licenx ass Lie» ^p Dam - I Cunlranro NOV 2t 2004 ly ARCHITECTS DEC R N �i ; 1 undenund my plans shall he used a p.hiie rtCards C. n� Licensed Professional ff tI p p, II /� `rot OWNER-BUILDER DECLARATION II II fl ®�ate,1I// — 1 herthy.(tion than 11. ,sumps from the Conlnaors License law for Iha II�JII L Iry1 XVII\\`r—/j/ C o following mason.(Semon]ensu Businessandmpr ve de iom Code:Any tiny s county which royuins a Permit ro emotes,,,alter,improve,demolish,or repair any structure _iy paeans becuedprote nt to the the inion Or for sahanniuoiec..geed summcm (commencing wJ Punuamoth,previsions ofi1a,ntsiness Lkcnselaw(LTupmr9 Sq.Ft. Floor Area Valuation yf C' (commencing wish Section 7(IlhO)of Division)of the Busines.+and Professipm Code)or 'y $ than he is exempt therefrom and the basis for on,alleged exemption.Any violaton of Section 7031.5 by any applicant for a permit subjects she applicant to a civil penalty of 3 9RN7,0"cr0 0 Occupancy Type om ream Nan fivehundred dellsrs(5500). . ❑I,as owner of the Apert,or my employees with wages as their sole compensation. _ will do the work,and Ne auucmrt is not intended or offered for sale(Sec.704x,Buainev and Profeuium Code:The Concr cin Li.Law arcs nal-pso an owner of Required Inspections pmpenywho builds orimprovu thereon,and who does such work himself or through his own employ=,provided that such improvements are not intended oroffefed forsale.If. however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that be did nor build or improve fm purpose of sale.). ❑1,as owner of the propeny,am exclusively comuacring with licensed convect.no co a uct the project(Sec.7044.Business and Precisions Cade:)The Conlraesur's Lt. cc=law drcs not apply to an owner of property who builds or improver thereon,and who contracts for such projec%with a contfacmr(s)licensed pursuant to the Contractors License Law. ❑I am exempt under Sec. .B&P C far this reason Owner Data WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty or perjury am:of the following declarations: I have and will maintain a Certificate of Consent to elf-insure rorWorlacesCompcn- ration,as provided for by Section 3700 of the Labor Code,for the performance of the we k for which this permit is issued. 1 have and will maintain Worker's Compensation Insurance as required by Section 7 of the labor Code,for the performance of the work for which this permit is issued. My Worker's!Compensation lnaumnee carrier and Policy mcnitur/�am: _ Carrier. FNt� r� Policy No.:It VI"177` . CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section tad not be completed if the permit is foram,hundred dolhu(SIM) or less.) I Certify that in the performance of the work for which this permit is issued,1 shall net employ any person in any manner an as on become subject to the Wmkers''Compensation Laws of California.Dasa Applicant NOTICE TO APPLICANT:If.after making this Cereficam of Exemption,you should become subject ro the Worker a Compensation provisions of Ne labor Chile,you must .JO forthwith comply with such provisions or this permit Shall te deemed revoked. zCONSTRUCTION LENDING AGENCY 'f-a r7w (hereby aflism that there is a construction lending agency for she performance of CL > the work for which this permit H Issued(S�3097.Civ.C.) La] Lenders Name z lender's Address / U Q I Certify that 1 have read Nis appLieraiml and a..ton Ne above ihano.dun is Q U. P correct.l agree to comply with all city and county ordinances and suss,laws relating to OU building consuiction.and hereby authoea mpresentasiver of this city to enter upon the W ahovcmcntioncd propcny for inspcnl ores. (, y (We)agree to eve,indcmnif and cp harmless the City of Cupcnin r against pI liabilities,judgments.costs and ex hick may in any way accrue against xitl City U in con same yytt me ming (tris. rmit. ` ^' APPLI tyT'UNDER tJD W L OMPLY WITH ALL NON-POI�'{�' Issued by: Date SOU TI a t I- d Re-roofs Sign erep rA 111111��1lllTTpppp UConuacl Dau / AZARDO 5 MATERIALS DISCLOSURE Type of Roof Will the appli am or fl�fu c building acupant stem or handle haeudous material as dcOnc�,dhc�SslCrlrm Municipal Code.Chapter 9.11.and the Health and Safety Cork.Sectrems5 24)1. All roofs shall be inspected prior to any roofing material being installed. E3 Y. ❑ Will the applicant or ruthe building occupant ase equipment or devices whim -If a roof is installed without first obtaining an inspection,I agree to remove mit hooardnus air Contaminants as dcOncd by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes Nu I have read the hanNaus mmcrisls requircroenu under Chapter 6.95 of thc Calif., ria Health&Safety Code.Seeaum 25505,15533 and 2553x.1 undersand Nat if tM building docs mol Currently isms a mink Wal it is mY reaporoibilitY m.061Y the occupant of Ne regeiremenLa wham must he met poor in issuance of a Ccmrcau,of Occupancy. Signature of Applicant Date Owner or aamorioed ag,nt Dal, All roof coverings to be Class••B" or better