06120030 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMITCONTRACTORI�IFORN,[ATION
BUILDING ADDRESS: ALLBRAND WINDOWS PERMR N0.06120030
OWNER'S NAME: PE 34TT ISSUE DATE
jOk PAN YULIE 551 INDUSTRIAL RD 12 /11 /2006
NE: SANITARY NO. CONTROL NO.
(650) 622-0330
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION lob Description
1 w I ion It .)mitre that 1 Me l'nenWtl under Provinces.(chapter 9(cnmmmeing
wit Section 7sl(pt of Division 3 arts Business and Professions Code.and my license is
,HN imfall r.n.anderrg S REPLACE WINDOWS
i F CZ Dao: Canuacar
ARCHITECTS DECD ATIO
i I understand my plans shall W used an public records
:.0
LL o, Liccnad P iromonal
're3 OWNER-BUILDER DECLARATION
I herby alTirm Nal I am exempt into We ConuacmYa Licunce law rat the
p o following wan.(Sec6an 7f)31.5.Business and Professions Codc:Any city ser coumy
<m which implies a permit as construct.alter,improve.dcmnlih,mr¢pair any structure $1060
ui< prior m its issuance.MIs requires the applicant for such permit ue file a signed statement
tat he is licensed pursuanno one provieioot of be Contractor's Liccnrts law(Chapter 9 Sq.Ft.Floor Area Valuation
(commencing with Section 7=)of Division 3 of the Business and Professions Code)or
e3$ dot he is exempt tmefrom and to btu far to alleged examption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3AW f4jjfiMF Occupancy Type
not mart tan five hundred dollars
❑I,uownet of the propuny,mmy emplaycu wit wagnm te'v sok compcwdon,
Maid Pr Maes Mart and thestructureranalintended seraw it fatsalt(Sec.in at.,Budrcss
and Pray he
tae:The C dimear.And
law aces nal apply m an rout.of Required Inspections
pmpeny who builds mimpravu Neiman,and who daenoteh work himself at trough his
awnemployru,provided Inori tat such improvemuits see trot ear oft opted n,for sat..B,
however,the have
Me or improvement is sold within Act
year of improve
for this owner,
builder will Nve Mac burden of proving Cast k did ret htiW m improve far purpose of
AMC.).
❑1,u owner of the prpeny,am eaclmivuly containing wit licensed camrantme so
corutmct this project(Sec.7064,Business as Profusions Coe:)M Comeactofs U.
came law don not apply to an owner of propeny who builds or imprvu thereon,and
who Contracts for such pmjecu it A cantonsun at licensed pmsuam m Me Canusetor,
License Law.
❑ 1.m nempm under Sea. ,B k P C far this won
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby aflum under penalty of perjury one of to fallowing declamfiau:
I have and will maintain a Cmtifinse of consent to self-insure far Warkefs Compen.
Milan.As provided far by Section 37M of to Labor Code,for to perfmmance of the -
work for which his permit is issued.
j?kf'f have and will maintain Workce,Campensmion Imran.,as required by Section
370(1 of to labor Cads.for the perfurmanec of this work fm which Mass Permit is ounce.
My Workers ca Pecona Insurance mer and Policy number art:
Camricr. F Policy No.:
CERTIFICA OFEXEMMONMOMWORKERS'
COMPENSATION INSURANCE
(Thu Auction reed nut beeamplated if Mac Permit is Intone hundred dollars($10()
nr I...)
1 certify tm in to performanec of to wart for which tis permit is issued,l shall not
employ any person in any manner so As m become subject in do Workers'Compcnsmion
Laws of California.Dote
Applicant
NOTICE TO APPLICANT:If,ofcr making this COME=of Eamption,you should
become subject b the Warkcts Compensation provision of be Labor Coe,you muse
z 10MW lth comply wit such loovisinn or tit Permit shall be deemed evoked.
Z D' CONSTRUCTION LENDING AGENCY
[-a 1 hereby aRhm tam there is.coutruction lending agency for the perf....of
eL > to Mark for which this Permit is union(Sec.3097,Cil ret
a25Landels Name
:D z Lender's Address
V Q 1 anify tat 1 have mad this application and cute that the above information is
IL F correct.I agree to comply wit At city and county ordinances and Mile laws relating to
O C.1 building construction.and hereby aumhome representatives of this city to crcr upon the
purp
W ab.vC-mjudgm es,ca y(for eSpenes which may
F y (We)agree to save,indemnify and kap harmless to City of Cupertino!gamut
Z incoitiuticum,Or the
Of thiseswhich may inany way.terve against said City
V Z inconsequence of this granting of this permLL
^ APPLICANT UNDERSTANDS D WILL COMPLY WITH ALL NON-POINT Issued by: Date
Sp �i t P2�
REG NS.
�� ( (/ta
Sngnmure of Applican✓Canuacror pale Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will to applicant or future building occupant vat or handle hvallou material
As define by the Cupenino Municipal Coe.Chapter 9.12,as the Healt and Safety
code.Seaton 25532(a)?Oyinspected All roofs shall be prior to any roofing material being installed.
Will to applicant or future building us:apart use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove -
cut,ho.oktur air contamiranrs As de0ncd by to Bay Arca Air Quality Management all new materials for inspection.
District?
Yes
I have mo the Woodcuts materialsmquiromems under Chapter6.95 of Mac Califor-
niaHcaltk Safmy Codc,Secdons 25505,25533 0d25534.1 uaerstao tatifte Wilding
does not 9wentlk h.ve a am ',Wt Il' my respome.ta ity m andfy w occupant of to
require msw 'hma tpiior OMece yfseerdficateorOccupan Signature of Applicant Date
N �4 t2�I 1 016 All roof coverings to be Class "B"or better
Owner or autarized agent pale' g
CA
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COPY
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12/04/2006 17:26 16506220320 WINDLIW-'( I .-CZM--0j -NAIL -04/27
c%
i
JOB NO A01111175 DATE 12/512006
MEASURE TECH PAUL BORDEWICZ TIME 141 prn
Items Notes
Anderson Assemb
Be Roof
Bow No Roof
Build U s
coil w
Cut Down
Cut Posts not structural
Cutti Steel Frame susi
Door IS 6&8
Door 9,10&12
Electrical move outlet for cut down
Ent Door Double w/sidelights
E Door Double
EntryDoor sin to wiside' hts
E Door sin le
Exterior sill MetaVvin SiII Ca
French Door Double w/sideG
French Door Double
French Door Sin le wlsideli hts
French Door Single •
Garden New Const w/Flashing`
Garden Retm Installdtion `
IG units
Inside New Wood Sto
Iron Bars take down
Jamb&Case
Jamb&Case Trim Kit
Jamb ExtensionlL-Trim
New Const.on Rough Frami Onl
Now Const.Wimtows w/Flashi
New meaderfRafrannim Included Inside Flnishin
New Wood Stool
other take hoto rhour
Out Side Wood Trim
Reframe O enin 1 Build Post
Re lace Framin
Roof for Be
Roof for Bow
Roof Metal for B
Roof metal for Bow
Sheetrock for Build Up itnClUdes to mete,comers
Sid for Build U
Stucco for Build U
Stucco for New Construction WffidowsiDoors
Stucco from Door to Window Build U
Windows
Please make sure you COMPLETE this form A TURN 1N on a LY Dads. Your bonus pay will •
be hased on the axurecy of your written 6domtedon. Thank you.
CITY OF CUPERTINO
2 of 2 PERMIT RECEIPT OPERATOR: bethe
COPY # 2
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35920040.00
DATE ISSUED. . . . . . . : 12/11/2006
RECEIPT #. . . . . . . . . : 36993
REFERENCE ID # . . . : 06120030
SITE ADDRESS . . . . . : 20816 MCCLELLAN RD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : PAN, YULIE
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : ALLBRAND WINDOWS
CONTRACTOR . . . . . . . : JACEK PASTERNAK LIC # 24829
COMPANY . . . . . . . . . . : ALLBRAND WINDOWS
ADDRESS . . . . . . . . . . : 551 INDUSTRIAL RD
CITY/STATE/ZIP . . . : SAN CARLOS, CA 94070
TELEPHONE . . . . . . . . : (650) 622-0330
OE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
BENERGY PERMIT FEE 1.00 34.86 0.00 34 .86 0.00 '
BPERMFEE VALUATION 1, 060.00 83.16 0.00 83.16 0.00
' BSEISMICRE VALUATION 1, 060.00 0.50 0.00 0.50 0.00
BPLANCHK PERMIT FEE 1.00 83 .16 0.00 83 .16 0.00
----------
TOTAL PERMIT 201.68 0.00 201.68 0.00
METHOD OF PAYMENT AMOUNT NUMBER
__________________
OTHER 535.70 VISA
TOTAL RECEIPT 535.70
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Community Development
10300 Torre Avenue
Cupertino CA 95014
4 µ
Telephone(408)777-3228
CITY OF Fax(408)777-3333
#UPEkTINO
.Building Department
JOB ADDRESS: PERMIT #
20916 cclella Ca 1 D 6/ Z- 3 6
OWNER'S NAME: u LC/ � PHONE #
GENERAL CONTRACTORb„y. , 'o, , FAX #
I am not using any subcontractors:
Signature
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
_• 1
2
Owner/Contractor Signature D to
SP CITE' OF CUPERTINO
CUP TY' OF PERMIT APPLICATION FORM 04Qla0O D
APN# ;26� Date:
12- 11 /06-
Building Address: Mailing Address (if aiffereAt from building address):
focciellawG., �. CP)
Owner'sNam • Pho e#:
e � ,. . .36 - I
Contractor: License#:
A 11 X27 _T-
Contact:
Contact: Phone: 180o)4pD-0?q? Cupertino Business License#:
0_6 l3 as�t 1 Fax: 65o 6
BuildirIgPernit Info:
Bldg Ly/ Elect ❑ Plumb ❑ Mech ❑
Job Descriptio:/
Residential L Commercial ❑
Sq.Ft. Floor Area: Sq.Ft.:
Cost of Project: Occupancy Group:
I 060 \2-3
Type of Construction: Please check this box if the project is a
second-story addition: ❑
*roject Size: Standard Large �E] M�ajor
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> I OOK to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to 1M Btu MECHANICAL
BBOILER4 Boiler> IM 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 <= IOOOA ELECTRICAL
BELEC1001 Elec 600V > 1000A ELECTRICAL
BELEC200 Elec Svcs 600V <=200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Ener y Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
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,�,pvt
CITY OF CUPERTINO
ciTYOF - PERMIT APPLICATION FORM
CUPEkjlNO,
Quantity Fee ID Fee Description Fee Group
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 Pblg 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 Storm/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> IOK 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
BREMRESAPP Remodel Res Appliance ELECTRICAL
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i✓d ? 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, Mar uee 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
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMFEE Mechanical sq. foot MECHANICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
PLLONGRNGC Planning LR Comme/ Multi-Fam PLANNING
PLLONGRNGR Planning Long Range Residential PLANNING
ZADDCHG Address Change BUILDING
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