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05020110 Cary OF CUPt R•rtNO ��,, , > I� I I 1,11.,v�- BUILDING DIVISION PERMIT P'CON+TRACTnRdINT®RMATION r rte- �• ;� tom. 3�T si��::,., BUILDING ADDRESS: HAYEDE NIUFAR PERMIT N`05020110 791 ARATA WAY OWNER'SNAME: PERMITISSUEDATE HAYEDE NIUFAR 18791 ARATA WAY 02Z15/2005 ONE: SANITARY NO. CONTROL NO. ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 ?00 LICENSED CONTRACTOR'S DECLARATION ]Ob Description {Z C I thereby affirm that I am Iiccnuld under provisions of Chapter 9(commencing p e<U with Seelion]OlMpof Division 3 of Or Businuz and prufcuions Code.and my lumso is '.may imfull form,and effect. NEW SERVICE PANEL (125 AMP) License Class Lou.X c H O Dale Contactor Ln ARCHITECTS DECLARATION C`d< l understand my plans shall Las used as publicrecords )yU oG Licensed Pmfeasional S OWNER-BUILDER DECLARATION <I 1 hereby affirm that I am exempt form the Contractor's License Law for the p O following mann.(Section 712 1.5,Business and Pmfessimv Code:Any city or county which requires a pelmii to construct,alter,improve.demolish,or repair any structure $1000 prior set ill is mance.also ramires the applicant forsuch permit or f le a signed statement -�< inatneislicensed pursuant 10the provision of the Contractor's License Law(Chapter 9 Sq. Ft. Floor Arca Valuation sFo (commencing with Section 7000)of Division Sof the Business and Professions Carte)or that rte is exempt therefrom and the bum for the alleged exemption.Any violation of ®n Scedmi 7031.5 by any applicant for a permit subjects the applicant m a civil penalty of /APN4qjir*rrU not more than fin hundred dollars, (55(10). �a $y/I1�� std Occupancy Type 01,as owner of the proof or my employees with wages u their sole compensation. A)sq` N _/:a. will do the work,and Ne structure is not intended Or offered for sale(See 7064,Business -1.' Il O H and Professions Code:Tbc Carr actors Liman Law dose not apply to an owner of 411, Requires Inspe`tiioons propeny who builds or improves demon.and who does such work himself ore through his 9n own employees,provided that such improvements are not intended uro0cad for sale.If. <uo however,the building or improvement is sold within One year ofmarplaion.the Owner- �� C builder will ban Or burden of proving that he did not Wild or improve for purpose of 'D/A ✓ sale,). I,as owner of Ne(See .B exclusively contracting with licensed canvacma m ecowConstruct the project(Sec.o an Business and Professions code:)The Contractor's Lid ase Law encs not apply m an Owner of property won sed p or Improves;coutha;and wbense Lacts for such projects wimamnuaaar(s)licensedpursuams Convenor's License Law. ❑I am exempt antler 5 .B&P C for thisreawn Dwner`k Dale rNOR MFSC PEH A O D LA ION 1 hereby affirm render pcnah of perjury o of the following declarations I ban read will maialainaeeniB mofCorse to self-InsumforWorkerhCompen- sation,as provided for by Section 37M of the Labor Code,for me performance of the work for which this permit is issued. ❑I have and will maintain Worker's Compensation Insurance,as reyviaed by Section J700 of 00 Labor Code,for me pcRormance or the weak far which Nis permil is issued. My Workers Compensation Irsuanm card.and Policy number art: Cmaicr. Polity No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE t3Tu secom recd nal W completed Kthe permit is for anc hundred dollars ulg0 or less.) I Cuddly that in the performance of the work rot which this permit is issued,1 shall at employ aa, rsor many mann month omex j ctMthe Wortcrs'Cumpensa' . Laws of Cali Porn' Dm � a�->` n Applicant NQTICE TO MIPLICANT:If,after king thr eniR m of Exempt on,you should becomeh comply with the Worker's Com nWlionermitosof themed Code.. muse �Z forthwith comply wilM1 such pmvisin sof this permit shall Wdccmctl mvokctl. Z O CONSTRUCTION LENDING AGENCY I hereby which affirm that thew is sued Ike, Ch,agency for performanm of 34 the work fur rens this permit is issued(Sec.)097,Civ.C.7 �. '4 Q Lcnka's Name Zs z Lcndcr's Address J p I certify that 1 have read this application and sue that the above information is .L F^ building l agree m comply with all city and county nNiwrma and sum laws relating Iu Zi U above mentioned property hcmbyauthoniacmpresenalivcsofmiscity to enter upon llm C above (Wed a tee property for inspection proposes. x� J (Wed agree to save,inderandyexpenses and keep M1ay in an the City Of Cupertino idCtagainst r D rN liacmises,judgments,cmemand of Pis primhichthey in anyway seems against said City s ;J,'Z APPLICA T of the granting of this permit. APPLICANT UNDE 5 URGE REGULATIRSTAND COMPLY WITH A NON-POINT Issued by: Date ON . Re-roofs Signauitof Applic UCnna...a' "Dail" HAZARDOU MATERIALS DI CLOSURE Type of Roof Will the applicant ser(atom milting mc.P..L sorrc or handle bvudeus material ss dcBncd by the Cupertino id ipal Cwk.Chapter 9.13,and tW Health and Safay Code.Section 35532(x)? Q�� All roofs shall be inspected prior to any roofing.material being installed. 0 ❑Ycs Will IhdappliGuhmfulurc builJin6occupantvxdyuipmcntordcviceswhich If a roof is installed without first obtaining an inspection,I agree to remove mil hasardous air contaminants az�y Nc Bay Arca Air Quality Management all new materials for inspection. District? ❑Ycs 1 have mad the hararmms materials reyuircmcnu tooter Chapter 6.95 of Oc Calibre. ria Hcilth k Shicty Code,Seedma n5A.35533 surd 25534.I ookerhaM that if tltc Wilting does Out currently haw a tenant cspomibilitym codify that occupant of the remcnuu which mug or 4roo I Ccmr, actpa"da Signature of Applicant Date Owner ora mmired agent m Dae 5-Ora All roof coverings to be Class "B" or better Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 SUPERTINO Building Department JOB ADDRESS: ` PERMIT # 0S 0Z 01 / O OWNER'S NAME: -p b LX PHONE D GENERAL CONTRACTOR: Za 2 FAX # _ I am not using any subcontractors: Z�IS 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 Z-5 off Owner ontrac or Si ature Date CITY OF CUPERTINO CUP TYOF O PERMIT APPLICATION FORM N# Date: 3 0 Building Address: Mailing AdqesTaf different from building address): Owner's Name: Phone#: qq 4,�O S Contractor: License#: ar �� Contact: Phone: 417-a(,p(p Cupertino Business License#: r k2 c7 Fax: Building Permit Info: Bldg ❑ Elect Plumb ❑ Mech ❑ Job Description: ( ZS AtiR� Residential J C_ , Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: Occupancy Grou J7T1� c90 Type of Construction: 1 Please check this box if the project is a �w� Q second-story addition. ❑ ro'ect 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 IM Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILERS 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 BELEC200 Elec Svcs 600V<= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING te6(4 1 of 3 ��, Z CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housin 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 BPSPRD\K Lawn S rinklerBackflo PLUMBING BPSTORM Stonn/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 BRENUMHAN 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 > l OK btu MECHANICAL BREN=AT 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 BREMR.ESAPP Remodel Res Appliance ELECTRICAL 2of3 CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Sips Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee 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 Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Change BUILDING 3 of 3