The URL can be used to link to this page

02030225clBUt OF c pr DIVISION PERMIT CONTRACTOR INFORMATION: R1IIL114G�,Dr6513YSHIRE DR PERMIT No 02030225 ryaJt.P IS,fE:& ANDALUSIA KHECHFE LV L" AvpL`cyTJpp(s�IB,k)ts'[!:2 \ PR�iO1N�lE1 SANITARY NO. CONTROL NO. ARCHIT[CT/ENGINEER: BUILDING PERMIT INFO - BLDG ELECT PLUMB MF -CH LICENSED CONTRACTOR'S DECLARATION I hereby affirm that l am licensed under provisions.(Chapter 9 (commencing I 7000) ADD pp �tttf J b R 7 6 5 S/� FT SQ.FT. with Section of Division 3 of the Business and Professions Code. and my license Isle Poll force and cHen. License Class Lic. p . - Dam Commune, ARCHITECT'S DECLARATION i 1 understand my plans shall b= umd as public mrom. r DG O 2002 5 Liremed Professioml - OWNER -BUILDER DECLARATION 1 greasy aRrm that 11. exempt from the contractor's Any c Law for the 7031.5, Business and io Any city or county my followingreason.a. permit $102000 BUILDING h,me: t which requires a permit to mower, alcor, improve, demolish, or repair any mm�um demolish, w. de j.-prianoit, issuantt. also rtquires the applicant for such permitmRleasigned smtemem - mtji r n:api?alt m<p ,' sanneconaa<tor:L ha (cnipmr9 (co n8 with Sen 7o(0y f Division 3 of the Busmen d professionsGoer) 35�.�3.(FRfi3r:eAi@a-Ya ..,,', Valuation t� \ ` (it yC i : r or that he it exempt theirfrtom and the basis for the alleged dwnptmn. Any violation . . li. ! .! V L- \J a 1:3 -of Section 90315 by any applicant for a permit subjects the applicant a civil penmly, or not mom than rive hundred dollars ($50(h. 101AP�k'` b&UNDATION ..t..... Occupancy Type 01. as ownerofthe property. onny employees with wages as tneirsole compensation, 102 — PIERS will do the work, and Me'swcmre'is not intended im offered far sale (Sec: ]011, (Business and Professions Code: Thc Contractor's License Low docs not apply to an - - - - 1 - U Required Inspections''' ox' r of prnpeny Who bmlda or improves thereon, and who dos such work himself 104 – REBAR or through his own employees pmv den that such improvements not intended or -bf@eaafon sale If gowner thebuildingerimprovement :'s old W,ms within notb of --""'"."--'10.5 -'"ANCHOR' --BOLTS--—'- completion, he did improve t the ower hu leer will have the burden of proving Mm he did not bulla or- mproverorpiryosrotsaml. 106 – SEWER & WATER l us owner annep pear ly g 'ihi a sed tractors is – "202--- –UNDERFLOOR—PLUMBING' PLUMBING - construct the pmirm (S 7014 Business d Professions Cod ) Th c wctora License Law dos not apply m an owner of property who builds or improves thereon, 203 i – UNDERFLOOR MECHANICAL --- , ad who mnwcts forsu ah-prjeco,with.stortmems)licensedpursoamlo.m=.._._......_ contmrmrs 'cert e ❑lam ".is'&P.0 204_._. UNDERFLOOR -_FRAME...__.—___. _ =ie' 205 – UNDERFLOOR—INSULATION ,a�� -^ 301 – ROUGH PLUMBING OR OR [R'S COMPEIJS'gylON DECLARATION - ' - 5/ / 302 - TUB & OR SHOWER "• Inrrtbyarrwindrtpenohyorperjuryoneoflh<(ollowingdttlamtions: 303 - ROUGH MECHANICAL ' D 1 have and will mainmin'a cemreate of Consent to self insum for workers 3 04 - ROUGH ELECTRICAL Cemar ani... as ...video for by Section 3700 of the Libor code. for the peHnwance ar tn<wark mr,.nien Ims petn,il i., ia,:m, 3 0 5 — FRAME ❑ I have aaa win'maiataidWake, s Compensation Insatiar , as eaquiree by section 3 0 6 - HOLDOWNS 37W of the Labor Code for the perforinance of the work ter which this permit is � 3 07 - INSULATION iseu d My W k s Co pensat 1 um currier d Poly be '. – 308 SHEETROCK rs+Pot yNo, ..t- - f CERTIFICATIONOFEt(EMPTIONFROMNoRKmR . t_1). a.30;9;,-{-EXTERIOR'eLATH. COMPENSATION INSURANCE' u ..:t..crns _. 31.0;-.,.—INTER-IOR_..LATH ---. _------------- sand'aandtxrompinedam<n=tmnrsroron<nondrtdaanars 3-- 11%,_•. SCRATCH COAT r., ($1001 or less) • nfynti n n sot -i -*r n�nmspr F' ... .._...-313- _ROOF.,NAIL=.,=.. person shall tem 1 ny pe anyMoore,so a m becomeobjecto the Workers 501 – FINAL EliECTRLCAL' ENERGY'' corp m°�wsgrMe cll ,"Iiriuru L' 503 FINAL PLUMBING EN ENERGY FINAL MECHANICAL'�ENERGY ' t NOTICE Trad,, hCANTI'rt making this crtraat<fE pt yoyua In ec esubjecun the Workers Conpensal nprovii ore of th Inbar Code, you muss fang with comply withmch provisioas or this penmh shall be deemed revoked. 504 – FINAL BUILDING ENERG� " CONSTRUCTION . " -505 - FINAL ELECTRICAL -- - Ih"byarfrmNatthamisacon.d(Sea l<ndmgoge cyfor thc performanm do a umk for which this pewit is issued (Sec. JU9], Civ. C.) ";' Leed<rs 506 – GAS TEST ' t.l'. - :.......:.. ......... _..:,.., .. Nano, un err: Aaeress ' ......507-- FINAL- PLUMBING -. .. .. _.. - 'l certify that l loommid Nisapplicetioa and anummiumaj arve information is 508 - FINAL MECHANICAL maintain. agree ro comply with an city and repramminagces and stem laws ealatmg ofthii city to rnmr upon the 509 - FINAL GRADE / above Jornamadpropndy for speedamairnpuprcsenmtives the ebovennemioned property far inspection,purpous. 510 - FINAL PLANNING (w cetosave.indcignifyindkeepharmlesstheCityofCu4nindagainst liabditi , jo nta, Is and uses which may in any way accme against said 514 y - FINAL PUBLIC WORKS ( City' co ce rimsf thIPNOt.' APP .ICA. DWILCCOMPLY WITH ALL `yp FN' `$O :RCEI N. ONS. ✓ /d n V Issued by: Date gni ..t or AMadery rantraaor `, 11 .. .. .. •` Da Re -roofs /. RE '�'"" WIIM appl�zaanoubMcodmcna �stomora�cHealtamoo.'d .nal as Eeiedb -_ Type.Of ROOf.. Ih Cu rtnoM P fety - _ .•. .- ...-.. __ - -".�' Code Seton 2553211 r 'OY a:,/ •• r . roofs shall be inspec(ed pnor to_any roofing material being installed. Will theaapplicant future Nordin c e nt ase . i e t devices ahemich mil h zardo r cnnmmmams az nefinetl by th Bay Arca A Quality hlanbg<mem If a roof is installed without first obtaining an inspection; I tagree,t0 remove Distinct, - pv all new materials for inspection. A Itcant-understands and will comply with '.-.egllati * - -- pp all ntin=poitiC source � v .-- - - -- 1 h e cad the samovars tori I. q ,m ants and Chapter -695 of the califnno Han"' &Sorely Code, Srdt ons 25505 25533 and 25531, l understand that ,-it I g s not r wetly have a mount- that it is MY maponsibillty to notify the nt o t qui his vrhicM1'inun be met prior I. issuance of a CertiBcam of , s c t ' - k / _ Signature of Applicant _ Date _ All roof coverings to be Class "B" or better own m raea,agmt Date .: ..OFFICE" -- CITY OF CUPERTINO PERMIT APPLICATION FORM APN #3 i0 Z - 2-1- D 2 ., Fee Description Date: Building Address: 11C17, % ire �,Q GU P6�+2T/�v U Owner's Name: AMl,ve 4-4A/DAL u.5/ft y Phone #: !/p 8 - Z S - 9.3 2 - 78,6 Contractor: %gP MECHANICAL BBOILER2 License #: Contact: BBOILER3 Boiler > 500K to 1M Btu Phone #: Applicant/Contrac or: Mi,�r�cN�,E Boiler > 1M to 1.75 M Btu MECHANICAL Fax #: So - uilPermit Info: MECHANICAL BCONSTAX Bldg (ect �) Plum Mech esaon: Residential: l: 157aiQy A4bi770A1 Co r . Sq.Ft. Floor Area: Con. Tax for BQ Zone $/Sq.Ft.: Architect/Engineer: Hotel and Motel BUILDING Valuation: Constax - Resi/Mobile BUILDING BELEC1000 0e- 0C> Type of Construction: V BELEC1001 Elec 600V > 1000A y roup: Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING 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 BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BRWESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING 1 of 3 cl 0 tF0- ¢ Z u rn¢d E—NZ $No U 0O a U rn J 700 X tr F Z Q f 21 a3— Oz z° CITY OF CUPERTINO BUILDING DIVISION PERM1f'p' � ) 1�� BD��VIMBYSHIRE DR O"OvE& ANDALUSIA KHECHFE PHONE: ARCHITECT/ENGINEER: LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class Lic. N Date Contractor ARCHITECT'S DECLARATION 1 understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the " following reason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement that be is licensed pursu2nt to the provisions of the Contractor's License Law (Chapter 9 (commencing -with Section 7000) of Division 3 of the Business and Professions Code) or thai he is exempt therefrom anp the basis for the alleged demptibn. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500). ❑ 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 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.). as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractor's License 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 Contractofs Wen 01&1 ampxe , B & PS',`for is rens n �w'pFr � 2t� /' r' OR R'S COMPENSPQfgN DECLARATION I hereby affirn under penalty of perjury one of the following declarations: ❑ I have and will maintain a Certificate of Consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for whish this permit is issued. My Workers Compensation Insurance carrier and Policy number arc: Cartier: ' Policy No.: CERTIFICATION OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars IS 100) or less.) 1 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 Califomia. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption. you should become subject to the Workers Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) Lender's Name Lender's Address I certify that I have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby'authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. (WAle to save, indemnify and keep harmless the City of Cupertino against liabiliti )u nos, is and nses which may in any way acerae against said Ciry i co ce a of this permit. APP ICA ND WILL COMPLY WITH ALL i/�i S6 RCE [L ONS /1 \ 11� ,Z_grr5170M of ApplicantlComracior '" Datb HAZARDOUS MATERIALS DISCLOSURE 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, Section 25532(x)? L�� v/� ❑Yes & Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District? ' ❑ Yes ilo I have read the hazardous materials requirements under Chapter 6.95 of the Califora ealih & Safety Code, Sections 25505, 25533 and 25534. 1 understand that if th t g dj�s not eyrrently have a tenant, that it is my responsibility to notify the up t o tFlfquiry(t ELn_ts which must be met prior to issuance of a Certificate of owner or autnonzed agent NO. 02030225 'T� 'I's2`n2 2Y NO. CONTROL NO. BUIL BLDG ELECT r_� u ADD 765 SQ.FT, J9bggrc ,>� 3 642 TkZr.MOa $102000 PERMIT INFO PLUMB MECH I _-1 1 -1 Valuation 10 IARN Nifrki) NDAT I ON Occupancy Type 102 - PIERS 104 105 106 202 203 204 205 301 302 303 304 305 306 307 308 309 .310 311 313 501 502 503 504 505 506 507 508 509 510 514 Issued by. Re -roofs Type of Roof - UFEH Required Inspections - REBAR - ANCHOR BOLTS - SEWER & WATER - UNDERFLOOR PLUMBING - UNDERFLOOR MECHANICAL, - UNDERFLOOR -FRAME - UNDERFLOOR INSULATION - ROUGH PLUMBING - TUB & OR SHOWER - ROUGH MECHANICAL - ROUGH ELECTRICAL - FRAME - HOLDOWNS - INSULATION - SHEETROCK EXTERIOR LATH ---INTERIOR LATH - SCRATCH COAT - ROOF NAIL - FINAL ELECTRICAL; -ENERGY - FINAL PLUMBING ENERGY - FINAL MECHANICAL ENERGY - FINAL BUILDING ENERGY - FINAL ELECTRICAL - GAS TEST - FINAL PLUMBING - FINAL MECHANICAL - FINAL GRADE - FINAL PLANNING - FINAL PUBLIC WORKS �, Date All roofs shall be inspected prior. to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Applicant understands and will comply with all non -point source regulations. Signature of Applicant Date All roof coverings to be Class "B" or better OFFICE