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03060114 CITY OF CUPERTINO BUILDING DIVISION PERMIT `=CONTRACTOR INF,.ORMATION .:i: . BUILDING ADDRESS: KARAM & S'AMIA GERGES PERMIT NO 03060114 OWNER'S NAME: 10376 JUDY AVE PERMIT` "717/2003 NE: - SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 000 LICENSED CONTRACTOR'S derpDECLARATION JobDescri tion mC 1 hmcbY affirm that 1 an fn Bu under ditf s Of&C Chapter 9(my tic i ig p 0W withSorce TIXp)af Division Sof tine BUYnrsa end Pafcuians GOx,aMmjlieena is n-c pea License 0e and Arcs`` WINDOW REPLACEMENT/CHIMNEY REPAIR��b�� a yA i Licence Class Ix.« �t,q DOW Con AUG 20 3 € ARCHITECTSuse u DECLARATION aaNs W U I understood my pleMa na l w used public f s G� Licensed Professional g 3 OWNER-BUILDER DECLARATION BUILDING B 111 71f)pgn A�f 1 hereby affirm that 1 am exempt from the Contractor's License Law for tw CJ L D 1 V G 20 following reason.(Section TID IS,Bod.and Profassioro Cox:Any city or County 5 m which requires a permit to Corsuuct,Alter,improve.demolish,or repair Any structure _Z6 prior to its issuance.also requires the applicant for such permit in Ole a signed sukment m thin heulocated punuanttodue provisions of the Contractor's LiccueLaw(Charter 9 Sq. Ft.Floor Area $3VPg gtion a� (commencing with Section TOW)Of Division Bafthe Business and Professions Code)or y that he is exernpt therefrom and the bevis fm the alleged exemption.My violation of Section 7051.5 by any applicant for a permit subjecu the applicant to a civil Penalty of 3ANT OQ9bu 0 0 not am Occupancy TyPe 1,u Owner Cf the property,or my employees with wages u their sole compensation, wi to the wart,and to structure is not intended or aRered forage(Sm.?Oaa,Business and Profession Cox:The Comuxtars License Law dors nut apply as an awns.of 102 2 — PIERS d Inspections property who Wilda or improves thereon,and whodassuchworkhimalf ortnrough his own employees.provided Nonsuch improvements am out lntmdad aoRered for Cak.If. 103 — UFER ha.cwt.de,building or impmvsment is sold within arc year of mmplesion,Ne cowc,- builder will has the hoiden Of roving that he did nm build ape nmprow,for Fortune of 104 — REBAR ask'). 105 - ANCHOR BOLTS 0 1.u owner of the p open,am exclusively contracting with licenced contractors to construct the project(See.70",Guiness and Professions Cox:)The Contractor's U. 106 — SEWER & WATER arae law does not apply in an owner of property who wilds or improves thereon,and, 2O2 — UNDERFLOOR PLUMBING License Lia wbenseLaw.urope such projecu with acontracmrts)Iiauedpursuant mlk Convenors 203 — UNDERFLOOR MECHANICAL O l am1/Campo under Sec. ,B Q PC for this moon 204 - UNDERFLOOR FRAME Owner KXYYw. Qssel Sau.'ca_ C..aie,ac Data�1+-1-1,3 205 - UNDERFLOOR INSULATION WORKER'S COMPENSATION LARATION 41 I hereby allium under penalty of perjury one of the following decla.uau: 301 - ROUGH PLUMBING I have end will maintain a Certificate.(Conant to alWasum for Workers C.Nn. 302 — TUB & OR SHOWER .tion,as provided for by Sad.3700 of she labor Code,for the Perform.of the 303 - ROUGH MECHANICAL wort for which thispermitisi.ped. 304 - ROUGH ELECTRICAL 0 1 baa and will maintain Writes Compensation Insurance,sat required by Section 3 0 5 - FRAME 57W of due labor Code,for On performance of the wort for which this permit is issued. My workers Compemation Insurance Cartier and Policy number am: 306 — HOLDOWNS Canner. PolicyNo.: 307 - INSULATION CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE 308 - SHEETROCK ofkss.) (Imo auction rad not he Completed if the permit is for one hundm-0dollan(S IW) 309 - EXTERIOR LATH 310 - INTERIOR LATH employ that m un rrrn.ana of the wart for Comm moa OnpennitWi is naso.I anon not 3 11 — SCRATCH COAT employ any person in any manners u w become subject to to Wurlmri Campeniaton Appica urrorma"Dite Applicant 313 - ROOF NAIL NOTICE TO APPLICANT-.If.after making this Certificate of Exemption.you should 501 - FINAL ELECTRICAL ENERGY Income subject to the Worker s Compen.don previsions of the 4wr Csdc,you most >aZ mrmwith Comply with much roriamnarthis permit mall wlearned rtvnmd. 542 - FINAL PLUMBING ENERGY ?O CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY I iteaby affirm that mea is a coestrucdnn lending agency,for the peffo.amx or 504 — FINAL BUILDING ENERGY > the work far which this pe.itisissued(See JW?,Cil C.) lancer's Name 505 - FINAL ELECTRICAL St 0 DZ LnxriAedmss 506 - GAS TEST J O 1 Certify that I have read Ws application and mate that the«Cove infO.adon is 507 - FINAL PLUMBING ]. Correa Agree I Agto comply with all city and county Ordinances and sign laws relating t0 J� wilding construction.and hereby auhonae rtpreanutxs of this city to enter upon the FINAL MECHANICAL } LU above-mentioned pmpeny,for iupenion purlics, ti gy (We)agree 10 UK.indemnify and keep harmless the City Of Cupenino against h nsO FIWNWGO lialnlities,judgmcnu,cosu ues mand expewhich may in any way accc againstsaid Cityin coequenceof twgrandngofthispe.it.SOULICARNT LR1TANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:5RKS Date If -)/03 Re-roofs 9lgroloW LApp1ICE.VCcnuaur Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will dre appincam or furore wilding occupant gore of handle h.Nmaterial aous as defined by dre Cupertino Municipal Code.Chapter 9.12,and the Health and Safety ode,S "10.25552nd? ❑res `IPI N. All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future wilding Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove Fit ha>ardaus air Conuminanu as,defined by the Bay Area Air Quality Management all new materials for inspection. District? O Yes IAN. 1 have mad the mutations materials requirements under Chapter 6.95 of the Califor- X( 9�� ans25505,255JJand255JC.lundenundthaznfte wilding t Naz h u mymareagalitymamitytheoccupantOfthe etpoortoisaaanae.neerdrewcaramp.rr. Signature of ApplicantDate ze ascot D,te All roof coverings to be Class °B"or better r - CITY OF CUPERTINO CUP TYOF O PERMIT APPLICATION FORM o3 v "q PAPN # Building Address: l03? 6 UV,ee, ca . 9s-1�-f Owner's Name: Phone #: V w\ a A Sawv Ger .5 10 - 2S-tf SI14 Or Contractor: License #: w v�2v- Contact: Cupertino Business License#: Building Permit Info: Bldg ❑ Elect ❑ Plumb ❑ Mech ❑ Job Descripti�on/: W/ K tnl Residential fid' Cmt:c rr Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: Occupancy Group: � r0X-�3`4ov Type of Construction: Quantity Fee ID Fee Descri tion Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> I OOK to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75MBtu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/ uasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel M G BCONSTAXREE6 esi/MobileGBELEC1000 = 1000A ALBELEC1001 > 1000A ALBELEC200 V <=200AALBENERGY GBENERGYADD Ener y Add Multi GBINVESTIGA Investi ation fee GBMITIGATC Comm. Housin Mit. FeeG 1 of � 7 . CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi-Family Res MECHANICAL BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL BNEWMULTI Multifamily Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMULTI New Multifamily Res PLUMBING BNUSFD New Single Family Res BUILDING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE PbIg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Iriterce for 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 Reins ection Fee BUILDING BREMACOVER A/C Unit> 10,000 c&nMECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMED{T Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> I OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc A azatus ELECTRICAL BREMNRAPP Rem Non-Res A liance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL 2 of 3 CITY OF CUPERTINO CITYOF PERMIT APPLICATION FORM ' CUPEkTINO Quantity Fee ID Fee Description Fee Group 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 BREMSIGNAD Rmdl Signs 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 Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING �l 3of3 ', I