The URL can be used to link to this page

06030122 CITY OF CUPERTINO BUILDING DIVISION P$RMIT 4 �C01 '1'ItACTQIZr1�,I*'4ILMATIQN' . c a1 a x,'.;. .s c.• Y*saw w:. v,l •,.,sec•.-t�4"&2• BUILDING ADDRESS: PERMIT N0. 1134 KENTWOOD AV I ?R'S NAME: PERMIT ISSUE DATE MOSTOFI, JALEH 2333 VERNA CT. 03/22/2006 PHONE: SANITARY NO. CONTROL NO. (858) 530-0058 ARCHITECGENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 'job LICENSED CONTRACTOR'S DECLARATION Job Descrition 1 hereby Affirm Net 1 am licensed under provisions of Chapter 9(commencing p A' With Section 701W)ofDivhi0n Sof We Business ad Prolmions Code,and my license is '' In mB force andeB Y RETROFIT 4 WINDOWS AND 1 DO ////�A�' ED 5p License . t,e.« /002.3,9 Date W4 Contractor /� 2 win ARCHITECTS DECLARATIONAPO H— 2006 I untlernd my plans shhe all used u rcc public nNs gsad Licensed Pmfcssi0nal w }pas%-- bgi Oat I am exempt front DECLARATION ��'��r p g COO hereby M.that I em exempt Bum he Contractors Con n:Any law the ��■�{■5 j`e176■ COO B V following rens a permit t ]1HIA,B, Iw!cod Nafetioro Code:Any city or mousy which requires n peonit ra)emend Aller,impmw,demolish,t or repair Any umumt �hay thatpriorW i m issuance,also rt to the thovisio antsat for Contractor's ontra tar's file. igad wmm)nt g�< (commencingwiit pursuant 700)of Division o(theeSummon ouJcensf law(Chapter9 Sq.Ft.Floor Area Valuation 99 (est he ingwWSudan hand the hods n3 nfuroegeiwu assumptnd ion, Cade)or Nat he ts esempt thrcfmm and tk bests for the NcgW esemptia0 Any violation 0( Section 7031.5 by my applicant for a permit subjects the applies.n to a civil penalty of not mom than Ow hundred dollen(5500). Um er Occupancy Type ❑I,as owner of the property,or my employees with wages as their role compensation, will d0 the work and the h.9mts han's Luded w A.do fu sale(Sec.]ON,Busiws and property oh Cade The veswar5ars w who law doh tent Apply lf an Owner of Required Inspections propem to ebuildsviImpeawsch improvements andwho dansuch makhimselfed though his awn employes,provided that suede improvements sae not ear of or offered haute.if. buildu the have t or improvement is hath within one year of completion,the owner- builder will haw the burden of proving that ha did not build or Improve for purpose of . ❑1,as Owner of the propenY,m exclusively contracting with licensed contrse]ors in contract the pmjea(Sen.7044,Business and Profession Cade:)The Contractor's Li. cense Law does not apply an an owner of Miserly who builds or improws Merton,and who contracts for such pmjew with a conuacmr(s)licensed pursuant an the Contractors License law. ❑Imesemptundu See .B&PCf.Ihi3 a Date WORKER'S COMPENSATION DECLARATION I hereby air=under penalty of perjury ane of the following dwtandoh: ❑i Mw end MII malnoin aCeNfiwte o(Consent mself-imam fa VlorkersCanpem action,u provided for by Section 3700 Of the labor Cade,fa the perfarmanec of the, work for which this permit is issued. haw and will maintain Workers Compensation Insurance,an required by Section 700 of the labor Cade,for dte performance of the work fa which this permit is Issued. My Work Compenscu n nsurm 'u�an�d,mPoal"ity number m: Cartier nllM1ym..: I0 9 / L CERTI CATEOFEXEMPTIONFBOM WORKERS' COMPENSATION INSURANCE mils ration need not h)cumpleed lithe permit I,raanchundaddoilm(5100) or it .) I certify dint in the performance of the work for which this permit Is Wand.I shall not employ any person in Any manncrm as an hccumc subject to The Workers'Comperuation Laws of C.lifamia.Date Applicant NOTICE TO APPLICANT:If,after making this CeNOcate of Eximption.you should become subject m the Workers Compensation provisions of the tabor Cade,you muse .J`,L forthwith comply with such provisions or this permit shall W damW revoked. Q CONSTRUCTION LENDING AGENCY f~r�+ I hembyarion thatthere uaconswcdnn kndingagency fordeperform.nwaf tYi 7 the work fur which min permit Is issuW(Sea.309].Civ.C.) OWi Q handers Nme Z hander's Address I,C 1 cenify that I haw rod this application and sate that the show information is U,F correct I Agree to comply withall city and county Ordinances and sole Laws relating to 0 U building construction,and hereby sciatica representatives of Nis city to enter upon don [27 aMw mcntiOnM pmpcny for impaction purpose, LL (We)agree to ow,indemnity snd kap harmless the City of Cupertino against ti to Ilabilides,judgmcm.cow and expenses which may in Any way acme against said City U 7 In consequence of the granting of this permit F7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH A NO POINT Issued by: Date [� souacEWunyNs 7 3�y ` CRe-roofs Signature of ApplicarmOtintriclor Dem HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the appliwn7 or force)building aeupant uorc or handle huaNam material I fined by the CupeNrm Municipal Code.Chapter 9.12,aM the Health and Salay .Saab..255320)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yen %ales Will One applicant or future building occupent use equipment or dcvies which If a roof is installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants an defined by the Bay Area Air Quality Management all new materials for inspection. District? ..''9/ ❑Yen 94 I have mad the humorous maredals requirements under Chapter 6.95 or me Califon nia Has lit;&Safety Code.Samlom 25505,25533 and 25534.1 understand that irthe Wilding den rent currently how a co an.that l7 h my mapamihlliry an our,de occupant of the requirements whichmost mel arm issuance of.CeNnwm of Oc:1x Signature of Applicant Date Z�/�"�10 All roof coverings to be Class"B"or better OW.Crr oriznd agent 'but. l CITY OF CUPERTINOBUILDING DIVISION PERMIT J ,CONT= " CTORINFO Am _ TNG ADDRESS: PERMITNO. 4 KENTWOOD AV OWNER'S NAME: PERMITISSUEDATE MOSTOFI, JALEH 2333 VERNA CT. 03/22/2006 PHONE: SANITARY NO. CONTROL NO. (858) 530-0058 ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 ;op LICENSEDCONfRACTOWSDECLARATION IbDtion i 1 hereby affirm that I am licensed under provisions or Chapter 9(commODescription with Section 7").fDivision Softh.Business and Prafessions Cade,and license is in full force and off" y RETROFIT 4 WINDOWS AND 1 DOOR iN� License a Lle.g r�023a7 Dow WD Comractar ARCHi EC1'S DECLARATIQI 1 1 understand my phu Nell be used as public recede 16 G Licensed Professional - -m3 OWNER-BUILDER DECLARATION ConimON l0I hereby.(Sero thus 1 1. exempt from he fission; o License Law for the p O following moon.permit t 71D L;B.ai iera and improve. de iuus Code:Any city nr county $4000 <$ which requires n Fmmit re cnnswcL plica improve,h permit t ore a sig ed structure u�Yr,+ pdarmits Issuance,also requires the applicant for such permit to Bic ealgned statement C that he is licensedpunuanttatheprovisionsofNeCoriestUamonLaw(Chapter9 Sq.F[.Floor Area Valuation e (commencing with Section 7")or Division of the Business and Prornsions Code)at $ that he Is exempt therefrom and the taxa far One staged exemption.Any vi.hufu or Section 7051.5by,"applicants for,permit mbjecm the spplisanut a civil Faulty of APS um er Occupancy Type not...Nan five hundred talars(5500A ❑1,as pwncr of d¢property,or my employce,with wage u theirsele compensation, wilido the work and NesrrvcWre is not intended or offered(ontle(Sec.7044,Busing and Pmf sidn"Code:The Contractors Lt..Law docs not apply to an owner of Required Inspections Property who ,provided deuesch Improvements who dosesuch work hinuelfor his own employee,provided provehimprovementsannal intended arofc oraffmple rm.foralethe owner. builder builder ,Nebuilding orimprovementIssaid within one yearofmproefortheowner- .[a.).rwill have the burden of proving Nu he did not build or improve for purpose of tale,). ❑1,u owner of the property am exclusively contracting with licensed contractors in construct the project(Sec.7&44.Businessand Professions Cade:)The CWun ctoh Li- zr/ ecru.law don not apply to an owner of progeny who builds or impact.thereon,and / munscut for such projects with a eonuacur(s)licensed pursuant to Ne Cantneloes / nu Law. oro exempt under Sec. ,B k P C for this reason Owner Data WORKER'S COMPENSATION DECLARATION I hereby affirm under Nulty of perjury one of the following declarations: ❑I have and will maintain aCenlBeate of Consent W self-insureforWorkcrsCompen- sation,as provided for by Section 5700 of tM labor Code,for the performance of dr, work for which this permit is issued. hoe and will maintain Workers Compensation luanu ucc, required by Section 700 of Ne labor Cade,for sin:performance of Ne work for which this permit is issued. - MyWark Compe"a' n surarmt 'er and Policy number art: �+ � G.rrier .,: 10 9 TYP CERTI KATE OF EXEMPI70N FROM WORKERS' COMPENSATION INSURANCE (This sectin.nod nal ba completed If the permit is for one hundred dollen($100) or ass.) I unify Nat in the performance of Nc work for which this permit is issued.I shall not employ any person in any manner so u W become subject to the WorktW Compensation Laws of Cslit.mi&Data Applicant NOTICE TO APPLICANT:IL after making Na Certificate of Exemption,you should become Subject W the Worker's Compensation provisions of the labor Code.you must .J O forthwith comply with such previsions or this permi&hall be deemed revoked. ,zi0 CONSTRUCTION LENDING AGENCY [-+ars+ I hereby affirm that Nen is construction lending agency for the performance of r1 7 the work for which this permit Is issued(Sec.5097,Civ.C.) QUndcrs Name - �z Lender's Address U Q 1 ttnlfy Net 1 have read this application and state that Ne above Infomuuun is Ir. correct.1 as=to comply with all city and county ordinances and Sum laws relating to D V building construction,and hereby authorize representatives or this city to cnmr upon the W show-mentioned property for lnspcetion purposes. f�y4 a (We)agree to save,indemnify and keep harmlus On City of Cupertino against f.y f/) liabilities,judgments.Posts and expenses which may i0 any way see=against said Lily In consequence of hcrantin of this emit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH AA NO�POINT Issued by: Date gOURCMLATIfN15� � Y/ S � �^r / Re-roofs Signuure of ApplieanV Data u US MATERIALS DISCLOSURE Type of Roof WIII the applicant as(Muni building e,Chapter store or and th ha�ous dSafrmaterial u defined io the Cupertino Municipal Code,Chapter 9.@,and Nc Health and Safety Code.Section 75537(.)? ❑Yea knNu/ All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove craft humorous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes I have and the husrdnurmaterols requiremenuunder Chapterri.95of the Califor- riaHcal"S.PuyCod0.Seniors 255(15.75557 and 25534.IundcrsmtM in.i(Ne building don not currently haw a mnanL Nat It is my respm¢ibutty to nobly Nc occupant of Ne requiremenn which'm-u�t `�me�° aW�wtonnne..a .een;neate or occupancy. Signature of Applicant Date " ��}�i�-2w All roof coverings to be Class"B"or better Owner m llbod,rd aue.1at'O c ( F _ _ _ 1 t-ITY OF CUPERTINO CUPERTINO PERMIT APPLICATION FORM APN# 36q — 31-055 Date: Z3 D Building Address%! 2 Mailin ess (if different from building address): Owner's N L_"J Phone#: Contr ctor: 1///9 X License #:6 Q Z 3 3 Contact: Phone: (S/o> Cupertino B sin ss License#: GFax: c —� 6 d Building Permit Info: Bldg Elect ❑ Plumb ❑ Mech ❑ Jobescription: - /y) ( ��,N � y- 1, $ Doves• Y16 LL)M re Residential l� Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: o� Occupancy Group: Oto O ' ype of Construction: Please check this box if the project is a second-story addition: Project Size: Standard ❑ Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILE.R2 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 BINVESTIGA Investigation fee BUILDING 1 of3 ITY OF CUPERTINO 0 '• CUPEkTINO PERMIT APPLICATION FORM 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 Pb1g 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 Cbeck Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinklerBackflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER InstaWAlter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfin MECHANICAL BREI LUGIAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Fumace MECHANICAL BREMFURNOV Relo Fumace> l OK btu MECHANICAL BREWMAT 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 2 of 3 CITY OF CUPERTIN CUPEf�F PERMIT APPLICATION FORM QuantityFee ID Fee Description Fee Group 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 Inspection 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 PLLONGRNGC Planning LR Comme/Multi-Faro PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Chane BUILDING • 3 of 3 03%04/2006 14:16 7075287663 PERMIT SERVICES INC PAGE 02 03/04/2006 13:52 51048.4544,2 HDIS SP STRIEV) PAGE 02/06 �1 44 �6 3 l � a .............. .. ,_. H L O5 VC (� p�