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06050228 CITY OF CUPERTINO 77,1 BUILDINGI)IVISION PERMIT G,Q1tACTCTR.'�I 11F0-RMATIQN ; BUILDING ADDRESS: KITCHEN WORKS INC/DBA HOM ffftWD06050228 1134 KENTWOOD AV OW HER'S NAME: PERMIT ISSUE DATE MAJID TEHRANI 615 IRWIN ST 6 JNE: SANITARY NO. CONTROL NO. (415) 456-4696 ARCHITECT/ENGINEER: BUILDING PERMITINFO BLDG l� O PLUMB O MECHD 3oj LICENSED CONTRACTOR'S DECLARATION Job Description ow 1 nay affirm that 1 aro licensed under provlins oof Clupe,r 9(Cone cimg p MN Section 1000of Dwiskm 3Ofde,Busiruu and fteressuns Cade.and my luene is w« llto i And ufect.Aor w.a �� X96 ENLARGE KITCHEN WINDOW TO 6X3 . RELOCATE ELECTRI 'M Dam =A 'Contractor RECEPTICAL. NEW 4X12 HEADER £ � ARCHrECrSDECLARATION KITCHENWORKS PAID FOR BL 5/26/2006 y a. 1 understand my plane All be used u public records m G Licensed Professional yq OWNER-BUILDER DECLARATION 2 I hereby affirm Not I am exempt roue the Cantramar'a Ucenu Law far the a O following moon.(Section 7031.5.Business and Profusions Cade:Any city or county S9 which ratio.a permit in cwworoc4 alar nnpew,dwmOIW4 ar repair any umnum -try^ prior w its issuance.auo requires Bre applicant far Inch pewit in file a signed statement pp C Ihuheisnamed puranitowhepmvismmoflaeContrcmriUanxLAW(Chapo9 Sq.Ft.Floor Area Valuation m i 9 (commencing with Section 70DO)ofDivision 3ofthe Businessland PmfwiomCode)or $3900 3.- that he is mumps Namfmm and the basis for W alleged exemption.Any violation of Section 7031.5 by any applicant for a pemiuubjeeu the applican410 a civil penalty of APN Number Occupancy Type Out wort than five hundred da1Wa(5500). O 1,u awe of do pmpem.m my wploym Mth wages u nnbmte eompewdon, win do the wark,indlhestmeue is mtintended dominated foredo(Sec.70".Business � Required Ins/sections and Profession Cade:The Contents License Law does set apply m an Owner Of 9 Y property who bulldeoimproves demon.andwhodmwchwmkhinuelfarW ugh his Own employe,provided that wen lmprowmmu see not immnded or aRerd for sale.If. however,we buildingor improvemem is sold within oro year of eamPhAl ds,atvw� /•� builder wi0 haw the buN,n of paving that he did rot bulb or Improve far purpose of umJ. O 1,u avant of the property am exclmiwly Connecting With RConand mnroess in contused the proem(See.7044.Business and Professions Coda)The Contractor's LI- came Law de not appy in an owe of property whO builds or Impmm Nemo.,and, who coraco for such projects with a Conuamar(I)licensed parmm,in ire Conuactor's Lime Llaw. or ❑ , IBm aempt redo Set .BBPC far this reuoo / Owner Dam / WORKERS COMPENSATION DECLARATION 1 hereby.M.under penalty of pin ay am of the following declandimm b 1 haw and will maintain aCartilk m of Consent an anlyimaon farwmFmseCooper- Adan,As provided far by Section 3700 of rhe labor Code,far Ilse performance of Ilse work for which this permit is leaned. 2 1 haven and will meinWm Worker's Compensation Insurance,as required by Section 3700of the Labor Cade.far the perfomancn of the woe forwhich this permit Is loved. My Wetness�s Compensation InmranCo artier and Polity mastic,ae: eanien✓T,-TL 4--At Policy No.:171..3—e:0%7LA� CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE , Ohts melon smell rot hecompleud link permit Is foroan hundred donut(f lea) or teas) 1 testify dant in the performance of the work for which this permit is issued.I awl nm employ any person in any manner an As m become Anhwei to the Warhere Compensation Laws of Calttaeta.Dam Artificial NOTICE TO APPLICANT:If,afar making this CeniRmm of Ewmpion,you should became subject to Ih Wakens Compensation pmvisiam of the IAke Code,you muse z forthwith Comply with Inch provisions ar this permit shall be damW mooka „zt0 CONTTRUCTION LENDING AGENCY [—r I hereby eM.thu dere l...... cdm lending agency far the part....of Cs .>. the work for which this parent,Is intend(Sec.3097,Civ.C.) 14Q Lenders Name 7 z LendenAddma, U0 I certify that I haw mad this application and etc Nal the show information is U,H comet.I agree to comply with all city and county ordinances and some laws elating lo 0V building comwctirn,and hereby outhmin eprounmiws Of this city to enter upon Ne Uahovomentioncd propny for inspection puryems (We)age,to save,indemnify and kap harmlessth,Cily of Cupertino against Iiabiliticapolgments,com and expnsn which may In anyway accrue,as ,"City U4in consequence of the granung of this permit. •^+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON.POINT Issued by: Date z- ✓"'a SOUR REGULATIOI,y Re-roofs Sign.te a of AppfimreCommoser Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Win de,applicant or future building acupan,sloe At handle overdoes material As donned by the Cupertino Municipal Code,Chapmr 9.12.and the Health and Safety Cade.Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. Oyu balu 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 .;emit huardwo air mntaminanu u defined by the Bay Am&Alr Quality Managemem all new materials for inspection. District? OYm _JRNo I Nov,read the haurdau maurials requhemme undcrCTepur6.95 of du Collor. .is Health&Safety Cade,Sncniau 25505.25533 and 25334.1 undenuM this Blhe building doe:n„cu tion,haw a leen,that it is my responsibility in sooty the occupant of the equimm ••hichmost be:me rsousuuuaofaCcmflcamafQm Signature of Applicant Date S� Ower onuthomad Igen me,' All roof coverings to be Class nBn or better Community Development �„� 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CI OF Fax(408)777-3333 4fUPEkTINO Building Department JOB ADDRESS: PERMIT #/ l3 �allq-Ums vB � O aSnZ2 �' OWNER'S NAME: my ;L e PHONE # GENERAL CONTRACTOR: rK KJ FAX# Y%s� y fY-Y6 I am not using any subcontractors: 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 Owner/ tractor Si tore Date ti CITY OF CUPERTINO 4km 1 of 1 PERMIT RECEIPT OPERATOR: amyw COPY # : 2 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : .35931055 . 00 DATE ISSUED. . . . . . . : 05/26/2006 RECEIPT # . . . . . . . . . : 34573 REFERENCE ID # . . . : 06050228 SITE ADDRESS . . . . . : 1134 KENTWOOD AV SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : MAJID TEHRANI ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : RECEIVED FROM . . . . : KITCHEN WORKS CONTRACTOR . . . . . . . : PRELL, LARRY LIC # 17457 COMPANY . . . . . . . . . . : KITCHEN WORKS INC/DBA HOMEWORK ADDRESS . . . . . . . . . . : 615 IRWIN ST CITY/STATE/ZIP . . . : SAN RAFAEL, CA 94901 TELEPHONE . . . . . . . . : (415) 456-4696 EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ----------- ---------- ---------- ---------- BPERMFEE VALUATION 3 , 900 . 00 104 . 76 0 . 00 104 . 76 0 . 00 BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00 BREMRECEPT NO. OUTLETS 1 . 00 1 . 20 0 . 00 1 . 20 0 . 00 EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 BSEISMICRE VALUATION 3, 900 . 00 0 . 50 0 . 00 0 . 50 0 . 00 BUSLIC FLAT RATE 1 . 00 105 . 00 0 . 00 105 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 284 . 69 0 . 00 284 . 69 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ CHECK 284 . 69 5719• TOTAL RECEIPT 284 . 69 f. . - - l / l C���■■off■W■■■■■■■■■■■��■■.■■ ■■■■ME 0 ISE ME ONE ■■■■■■■■■■■■■■■■■■■■m■■M■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■���� .■rel' "i�■■■■■■■■■■■�Iiit1■ ■■■■■„■ :,■ ■■■■■■!■■■■■■■■■■■■ ■■■■■ ! ■WEMME■W■■■■■■■■■■MEN ■■■■■■■■■■■■■G■■■■■■■■■■■MEN ■■■■■■■■■■■■■■fr■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■ � ..... -.w.._.. .-,�._ .�.'.._...-..._..rv....r_a.4r.......r...... ......-..u.M a.v:.... ._._..•.+....-...--�. .n. � _ . by - ...., ._ .•.._ Y .., ,.�.. .. Asviewed4rom OUTSIDE: \ WINDOW SITE .INSPECTION LAYOUT : X= Operable O= Stationary x ,--�- Measurements approx 1 guar =12 inches ak;: �mer:/y, o,_j',TdC, gjVj/ Job #: N3gll '1 Date: ROOM:-- - _CdtG.---- /J_ /VL! ......-- ...... ROtS _ -- -- - - ------. ..----------- -- ---------------- .V-, C..k, -0---14 t/;r(Pe_.;... ------------ --- --- ........ ----- -- ---...-- -- -- 2k/1 _ 16 j --�( Io L - LdV.9av Eat e _ 1Fcr�.- o _4 f4- _ LL / n �pj I X- .. _. x._ _ _.._.,. -- � wL71... . tT� _C,.f_.Cl, 2. .f bs_�'A ( LI-i", el - ------- - . . ..--- - -- . __ - -- - �-. --- F._S.0 I SPECIAL- �Cfy Yltk.!�1 srz_t=1-6 t_!�3� - - - SPEC I ------------- - - ----- ...--- - ----- -. . ?,A4, v ROOM: ROOM: : I ------------ ---- -------------—- ----------- - ------------- ---- -- --- I SPECIAL: SPECIAL: - ----- -- -.._. -.------ ---— - - -- -- ---------- - ---- ----------- -- -- i ---- -------------...----------------- -- — --------------- ROOM: ---=----- -- ----- ..ROOM. CIA4_ _ _ _$PE.C.IAL: Site.lnspect _Customer___.�y� �( _ _...... Signature: � ' f i�'�it�/ — Acceptance: / 00010100 WHITE-OFFICE YELLOW-PRODUCTION PINK-CUSTOMER DRAWINGS NOT TO SCALE ----------- ------ Q D J ' Q g d e .St J' k ^. V �X r!¢ Sr" Serf • ■■�-�■■■■■n■■■■�!�■■■■■■■■■■n ■■■■■■■■nn■n■■■■■■■■■n■n ■■■�■■�■a■■■■■■■■■■■■■■■■■■ �rrw�i������n■■■■n■■■■■■■■■■■n■ =■�■■■■nnii■ni■■i■■■■■nen■ ■■s■■■■■n■■■■■■■■■■■■■■■■■i■■ ■■■s■■■■■�■■■■■■■■■■■■■■■■�n n■■■n■■■■■■�!■■■■■■■■■■■■■■■ ■■■■■■■n■■■■■■■■■■■■■■■■■■■ ■■i■■■■■■n■■■■■■■■■■■■■■■■■■ ■■i■■■■■■■■■■■■■■■■®■■■■■s■■ in'■nii■nnnnn■n■n■������►■in■n ■■■■■■■■■■■■■■■■■■■■■®■■■■■n e■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■n n■n■■■■■■■■■■n■■■■■n■■■■■■■ ■■■■■■■■n■■■G��i■■■■■■■��f�i■ ■■■■■■■n■■■■■n■■■■■■■■■■■■ ■■■n■■■■■■■■■■■■■■■■n■■■n■ ■■nn■■■■®■■■■■■■■■■■■■■■■■n . .. .:-.at^h+J-�-.;^.rn^Tei-'a�.�u�..^.;+,{'d.u...�.�:.a.w...-.:-.we..... .,,.._. s-.wl«a•..ti+y_w:W-'=-.t. w .,u .. ..w�: Y,a. "'*`i'.=b' As viewed tronT OUTSIDE: WINDOW S f T E N S P E C.T I O N LAYOUT'" X= Operable 0= Stationary - Measurements approx 1 quay =12 inches ieomerm os'Tdcl1-efiAyW Job #: N3111 '1 Date: -ROOM:--! I --- --------- ---------- - -- -- --------------------- --------------------------- ---- - �_404J -- - - --- ' Ealy 9°v�� �1Fcr�-•_ht'c1,�!' ��,..� �(uy-=1'° --- - - -- - -.. - ----- ---- ---------..---- � �-�=� -------------- _371---- 11�uNra dYwv�� Ki _ i azl krr -SPMALi rr icl� r+ �--S IZ p - SPECIAL. I ' - - — - - -- ----- - -------- -- ----- -- -- ROOM- ROOM: ----- - - --- - - . s I � I SPECIAL: -- ------ -- --- SPECIAL: ROOM. _! _ROOM — ---- -- j j-- --i — -- — i I I 1 r I I I ' I CIAI' _SP_ECIAU .Site. L% .._. ... SignatuAcceptance: 00010100 WHITE-OFFICE YELLOW-PRODUCTION PINK-CUSTOMER DRAWINGS NOT TO SCALE ------ ---------------------------- a z J J S7'l-d u4j � u V a x o 4 k v �X ' �� Sr.,d CITY OF CUPERTINO CW050 ;� CUPERTINO PERMIT APPLICATION FORM APN# 31 ' U55 Date: � 2_6 G6 Building Address: / Mailing Address (ifdifferent from building address): / Glrr(feod •vim Owner's Name: Phone'• ��ti og — ea7'`i' Contractor: License#: i (VBi4) Nel�W01-Ir r Contact: Phone: Cupertino Business License#: `/D Y �/- YC 6LV-;/ Y Building 7 G;ry 6�3P o/ Permit Info: Bld -E Elect Ou Plumb ❑ Mech ❑ a e%cv2 94ec. /Pei nolW I /r . Job Description: ��� /fie ��. !.//%JJoj'✓ 'j 6 c2c�' Residential 78 (,xj yezCommercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: d a Occupancy Grou l 3 4C_0 Type of Construction: Please check this box if the project is a second-sto addition: ❑ Project Size: Standard' Laze ❑ Major ❑ QuantityFee 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 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 Ah BINVESTIGA Investigation fee BUILDING 1 of 3 CITY OF CUPERTINO CUPEI�TINO PERMIT APPLICATION FORM uanti Fee ID Fee Description Fee Grou • 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 BldgPermit Fees BUILDING BPFIXTURE Pbl 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 R eat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinklerBackflo PLUMBING BPS TORM Storm/Rain Water PLUMBING BPTRAP Kitchen TraD PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER InstalVAlter 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 BREMAIRHAN A/C Units <= 10,000 ch n MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Buswa s ELECTRICAL BREMFIXT Lighting FixturesNMECHANICAL AL BREMFURN Relocation of FurnaceCAL BREMFURNOV Relo Furnace> IOK btuCAL BREMHEAT Heater InstallationCAL BREMINHOOD Installation of Hood BREMMISC Misc Apparatus CAL BREMNRApP Rem Non-Res At liance ELECTRICAL BRE OL 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 ADoliance ELECTRICAL 2of3 CITY OF CUPERTINO CUPER,TINO PERMIT APPLICATION FORM Quantity Fee 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 Swinuning 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 Ran a Residential PLANNING ZADDCHG Address Chane BUILDING • 3 of 3