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