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06070102 CITY OF CUPERTINOrAY:u r BUILDINC'DIVISION PERMITONTRefi. t'C1R`IN' 'ORMATI�N` t1U1LDING ADDRESS: ' AND ULLAH PERMIT NO06070102 1149 KENTWOOD A OWNER'S NAME: PERMIT ISSUE DATE ANDY ULLAH 07/17/2006 E: SANITARY NO. CONTROL NO. ARCHITEC IENGiNEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH IOzp LICENSED CONTRACTOR'S DECLARATION Job DI:SCrIpt100 M , I hemby affirm Nal 1 am Ikemed under provisions of CMpmr 9(commencing withS=don70w)a(Divi6on3afde BiLsinmad PrafcuW=Code,Wmylke is M inrullface4naerc POOL DEMO FILL IN . >OZU License Cl Lica tOd . qq Dam Comranar n 'S ARCHffECTSDMIzlit-p.544 449, ARATIO paoLS4SPAS LOAYZA' S LANDSCAPE, POOLS & SPAS PAID BL 7/17/0 c 1 undeumnd my plans shall he Cud of public rtcnNs )yU aC Licensed Pmfcasional '0 OWNER-BUILDER DECLARATION <I I hcmhy aIErm mol I am caropt from the Conlmcmr's Licam Law for the 40 following mason.(Section 703M,Business and Pro(osshlos Cade:My city or county 3$ which nnlulres•permit An ea 4 sham.hap AO.demMW,p mp41r any stmururt z'y^ prior An its issuance.ala requires lMapplica'for such permit in rile a signed comment that he is licensed pursuant to the provisions of Mc ContratpY License Law(Chapter9 Sq.Ft. Floor Area Valuation 27ai (Comm=ming with Sedan 70DO)of Division 3 of the Businmad NofmionCade)ar $4500 tiw ha k esempt thmtfam ad Ne basis for the alleged esemptiam My vkddon of Section 7031.5 by any applicant for a permit eabiecu the applicant 10•civil penalty of AFN Number Occupancy Type nm more men Bve hundred dollars($500h ❑I,as owner of une property,or my empleycm with wages As their mlecompemation, 5 93 00 will do the work,end the sirumum is ret intended oranered for We(Sec.70".Business Required Inspections end Professions Cade:The Contraries License law dors at apply m an Owner of q P pmpeny who buildearimprovea masa m,and who dosouchworkhaself m through his Own employees,provided that such improvements am me Intended orarcesd Waite.If. I�r� bhowever, Iden vel the the burden or of proving duvement is al Ac tldidaat build ar Improve for purpose of (}� sok.). tt{��N Ai� 'LISP ❑1,as owner of the pmpeny.am=elusively contracting with licensed an==An mnswct the project(See.7044.Business and Professions Cade:)The Cmtracmes U. Co.Law does not apply An en awns Or property wM hatless a,Impose thaeom andwho contracts for such projects with a comsumr(s)licensed pursmat in me,Camracmfs License Law. ❑lam esempt under See .BAPCfor Nm lama (s{/ffJ65/fyll �� Owner Dau WORKER'S COMPENSA71ON DECLARATION 1 hereby Africa order penalty of perjury oro of Me following dedardona Ihem pro will main by eCcNOmm of Consent=Coda.for rpWobnr'sCampen- atian,u provided(p by Section 7700 of de labor Cade,far the perfamace of the ova or which this part is issued. I have and will maintain Workers Compensation Imuran¢,as required by Section 3700 of the labor Cade.for the perfmmance of the work for which this pewit In laud. My Worker's CCompeemWm N corrin a carer ad Policy number am: Can A,..6TA93 FV0D Policy No.:60Jg?e196-'a2eV CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE Cros scellan need rot M completed Ifline permit is foram hunamddo0aa($100) or less.) 1 certify that In the perromunce of the work fp which this permit is issued.I thall not employ any Noun in any manor se As At become subject to the Workers'Compensation Laws Of Califamie Dam Applicant NOTICE TO APPUCANP.If.after making this CcnlReste of Exemption,you Mould become subject m the Worker's Cooperation provisions of the labor Code you masa .J O foMwim amply with such provisions p this permit 001 be damd remad. z� CONSTRUCTION LENDINOAOENCY F 1 MmbY 4Rim that Wertla a comuucdon icndinS agency far the Nrformaae of Q'i 7 tie work for which dust permit Is l ouse 7 Z d(Sec.3097.CW.C.) WM Q Lender's AM Lender's Adamas U0 I candy that I ham read this application W sum dsas the above information Is LI. H correct I agree to comply with all city ad county ordinances and Stam laws rtlating m 0U buildingconsuunion,and hereby awhodm=preanm'ivas of this city'.ant,upon the CIl aMvo-mcmioned pmpeny for inspeedon purposes C (We)qme to ave,led...try ad keep hamlet the City of Cupenln r against rr rA1 liabilitice.judgmente,casts and expanses which may In my my acerae against aid City U Z in consequence of the granting of this permit. .. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date sou -7171106 Si mart of ApplianuCmuacmr Dao RC-roofs HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will tho appear or Naw building oceupert sem plurdle hervdam mammal a defined by the Cupertino Municipal Cade.Chapter 9.12 ad be Health And Safety Cada.Section 25532(4)7 // All roofs shall be inspected prior to any roofing material being installed. El Yea FNa 41 ElYthe 4pplkat p future building Occupant use equipment or device which 'If a roof is installed without first obtaining an inspection,I agree to remove Will emit Mrasdnm air canuminants as defined by the Bay Area Air Quality Management all new materials for inspection. DianeB ❑Yes dNu I hem roti N the hvsmsmatedals mqulmments under .Chapmrti.95oRbe Calier. Ala Health kSafety Ccae,Secdem25505,25573 aa125534.1 undorsund thal(the building Joas rot cwmntiy have a want Jos It k my mpomlMli'y m notify tie occupan'of We m n _whiban •xmetpn�,I,aa_a,�a,,ayfacanirateara P"y. Signature of Applicant Date ''�; '" -7117/ � All roof coverings to be Class"B"or better wneroramhodmda m Dam' CITY OF CUPERTINO �m 1 of 1 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 35931019 . 00 DATE ISSUED. . . . . . . : 07/17/2006 RECEIPT # . . . . . . . . . : 35286 REFERENCE ID # . . . : 06070102 SITE ADDRESS . . . . . : 1149 KENTWOOD AV SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : ANDY ULLAH ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : , RECEIVED FROM . . . . : LOAYZA CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY . . . . . . . . . . : ANDY ULLAH ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . : �EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BSEISMICRE VALUATION 4 , 500 . 00 0 . 50 0 . 00 0 . 50 0 . 00 BPERMFEE VALUATION 5, 000 . 00 115 . 56 0 . 00 115 . 56 0 . 00 BUSLIC FLAT RATE 1 . 00 105 . 00 0 . 00 105 . 00 0 . 00 PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 297 . 80 0 . 00 297 . 80 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ OTHER 297 . 80 VISA TOTAL RECEIPT 297 . 80 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- -------- ---------------------------- -------- ---------------------------- 704 DEMO • • CITY OF CUPERTINOD I DL CUPEkTINO PERMIT APPLICATION FORM Ilk N# 3501 ��Ot Date: Building Address: 1 Mailing Address (if different from building address): GI ,U ov Avg Owner's Name: Phone#: ,u oil) Nob-790 Contractor: License #: 5v& Dl Contact: Phone q -97-5455 Cupertino Business License#: Fax: DB -S Building PermitInfo: �/ BldgEl Elect 2( Plumb I� Mech ❑ Job Description: Residential 2, idvz Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: Occupancy Group: Type of Construction: Please check this box if the project is a second-sto addition: ❑ ro'ect Size: Standard � Lar e ❑ Ma'or ❑ Quantity Fee 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 BINVESTIGA Investigation fee BUILDING 1 of & i CITY OF CUPERTINO CUPERTINO 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 Pblg 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 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 Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRI-IAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT 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 Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL VABREMPOLE 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 2of3 CITY OF CUPERTINO CUPER,TINO PERMIT APPLICATION FORM uantity 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 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 Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Chane BUILDING 3 of 3