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04050030 CITY OF CUPERTINO 717 BUILDING DIVISION PERMIT -T'0 Rj"NF " i" "ILDING ADDRESS: MICCICHI MASONRY PERMIT'0.4'O50030 �n4'nT.n Tc)wm rT OWNER'S NAME: PERMIT ISSUE DAM ETTEHAD FARHAD 180 CHERIS DR _.Q.S1QS /9004 ONE: SANITARYTOT' CONTROL NO. (408) 219-5964 ARCHITEC"ffIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTORS DECLARATION yaffift,imlimnwdua�rpmvi4onsofChapwrg(mmmencing Job Description &1 171, 1 onivision 3 ofth.Eyineagad Ponfoadions Code,and my license Is S`kyr - REPAIR CHIMNEY ROOF LINE-UP 5 LicenseDow Cminposes-M f I a I ARCHITECTS GEC�AON .bit litiludriand my V ublic records Oyu 0,t; Licensed Professional OWNER-BUILDER DECLARATION C �� I hereby affirm met I.m exempt from the Contractor's License Law for the n a f.H.O,ingmaxim(Seed which requires a permitre.....mu.I,alw,,improve,dereelibilb.or put,my sloolore prior to its issuance.also requires be applicant for such Permit to File a signed statement 'hot he is licensed pursuant to Me provisdom of the Commer's License Law(Chapter 9 Sq.Ft. Floor Area Valb-ati�, in (.'"conanchill wid,Section 7")of Division 3 of the Butiouss oil Prodlessimir Cede)or Mat he is exempt therefrom and the basis for Me alleged!exemption.Any violation of Section 7031.5 by any applicant for 4 permit subjects Me appiminfl,to a civil penalty of 3 5�erO 0 Occupancy'I�pe = not athan five hundred dollars($500). propery,mmymnplo,mrs withimi,exas theirs.l..crairmstithm. willdo Me work,and thestructum is not intended orofferaft ficurale(Sec.7W,Business and Professions Code:The Connector's License Law does not apply to an namor or Required Inspections property who buiIds orimproven duarson.and who does such work hi mself or through his Own employee,provided Met such improvements are not firmandadmid5mad fairsidle Ir. however,Me building Or inpunwhouL is Mid within one year of completion,the Owner. builder will have Me burden or proving that M did not build or improve for purpose of sale.) 0 1,as owner of the property,am exclusively contracting with licensed commuctera in construct the project(Sec.7044,Business and Professions,Cade:)The Contractors U. came,Law does no,apply in a...a,of property who Wilds or uppron.thereon,and who contracts for such pmkcm with a contractor(s)licensed pursuant to Me Crourectur's �r,nsa Law. , son exempt under Sec. _,B&P C for this mason weer Dam ATI Da WORKERS COMPENSATION DECLARATION I hereby affirre under Penalty of perjury one of the following declarations: I have and will maintain a Cerifficale,ofConsiont to self-busum for Works r's Cornier- a sation.as ponvided for by Section 37M of the Labor Code.for the Performance of me work for which this permit is issued. W 0 1 have and will maintain Worker's Compensation Insurance,in required by Section 0 W of the LibetrCod..for M.performance of Me work for which Nis picornit I.laxed. My Workers Corn,,matiodon Insurance carrier and Policy number am: Carrier. Policy No, CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (ruleaction need no,Its,mrolilved lithe permit Is forme,hundred dollars SI0(o or ICSL) I certify Net in the performanec o New k for which Nis permit is issued.I mail not ITpM tryonto in any in Cuing...mm 0 C,If I nL N — �p IC i;5APPLICAPE.If.,fire x(making—15isrd�maw of � -CaExemption,you�o.ld It aubjocIIre th3W cc's Compensation prip,isiomi of Me Labor Codc,you most z forthwith comply with such provision.or this permit shot]M doomed revoked. C CONSTRUCTION LENDING AGENCY I lamphy suffino that More is a construction lending agency her to performance of Q'ithe work for which this permit is Issued(So,.3097.Ci,C.) I Lender's Name ILI ::)z Lmim'.Add., U 0 1 certify Met I have mad this application and MIM Met Me mere infairroadmi is correct.I agree to comply with all city and county ordinances and state laws relating to 0 U building construction,and hereby authorise representatives of Nin city to enter upon ft m0"-Imunfioned fumparly for inspection purposes. W (We) ter am if and leem harmless the City of Cupertino against rA lialiffidesju mcms,cos�indemnify A�ndd'pmLos which may in my way accrim against said City Hz inconsequ voofthojIfoutuagIntids,serml. APPLIC UN WITH ALL NQIN P MIT Issued by: Date SOUR, R Re-roofs Aignuter"t ApplucanVU64arrector am HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will Me applicant or future building Occupant slum or handle ass ossa material as defined by Me Cupertino Municipal Code,Chapter 9.12.and ft Health and Safety ".do.S lion 25532(a)9 Eyes Z2 All roofs shall be inspected prior to any roofing material being installed. or Will the applicant In yzierlding Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hamplous air contaminants m;defumd by The Bay Area Air Quality Management all new materials for inspection. District? El Yes I* I have mad the Inuoundmismaterialsisquiremeno,underchaptcr 6.95 of Ne Califor. .i.H.al SaftyCodc,Socnions,25505.25533 ImI25534.1 undoommil Net irth Imildin, domino ormody haw a mosm Nat it is my marmanditelity to notify ft Oce am f1ho mqui crox mccofaCerfifficionof nt Date r wittitioubcd agent - jxz I Xsen t I Signatore of ApplicaAll roof coverings to be Class"B"or better \Atiy(ok Community Development acloF 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 UPERTINO Building Department JOB ADDRE p T l �� O �� 22 1 OWNER'S N G I �c_e e t PHO # j GENERAL CONTRACTOR: FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: 60 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass/ Glazing Heating Insulation Landscaping Lathing asonryK..c Lk VIM 64 Sm Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile O / ntractor Signature . Dfte " - CITY OF CUPERTINO CUPEI�TINO PERMIT APPLICATION FORM 0 �' ��° " 3 N# Date: S Building Addre? : �� /G c�h iling Addr ss (i different from building address): Owner's Name: Phone #: z ✓ 2t � -s- � y Contractor: License #: k C-C- L L �� H "Z S——k CS) Contact: Phone: Cupertino Business License#: R\Cke4&— Fax: Building Permit Info: -Bldg [] ` Elect ❑ Plumb ❑ Mech El Job Description: d i✓ p Residential ❑ 'e Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: Occupancy Group4rift Type of Construction: Please check this Ject is a second-stor addi Pro'ect Size: Standazd ❑ Laze ❑ Ma'or ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to IM 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 Iof3 Zr -q7 17 7. S'11 CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPERTINO 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 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 BRENLUUTAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMPIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace > l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Lkppliance 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 2 of 3 am -� CITY OF CUPERTINO CUPEt�TiNO PERMIT APPLICATION FORM QuantityFee ID Fee Description Fee Group BREMRESAPP Remodel Res Appliance ELECTRICAL •1 .I BREMSIGNAD Rmdl Sips Add Branch ELECTRICAL BREMSIGNS Remodel Sips, 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 Ternp 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 ZADDCHG Address Change BUILDING • i i I 3 of 3