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03090008CITY OF CUPEWIJN0 T 0,jCbiVTRACT�QR ✓y mins r r ,�.ti'»% zt 't ..ta ��* �h INFRMATIO•r BUILDING DIVISION PERMIT BUILDING ADDRESS: '"435 9ANTA PAUIA Air MAHMOUD SHAHRAM ERMITNOO309000H """"03090008 NER'S NAME: PERMIT ISSUE DATE r ONE: SANITARY NO. CONTROL. NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDC ELECT PLUMB MECH 0 0 LICENSED CONTRd order s DECLARATION 1 hereby affirm that 1 am Iimnsed undo of Chapter 9 (mmmcnse lob Description P Pr000s with Scctian]IXIU)af Oivixian]ol the Business end Profusions Code. and my license is andis in full torte and eBbn. LiccnuCluss Lie. As SHED - Dell Contractor DECLARATION ARC a I tic used I understand my plans sea ud a public accords 7 / y Licensed Pntfessioml OWNER -BUILDER DECLARATION V I hereby affirm that 1 am exempt (rum the Contractor's Liecnu Law for the - following reason. (Section 7031 S, Business and Professions Code: Any city fir county which royuiru a pmmit m construct. her, improve, demolish, or repair any structure prior to ill issuance, ehu rcquims the applicant for such permit to file a signed sulem at that he is licensed pursuant to the provisions Of the Contractor's License Law (Chapter 9 Sq. Ft. Floor Area Valuation . (commencing with Section 7") of Division 3 of the Business and Professions Code) or Nat he is exempt therefrom and the basis for the alleged exemption. Any violation of 3S704053,00 Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type P Y YP - aotmore than two hundred dellan(35W). - - — --_ ❑ 1, as owner of the property, in my employcu with wages As their solo compensation, will do the wart. and Ncswcture is not intended .,offered IOW. (Sec.]094, Business 101—]€ end Profession cs Cade: The Convector's License Law donot apply to en owner of d Inspections property who builds or improves thereon, end who doessuch work himselfor through his 102 - PIERS own employers, provided that such improvements ere not intended oraQered for sale. If, 103 — UFER however, the building or improvement is mid within one yxu of completion, the owner - builder will have the burden of proving Nat he did not Wild or improve (or purpose of 104 - REBAR sale.). 105 - ANCHOR BOLTS I, as owner of the property, am exclusively contracting with licensed contractors to construct the pmjeo(Sec.]U44, Basin ad Profession, Coast) no Contractor's L6 106 — SEWER & WATER came Low docs not apply to In Owner of property who builds or improves Viencon. ad ho at cots ser such projeeu with aconvacmr(s)Iicaved purauam.. the Conuanah sec. w K. 202 203 — UNDERFLOOR PLUMBING — UNDERFLOOR MECHANICAL amp de ac. ,B&PCfor this rcuon `O 204 - UNDERFLOOR FRAME Data KERSCOMPENSA OND RATION 205 - UNDERFLOOR INSULATION I erebyaff Order penalty ofperryrytne hawing declarations: 301 — ROUGH PLUMBING ❑ I haw and will maintain a Certificate of Consent to self -Hurt for Workct's Compen- 302 — TUB & OR SHOWER mouth, u provided for by Section 37M Of the Tabor Code, for me perfwmmce of the 3 03 — ROUGH MECHANICAL work for which this permit is issued. ❑ I ban and will maintain Workeh Compensation Insurance, As acquired by Section 3 04 — ROUGH ELECTRICAL 37W ditto labor Code,for the performiaccofthe work forwhich this permit Warned. 305 — FRAME My Worker's Compensation Insurantt carrier and Policy number am: 306 — HOLDOWNS Cartier: Pol icy No.: _ CERTIFICATE OF EXEM MON FROM WORKERS' 307 — INSULATION COMPENSATION INSURANCE - 308 — S+HEETROCK (This shoumneed hot the completed if he permit is fm arc hundred dollm(31W) 309 - EXTERIOR LATH fir less.) 1 certify mat in the pe,fannmm of the ..,it for which oda permh u Issued, 1 shall oat 3 10 — INTERIOR LATH employ any person in any manner an ass become subject to the WorkeKComreuadms 311 — SCRATCH COAT Laws of California. Dow Applicant 313 501 - ROOF NAIL - FINAL ELECTRICAL ENERGY NOTICE TO APPLICANT: IL after making this Cenifinte of Exemption, you should become Subject to the Worker's Compensation previsions m( the Lihar Code, you most forthwith comply with such provisions or this perm it shall be deemed revoked. 502 — FINAL PLUMBING ENERGY CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY I hereby affirm that then is a communion lending agency for performance of 504 - FINAL BUILDING ENERGY thcwork for which this peamit is issued (Sec. 3M7, Ci, C.) LcndcrNamc 505 - FINAL ELECTRICAL Undeh Address 506 - GAS TEST (certify Oat 1have mad this ty and cunand sum that the above Information is wiling l agree to comply with end county ONinnxes and cute levet ro 507 - FINAL PLUMBING y auty building construction, and hereby luthorin ifpmsenudw.ol Nis city to corn upon the r upon CAL MECWNG r�6 ahavCmentirned factorty (m inspection purpOYa.(We) agree to save, indemnify and keep harmless the City of Cupertino against lOhilit-Oil cnotworts and Ox scull which may in any way accrue against said City 0 9 ZIN mconseq enc the nosing of this permit 5 IST'qANDS AND WILL COMPLY WITH ALL NON -POINT SOURC TIGI.M1 Issued by:5 WORKS Date Re -roofs Type of Roof ` S1 of AppliemVConvactor Date HAZARDOUS MATERIALS DISCLOU RE Will the applicant Or future building Occupant store or handle havahlous authorial as defined by the Cupertino Municipal Cade, Chapter 9,12, and the Health and Safety �udc, Section25512(e)? ❑ a. All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building Occupant use equipment or devices which emit haamduus air contaminants u J ed by the Bay Area Air Quality Management all new materials for inspection. Disvict? - ❑ Ycm I have mad the hamrdous materials mquircmcnu under Chopmr695 olthe Califon hie Hcalthk afctyCodc. Sacdom75505.25533 am125534. 1undcrsund mwifine Wilding Docs oat cu fitly o cant Nat it is my respmuihility to notify tW mcupmt of the requirc�µ hick st met poor to issuance of a Certificate of ampanc Signature of Applicant Date jj tom 5a All roof coverings to be Class "B" or better Owner sera thorind agent m TY OF • CUPEIZTINO C*Y OF CUPERTINO 0 PERMIT APPLICATION FORM d30 90618 APN # Fee Description Fee Group Date: % Building Acidres - p PCtJ.. BBLDGFEE ZZ 3 n � BBOILERI Owner's Name: n BBOILER2 Phone #: /y1G.y1 MV (A �J W )rA r1 Boiler> 500K to 1M Btu MECHANICAL Contractor: Sej) Boiler> 1M to 1.75 M Btu MECHANICAL License #: Contact: U MECHANICAL BCONSTAX Cupertino Business License#: riBing P � Info: BCONSTAX Ind/Off/Comm/Quasi Elect ❑ Plumb ❑ Mech ❑ Job ription: BUILDING BCONSTAXH idential I' Sled Commercial ❑ Sq.Ft. Floor Area: BUILDING BELEC1000 $/Sq.Ft.: Cost of Project: Liyl Elec 600V > 1000A Occupancy Group: Type of Construct' Elec Svcs 600V <= 200A ELECTRICAL BENERGY 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 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 BMITIGATC Comm. Housing Mit. Fee BUILDING 1 of 3 a w COY OF CUPERTINO C1N0 PERMIT APPLICATION FORM AkCUPERJTINO Quantity Fee ID Fee Description Fee Group 7 BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi -Family Res MECHANICAL BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL BNEWMULTI Multifamily Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMULTI New Multifamily Res PLUMBING BNUSFD New Single Family Res BUILDING 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 rinklerBackflo 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 BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL $REMFIXT 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 Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL 2 of 3 tamzm CITY of CUPEkTINO CITY OF CUPERTIl4 PERMIT APPLICATION FORM Quantity Fee ID • Fee Description Fee Group 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 BREMSIGNAD Rmdl Signs 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 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 Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING KIM 01 • CITY OF CUPESION 4 CbNaT.R.A.CTpR INFORMATIQN' nmLOmc Orvlsloly PERMIT . BUILDING ADDRESS: 9942S SANTA PAITIA. All MAHMOUD SHAHRAM PERMITN903090008 ER'S NAME: PERMITISSUEDATE NE: SANITARYNO. CONTROL NO, ARCHITECT/ENGINEER: BUILDING PERMIT INFO ' BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION jpb DGSCTI tlOn 1 1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing p with Section 70(m) nr Division 3 of Ne Business and Professions Code, and my license is / in full force and effect. SHEDO/ License Class Lie. g I ' Date Contractor ARCHITECI•S DECLARATION 1 understand my plana shall W used as public records Licensed Professional OWNER BUILDER DECLARATION 1 hereby affirm that 1 em cumpt from the Contractor's License Law for the following reason. (Section 7(131.5, Business and Profession Code: Any city or county which requires a pmmit ,, construct. alter, improve, demolish, or repair any structure prior sea its issuance, also requires the applicant for such pwmiito rile a signed aumment that be is licensed pursuant to Provisions or the conlmcur's License law(Chapter 9 Sq. Ft. Floor Area Valuation (commencing with Section 7") or Division 3 of the Business and Professions Cole) or Nat he is attempt themfman and the basis for the alleged asum ption. Any violation of , 35704053.00 APN Number Occupancy Type. Section 7031.5 by any uppilcant for a Permit suflOccie the applicant to a civil firmly of not more than five hundred della..(5500). _ .__.. _.. ._ ___ _ —___. ❑ 1, as owner of the property, or my employees with wages as their sole compensation, — {� (�.�� will do the work, and the structure is not intended or offered for sale(Sec. 7064, Business and Professions Count: The Contractor's License Law does not apply to an owner of zFe�`tlHCd IOSpeC[]OnS property who builds at improves thereon, and who does such work himself or through his 10 2 - P I ERS own employees, provided that such improvements we not intended or offered for mile, If. 103 — UFER however, the building or improvement is sold within one year of completion, the owner- builder will have the burden of proving Out W did not Wild or improve for purpose of 104 - REBAR sale.). lO5 — ANCHOR BOLTS L as owner of the m n am exclusive) contracting ❑ p I p x y, y sCodmicenseCoonmcmnio construct Ne m cct (Sec, ]044, Business and Professions Code) The Contractor's Li� 106 - _ SEWER & WATER cense law does not apply to an owner or property who Wilds or Improves lhemon,and, 202 — UNDERFLOOR PLUMBING Jain o nlmu or such projects with a contractor(s) licensed pursuant to the Comment's Lie m w. 203 - UNDERFLOOR MECHANICAL 1 am amp Je 'ec. B & P C far this reason 204 - UNDERFLOOR FRAME tWORKER'S 205 '- UNDERFLOOR INSULATION COMPENSATION OF RATIO 1 erebyeRbmunder Penalty ofperjuryone4. "cliciwingdecimations: 301 — ROUGH PLUMBING I have and will maintain a Certificate of Conxm to selflnsum ter Warker's Comper- 302 — TUB Sc OR SHOWER action, as provided for by Section 37M of the labor Code, far Ne performance of the 303 - - ROUGH MECHANICAL work for which this permit is issued. 3 O4 — ROUGH ELECTRICAL ❑ 1 have and will maintain Worker's Courcem ion Insurance, as required by Scchon 37W of d,e labor Code, for the performance of the work for which this permit is issued. 305 '— FRAME , My Worker's Compensation Insurance carrier and Policy number are: 306 — HOLDOWNS Curiae Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' 307 — INSULATION COMPENSATION INSURANCE 308 SHEETROCK (This section need not he completed if the permit is for mm hundred dilims 1$1 W) 309 - EXTERIOR LATH - Or Icrord.> mann of the work for this permit is issued, shall certify Nat ar 310 - .. INTERIOR LATH ' employ en nary in any manner so as In become subjccue tW Workers'Campemetian subje wi 311 — SCRATCH COATI' Laws of Laws of California. Dam Applicant 313 - 501 - ROOF NAIL FINAL ELECTRICAL ENERGY Ir, NOTICE TO APPLICANT: Cirmis of of Exemption, you Cmrmosmumhis Wcome subject to the Worker's Compcmetion provisions of the Lahnr GndC, you must you forthwith comply with such provisions or this permit shall he deemed revoked. 502 — FINAL PLUMBING ENERGY CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY - IherebyafirmOatthemisaconstructionlendingagencyfortheperformanceof 504-- FINAL BUILDING ENERGY the work for which this permit is issued (Sec. 3097, Civ. C.) Lander. Name - 505 - 506 - FINAL ELECTRICAL GAS TEST Landers Address 1 cenify that 1 have read this application and sum that the above information is correei. I agree to comply with all city and county ordinances and sure laws relating to 507 - FINAL PLUMBING building construction, and hereby authori®«presentatives of Nis Ci ty to enter upon the - FIN MEC H CAL above-mentioned properly for inspection purposes. (We) agree to s.Ve, indmamfy and keep halmleaa the City of Cupertino against O 9 t� y� I I b11111'aqd ea�L.cOits and mucosas which may In any way accrue against mid City 5 NG in connc the mining or this permR, TSTANDS AND WILL COMPLY WITH ALL NON-POINT T Issued by:5 C WORKS Date Re-roofs Type of Roof _ 6i'` S" o'Applicant/Conmaor Dim HAZARDOUS MATERIALS DISCLO URE Will the applicant ur future building mccupanalore or handle hmai dous material as defined by the Cupertino Municipal Code, Chapter 9.12, end the Health and Safety e, section 25532(a)? /. - All roofs shall be inspected prior to any roofing material being installed. ❑Yes 66'IU If a roof is installed without first obtaining an inspection, I agree to remove Will the appucentorfuture Wildingoccupantaseaqulprntotordevices which emit hemrdous air conuminanu u d ned by the Bay Area Air Quality Management - all new materials for inspection. District? ❑ Ycs I have mad the h=rdnus materials mquimmenu under Chapmr6.95 of the Califon nia Health& afety Code. Seemi.25505,25533on,125534. 1 understand Be iflW Wilding - Joea not cu rely a nant, drat it is my rcsponsihility m notily the a+cupent of the reyuircmcn Hien at met pdntmissuance nraceNnmmor«eupmcy— Signature of Applicant Date. All roof coverings to be Class "B" or better Owner dumired f 1 %,15w� sera agcut we