S 0167 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
,CITY OFCUPERTINO - BUILDING-ELECT HIC,IL - - PERMITNO
BUILDING DIVISION APPLICATION/PERMIT PIAMBIN0.AIBCIIANICAI. - O (�7
1. .,�., 'a tflU11.DINC.'1'NOJECT IDEN'1'IFICATIONJ 1,j; ! -es V
RUII.DING ADDRE,SS'. SANITARY NU. APPLUATIONSUBMI'TIALDATIi
zza g� *bTeVeAS lc-KEM� aA.i G
OW ER'S NAME: 1 PHONE: CONTRACTOR'S NAME: LIC NO
�� r�� NIC CON'IN -�
CI IITECVIENGINIiF.R: LIC NO, ADDRIiS�—' ❑ !//IIv11, (}}l/V({'„
C
ONTACT. ONE: BUILDING- BUILDING PERMIT INFO -
A 371^'} `3. ❑ Consultant Fees Paid by Applicant(Initial) 1LECT LUMB MIiC
C\/�\
LICENSED DECLARATION QTY ELECTRIC I ERMIT' '3 TEE'" 'f JOB DESCRIPTION
reby aIr t tl I nggare'Do .m n3 rtn Rosinc„anen f.,ian cd J tyles ,rsRESSDENTIAL i
'R 1 SUANCF.and effeel - SFDWI, ❑KITCHEN REMODEL
ss 1.ic.kAPPLIANCES-RESIDENTIAL ADDITION ❑PLUMBING RE-PIPE
Fw Umc Carmacmr,
m 66ARCHITECTS DECLARATION Wp1�$$$•••ppp El MULTI-UNIT ❑STRUCTURAL
F y Z i undersand nay plows sh:dl be anon e,public records JO% yp/1/Ipry� MODIFICATION
Oz4Q_ VP'[0/d1EB [I INTERIOR ❑CHIMNEY RI7PAIR
0. ;� a7 Licensed l'rnfitWomd t 201-I(M,OAMPS IMPROVEMENT ❑SWIMMING POOLS
f, OWNER-BUILDER DECLARATION l2P,OVnt V(Mglk6hkR' HAITI REMODEUREPA ❑
R DIiMOLITION
CG 1 hereby affimt that 1 ran exempt brain the Contractor's License Lew t `t��
"' ElC W U following activated,(Section 7031.5.Business and Probesninns Cone:Any city or candy SIGNS ELECTRICAL. El OTHER _
3a.E" whll 4 0 PelandI t t ami i parvo,
d 111 p Y t etum
patijnort t eal:omq Ih ppic tf hpc tl flsigned.statement SPECIAL CIRCUITIMISC.
X65
throahe is ficemed,am,malll tM1 p fm Call I...ciioSL I (Chapter 9 COMMERCIAL
�p�'QQ faimm neng with Section 7000d.fDewo J fth Bushes dl f:' Cdc)nr '1'EMI'.MEUR OR OLE INS'I'.
a Y c C That he is exempt beat...I and the basis fur the allege)excavation.Any violation on of ❑ RLDO)ADDITION ❑DEMOLITION
4• Section]OJLS by any applicant fare patsubjects the applim,to a civil penalty of POWER DEVICES rENANT El 1700D SFRVICF.
man ora team Eve hunddd ddl $5
ars( 110). PROVEMENT
h. C ❑ Las owner of the pmpcny.or my employees witM1 wages az lhcaside compensation. SWIMMING POOL BLECI'RIG ❑O HI?R
will do the work,and the structure is not intended or offered for sale(Sec.]Dlq business
and Professions Code:The Carmichael,License law does not apply In an owner of 01,1'LGIS-SW ITCI ILS-FIX'I'IIRES -
d'3` propeny who builds or improves thereon,and wha doer such work himself Or through
his own employees,Provided that such improvements nae not intended lir ofberul for NEW RESIDEN'PIAI,ELRCfR SQ EL
sale,If.however,the building mntprovcarm,iasold vallitiont,ywrofmumplchion,the SQ.PI',1 LOCH AREA� $ISQ.FI'.
neolmaiJer will have the buNen of proving that he did not build,),improve for Pur e-
p se, [ I ). (�
az f thep pent exclusively contracting with licensed contractors I
tst ith Irl tp own R : c dP fes. CJp'Rmve t t 1- - - - \ L fit`
cense La d t (Set.ply a fpnpeny h builds p Ne d QTY. �, II" -PLUMBING PERMIT' r}J- ' -'FELE -`
1 hott nsfl act,P us with,vonn eons)Imsrssed pur,arm tothc Condon, -
License Law. PERMIT ISSUANCE:
IL I am oxl,, lglfadofQ3A&P C lar this reason
ALTER-DRAIN&VENT-WAT' (IEA VALUATION
Owner Die � .
WORKEiR'. PENSATWI DLiCIARALON BACK PLOW IROI'IiCI'.D' ex or
-� r�
Iherchy affum nnJcrp alt,of perinry Ona nl rho following dccluratinns:
FIhave and will maimain sCcniacom of Canned lit self-in.mre for Worker's Comlven- DRAINS-FLOOR.ROOI'.ARIiA,C( STORIES 'TYPE CONSFROM ION
saran,as provided far by Seetian 37M of the Labor Code,for performance of the
work for which this peOam is issued. FIX'IV
FIXTURES-I'IiR'1'ItAI'
❑I have and will maintain Worker's Compensation Insurance,as required by Section
370tlafthe Lebo,Csde,bonhe perommnto of,hc.O,k borwhich this Iladod is issued GAS-IiA.SYS'rEw INC.4 OUTLETS OCC.GROUP AI'N
My Warkds Compensation dna mance carrier and Palley number nm:
Camey. Policy NO: GAS-IiA.SYSTEM-OV IiR 4(IiA)
' CIiRTIPICA'I Ii OF EXEMPTION FROM WORKERSGRIiASIIINDUSTRI,WASTLINTIiRCEPI'OR
COMPENSATION INSURANCE: UIL IN DIVISIONI'I]iS
(This nocninsxdnot be completed ifrhe pernal is for line hundred dollars 6100)
Orless.) CRI3A9H TRAP
'PLANCUECK : r
(certify that in the perPormance mf the wmkfnr which this permit is issomA,lshall SI1WER-SANITARY-STORM LA. IT.
Nat employ any person in any manner m as to beemax,object to the Warke,k Carped- ENERGY
Z xution Law,of Cold...trial.Duro WATER HEAL ER WN[NT/P.LIiCTR
O O Applicant s GRADIN 114
G NOTICE TO APPLICANT IL nfmr making thl,Cenihcaro of Exemption,you ehnulol WATER SYSTEM/I'REATINO
.Ni S(IILS IRiE
F become subject y the ,tell s loan,ordbi,pmvit ArI is the labor Code,you must
limbwith cmnply won such prtrvlsinns err this pormit shalihdemncd ravoAW. WA9'P.R SERVICE
'U O
CONS'I'ItUC'I'ION LENDING AGIiNCY NEW RESIDIiNT1A1.PLMB. SQ.IT. PAID
i herehy affirm that them a
il.,mmuction lendin6 ogcnry for the perlimmmice of
t•-i due walk for which thispermit is kowd(See 3097,Civ.C.)
I--' L<nder's Nome DEAL
V LcnJ :A W
>t is .♦ BUIL ,I'PP
I n fy that I have mad this apple i J.Into Ihm the about nlnnnal m i
t"i h am I I g t cmnply vi th dl etry and ty -li omie,and,tam mw,adiam m ,QTY., r `MECHANICAP PF.RMI f f FEE `
U Z building coastal and herchy amhmnss mprt,enmavesof this coy to cone,upon the SHISMIC FT'li
nowe-meminned pommy for inspection NaLlo seS. I'HRMI'I'ISSUANCE
(We)agree to save,indemnity and keep harmless the Chy'nf Cupmino agmina BLLCfRIC
Ef
firbabitics,judgmems,cuss and expenses which may in any way accme against said City ALTER OR ADD TO MECH. PLUMBING IE (�
in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT('r010.000 CFM) MECHANICAL .E
SOURCE REGULATIONS.
AIR HANDLING UNIT(OVER Hit I(10 CPM) CONS'IHOC['[ON YAX
Si,moure of Applamm Comsat,), Dam EXHAUST FLOOD(WIDUC) HOUSING MITIGATION FEE
HAZARDOUS MATERIALS DISCLOSURE' -
Will the applicant orfummbuiliingnecupantsamarhan:,1,'mmnus did HEATING UNIT(TO 100.0100 BI U)
as defined by the Calvinism Municipal Code,Chapter 9.12,end the EleaM1h and Safety
Code,Section 25532(0)^ * HEATING UNIT(OVER IO(pWO HTU)
❑Yes [I No - VENTILATION PAN(SINGLE RCSID) PAID
Dole Receipt X
Will the applicant or future building ce,opom use equipment lir devices which
ail minalt as air contaminants an defined by the Tiny Arca Air Quality Managenneot MOILER-COME'(3NP OR IW,IXMI BTU)
TOTAL:
istric" ROLLER-COMP(OVER jon,OaTO)
❑Yes ❑No
I have mad he hawrdamouiderlul,ver,iranmrt,under Ch.,a,,6.95 of the Cali. AIRCONDI'HONER ' ISSUANCEeTl
fomiu Health&Safny Cade,Seaians 25505.255JJ end 23531 I anJm,mnJ that if the NEW RP_SIDENTIAL MECH. SQ.FT. V Z7i `�I
building
of the mqJtim mlidemis which must
ts mnanh that it is my reepsmsibility In notify the oecnpam l%
be met lvaimnnissuantt ofa CenificmrofOccupancy. '
Owner tor...raised agent Date ��� NSUPOBY:
OFFICE
222` SG16
nop
_ RECORDING REQUESTED BY: hol I)e'r31'i Cott 2f�<I , F doOt.hUlrtBll!1188
rlVfi��%4 AKA
R FlWHEN RECORDED MAIL TO:
'MR. & MRS. NASROLLAH KAZEMI
3763 TRINA WAY Doc#: 13813719
SAN JOSE, CALIFOI NIA 8/13/1997 11 48 AM I ;
95117
DECLARATION OF RESTRICTION ,
This DECLARATION OF RESTRICTIONS made this 12th
day of AUGUST 4:
1997, by NASROLLAH KAZE T & NAHID hereinafter referred to as "declarant."
'WHEREAS, Declarant is the owner of certain real property located in the City of
,Cupertino, County of Santa Clara, California, more particularly described as follows: e
APN:
326-50-034 (Legal description attached as Exhibit A.) R.
v
WHEREAS, Declarant and/or persons acting on behalf of Declarant propose to construct
a second dwelling unit on an existing single-family lot.
WHEREAS, Chapter 19.84, an Ordinance of the City of Cupertino regulates the
construction a4maintenance of second dwelling units in single family (RI) zones as
follows:
1. The owner must reside on the premises in the principal or second dwelling unit'.
2. A'deed restriction setting forth the above-described occupancy requirement
must be recorded prior to granting a building permit for a new dwelling unit or
granting an occupancy permit for an existing second unit constructed prior to
%II the adoption of the second unit regulations. �
a t 3. The owner of a properly which contains a second dwelling must sign an H„
t affidavit on each yearly anniversary date of the approval of said second unit „xz
declaring under perjury that he/she is living on the premises. };
' 4. In the event the owner is unable to reside on the premises for any reason,
fi.' continued occupancy of two units on the property is invalid and illegal. Only one';,•
of the units may be non-owner occupied and the other second unit must be ,
rendered unoccupiable, except as an accessory building as permitted by the Rl, IV
residential single family, zoning district of the City of Cupertino. ;-
5. In the event, the second unit must be modified to conform with the accessory
building provisions of the R1 Ordinance by elimination of the food preparation 'E
capability within the kitchen area including the removal of cooking units including';.
range and ovens and disconnection of special electrical wiring and/or gas lines to
service said kitchen area.
t
lei
-
G. In lieu of eliminating the food preparation facilities, the owner of the property
has the option of leaving one of the two units vacant. A.
7. Certification of removal of the functional food preparation facilities must be
made by inspection by the City of Cupertino Building Department prior to non-
owner occupancy of the property. An inspection fee will be charged to certify thdt
v; the modifications have been completed.
8. If the owner elects to leave one of the units vacant, the owner must prepare a
letter describing the unit and the length of time it will remain vacant. The unit
must be subject to periodic inspections by the City to confirm that it is not
. occupied.
" . �. NOW, THEREFORE, in consideration of, and subject to, the terms and conditions set
` forth above, Declarant agrees as follows: �+
Declirant agrees to comply with the above referenced conditions and restrictionsand i
hereby notices all future property buyers of said conditions. yw
Declarant agrees that this declaration is intended to be covenant running with the land and',
will bind and inure to the benefit of the heirs, personal representatives, successors and i}
assign's of each present and future owner of the real property described herein!
' Dated: AUGUST 12, 1997 Declarant: dU� lwp� wT „
1-}rant
All Signatures must be Acknowledged -
��
.y
1 e
ny'
' V ,. ,
,t.,, f
ahs
Ore.,
1
,r
EXHIBIT "A" e
>"f The land ieferred to in this Report is situated in the County of Santa Clara, City of Cupertino,
State of C3lifomfa, and is described as follows:
r�
, q 4 Pazcel C, as shown on that certain Parcel Map recorded February 26, 1975 in Book
351 of 'Official Records, Page 47 of Maps, Santa Clara County, California.
�
1 •„3, .", EXCEPTING THEREFROM the underground water or rights thereto with no rights of
" sgsj surface entry, as granted conveyed to the City of Cupertino, by instrument,
w 2, recorded January 31st, 1975 in Book 8264 of Official Records, Page 476: ,
w . . 326-S
s; {' 0-034
.13027,,,.
NMBA V,- . .r.
a5 i rl A 326=50-007
A
�tl' d fJmlry
1
"Tia. • g?a
• 1 ,
1.1 • n� h
Y I ;
.aF4 s, • ,� Page 3'of 6 Pages -
1
1 r _
a
i
f]RT T1 r7.0
M 141
Are
STATE OF CALIFORNIA }
SS.
O JNTY OF SANTA CLARA }
On 12, 1997 before me, JOYCE H. VOSTERS
J. Ail,
'personally appeared
personally known to me (or proved to be on the basis of satisfactory
r.
;;evidence) to be the person(s) whose name(s) is/are subscribed to the
;within instrument and acknowledged to me that he/she/they executed ,
the same in liis/her/their authorized capacity(ies),and that by his/her/their
fl sigiiature(s) on the instrument the person(s) or the entity upon behalf of
tF; which the persons) acted, executed the Instrument.
171 WITNESS my hand and official seal.
Signature CIM6 (This area for official notarial seal)
i f$ .A.
^}i' � 220000000000AOpO�000T46�0
b JOYCE H. VOSTERS
245 comm. #1062131y q$
NOTARY PUDLIc'• � t:ALFORNIA 2 9AIrCLARA COUNTY z
thy
Comm B A A Juno t9,f ,A 22
�. �os�ooeo�es�Noo�ss000�oe�
=a
,t
to
I CERTIFY UNDER PENALTY OF PERJURY THAT THE "NOTARY SEAL" ON THE
DOCUMENT TO WHICH THIS STATEMENT IS ATTACHED READS AS FOLLOWS:
as
tri
NAME OF NO'T'ARY JOYCE 11. VOSTERS
DATE COMMISSION EXPIRES JUNE 19, 1999 <%a
PLACE OF EXECUTION CAMPBELL, CALIrORNIA DATE AUGUST 12, 1997';;
(Govt. Code, Sec. 27361.7) Fidelity National Title Co.
Signature (Firm Name If Any) jt
'" vl
J
T`