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04100019COF CUPERTINO - .: i" . ; ".':,:� BUILDING DIVISION - .PERT °V3,\"A l..'217LA41111A- BUILDINGADDRESS: PERMIT NO. 04100,019 20061 SUISUN DR OWNER'S NAM E: - PERMITISSUEDATE KOOROSH AFLATOO NE: SANITARY GL NO. 'INFHMECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT - PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Gyp e it J h tj r 9 (commencing 1 hereby affirm that I am licensed under provisions of Chapter with Section 7") ofDivision 3 of the Business and Professions Coda, and my license is in mu force And effect. BATHRM REMODEL License Class Lic. a Dau Contrumr ARCHITECTS DECLARATION I understand my plans shall W used as public records NOV 2004 ( Licensed Professional OWNER-BUILDER DECLARATION OWNER-BUILDERRATIOror's,License I hereby affirm thatOW 1 from the Law for the i following ..on. (Section 7031.5, Business and Professions Code: Any city or county - BUILDING which ".I. a pantie m consioal, altar, improve, demolish, ar repair any Structure 95000_ Prior At its issumce. als� mquines the applicant for such permit to flc a signed..used... Conlmcur's License Loa(Chapur9 Sq. Ft. Floor Area - Valuat oq i that he is licensed pursuant to the provisions oflhe (commencing with Section 7") of Division 3 of the Business and Professions Codc) or . Nat Ise u exempt therefrom and the basis for the alleged exemption. Any violation of .smwTrf a. ra,A, .. 3 6V2V WYSYer0 0 Occupancy Type .. Section 7031.5 by any applicant for a permit subjects the applicant a a civil penally or not mom than Ove hundred dollars (S500). - - - 0 1, As owner of the peeprty, or my employees with wages u their sole compensation, - - -' --Re aired Ins ections will do lbewark. and the sdrucdum is natinuntled oroffemd forsale(Sec. 7044, Business and Professions Code The Commences License Law does not apply u an owner of p property who build, or improves thereon, and who does such work himulfor through his own employees, provided that such improvements an, not intended or offered for sal:. If. - .- however, the building or improvement is said within one year of mmPletion, the WmAT- - W ilder will have the burden of proving that W did trot Wild or Wirmw for purpose of Asia.). AI, as owner of the property, am exclusively contracting with licemed contractors,to atmct the project (Sec. 70,14, Business and Professions Code:) The Contractors W- - came law does not apply in an owner of property who Wilds or Improves daemon, and , - who contracts for such prejecla with a cantor(&) licensed pursuant As the Contractor's License Law. 0 lam exemp on er �. B& P C forthis mason _- er /1 Dale O OR C - SS COMPENSATION 1 he y affirm under penalty of perjury oro of dre following decluntiom: hawand will maintain aCerOfcauofConsenttoself-insua for Worker's Compen-- . As provided for by Section 37W of the labor Code. for the performance of the for which this permit is issued. ❑ I have and will maintain Worker's Compensation Insurance, as required by Section 37W of the Labor Cade, for the performance of the work for which this permit is issued. My Workers Cmmpena ion Insurance canicr and Policy .umbar am: Carrier: Policy No.: - CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE - (This section need not W completed if the permitis forone hundred dollars (SIM) or lass.) I certify that in the performance of the work for which this permit is issued, I ana[] not employ any person in any manner eo az in become subject in the Workeri Compensation Laws of California. Data Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Worker's Compenution nominations of NC Labor Code, you most forthwith comply with such provistona or this permit shall be deemed mvokcd. CONSm ON LENDING AGENCY hereby I. A c agesmylnr the performance of - whicfvmthellnemissued(ec.3M.ndtng ' theLe work fur which Nis permit is issued (Sec. J09'/, Civ. CJ Lender's None Lendees Addmss I eagree that I have mad this and uses Net above relating is taws county aNtmnces and state laws mating u bonding l gree comply with all city coup y andrad buildingm-eunumb0om end herby de rposes nalivcs of Nis tiny m enter upon the shove-mentioned properly for inspection purposes ecdan p (WC) "me to saw, IndC111Nfy Nd keep nBrr111eS5 the (.'sly of L'YpCnlnn 8galnsl j inconsedgmentse gratsintl Capenusmit. may in tiny way ecemc against AsiO Cily in consequence of the granting of this permit. ' APPLICANT N TANDS AND WILL COMPLY WITH ALL NON-POINT A - ' Issued by: Date SOURCE E TI 5. / ( Re-roofs Si' sero nV nl ctn Data HAZARDOUS MATERIALS DISCLOSURE Type of Roof WIII c applicant or future building mcupannarom or handle hamrdous maurial az defined by the Cupertino Municipal Code, Chapter 9.13, and the Health and Safety coda. Sorties zss3z(,)? All roofs shall be inspected prior to any roofing material being installed. - Yes ❑YRI No If a roof is installed without first obtaining an inspection, I agree to remove' Will the applicant or future building occupant vu cyvipmem or ticviccs which til hammines air contaminants as defined by the Bay Area At, Quality Management 'all new materials for Inspection. ria? O Yes 14No I have will the Wmrdous materials mquircmcnts under Chapter 6.95 of the Califon nia Hasllh&S yCodc. Seed mM505,75533od35534.lunkmmtdthatiflW building ' does nrace I ham a team, that it is my responsibility u notify the occupant of the mquire c at prior to Issuance or. Certificate of Occupancy. Signature of Applicant Date All roof coverings to be Class "B" or better owndra,dtlagent Dane .4 CITY OF CUPERTINO 6016, FQRMA' N BUILDING DIVISION PER BUILDINGADDRESS: PERMITN004100019 20061 OWNER'S NAME: PERMIT ISSUEDATE KOOROSH AFLATOONI qftOL ONE: SANITARY NO. ARCHITEMENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION IOb Description 1 hemby affirm that I am licensed under provisions of Chapter 9 (commencing , with Section 7") tdnivision 3 of Ne Business and Promssiom Code. and my liceam is - -- -' in d ercett BATHRM REMODEL (1) License Class Lic.N a Class Dau Carlo., ARCHITECTS DECLARATION - i understand my plans aboll he used as public records Licer,md Pndcssional OWNER BUILDER DECLARATION I hereby .(fuer onnl 1 am exempt from me Contractor's License Law for the fallowing mason. 7W L3. Co um Code: Any mer countyIn. and prem, t, giant. de ri ants mucmra which raqukus a permit re extra t, aloe ImProw, Permit h permit t e a sig staumem p31or m its caned p alsorequires;to me the inions o for such pe tor's License s Law that he to N) provisions of Ne Connector's Liccnmlaw (Chapmr9 Sq. Ft. Floor Area Valuat on mommiailcensedpuaunnl (commentingwise Section of Division ofthe essani Prof Cnde7 or Any vi that k u exempt dert(ram and Ue bssu for the alktW eamptia. Any violation of and elmd 3 GAgnetfterO 0 Occupancy Type Section 7031.5 by airy applicant fm a permit subjects the applicant to a civil penalty of Out mme Nan fon hundred dollars ($5M), 1, u owner of tie propcny, m my employer with wages u de'v cele cempewdon, Required Inspections will do the work, end Can sm,c,ur is not intended oroffered for tam (Sec. 7044.Bminess and Professions Cade: The Convector' License Law dos nag mpty.0 an owner of propeaywho buildsorimpovrs be men,and who does sughwork ManseI(arNmuIh hla Own eoyre. provided Coal suchimprovements am ru r mpfleermd ani(. heva,me Wilding impmvcntis mid within am ear of completion, the owner. builder will have the burden of proving Nal he did rot build or improve for purpose of plc.). 1 m awmm of to propenY• ndus contracting with li eCconuutora to /l The co ones the project (Sec, 7044, Business and Professions Code:) The Contractor's Li- , B and cense law does not apply in an owner or property who Wiles or impmwa demon, and who contracts for such pmjecto with a eMpcmr(s) Ilc mandpu@Wnt in Ne L'nnhmm's License Law. aemp an B k P C far Nla msson ❑� �II%%am uyner Dau �-Q�V y // OR 5 COMPENSATION DECbAk_Doi, I he Y .Rum under puWtY of perjury one o(dte to,dmlentions 0 1 haw and will maintain a Certificate of Coaen, to self-Insum for WomkcesCompon- satlon, as provided for by Section 3700 of the Inbar Code. for the performance of the work for which this permit is mound. - ❑ I have and will mainWn Worker, Compensation Insurmcc, as required by Section 3700 of the LAme, Code, for Ne performance of me work for which this pemlit is Issued My Wa la is Compensation Insurance carrier and Polity number tae: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE , (This section need no, hccomple ed IDhe permit is forone hundred dnllara (51 W) or lea.) I nearly Not in the performance of the work fm which this permit is issued. I shall me employ any permn in my mancerm as to become subject in the Workers' Compensation Laws of California. Dau Applicant NOTICE TO APPLICANT: It, afmr making this CerliOnu of Exemption. YOU should becorEe subject 0 Ne Workers Competumim provisions of the Labor Cndc, you mus, rmmwith comply with such pravislam or this Ismail shall be deemed revoked. 70th LENDING AGENCY CONSTRUCTION Is a 1 herby affirm construction lending agency forme performance of Nem Is n the Murk fm which Nle pee ncil V issued (Sec. 31197, Cl,: C.) Landers Name Lenders Address 1 ec di, that I have read due application and sum the, ft above information Is carmcL I agree in comply with all city and county ordinances and suer laws misting to building construction, and hereby auNorian mpreunmivcs of his city to enter upon the shove-memiuned pmperty for inspection purposes (WC) agree to save, indemnify and keep harmins ,he City of Cupertino against I liabilities, judgments. cents and eaperucs which may in any way acme against midCity In consequence birth. {actin, of this permit. 4�; I APPLICANT N STANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOURCE E TI S. /n! -i ( Re -roofs Si w a n rat car Dem HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will capplicant orfuture building Occupant mor or handle harndous material ' as defined by Ne Cupertino Municipal Code, Chapter 9. 12, and the Health ad Safety Code, Section M532m)7 All roofs shall be inspected prior io any roofing material being installed. 0y.RNu If a roof is installed without first obtaining an inspection, I agree to remove' Will the applicant or future building occupant use equipma, or devices which 1 emit haadnm air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. Distrim7 ❑Yes No 1 haw mal site haaa,dous materials requim esus under Chapter 6.95 of the Califar. nie Fkslm&S yCadc,Sectium25505,25533ad25534.1undnaundmaifthc Wilding IL oft. how a unan4 that it is my rcspanslhili,y m notify the cecupat of Nc ayulr c a,pnor w issuance ora CeruOcau of Occupancy. Signature of Applicant Date All roof coverings to be Class "B" or better ownema , aeaatenl Dnte 0 0 Soho Vi- y,-1 , �rM� be1G.n� G�—'Gz window 53-1/4" x 29-1/2" Switches !,� 9uto� ion iC�r�o��g��.�bu1��V�o�•�, �•(e�Qf" t� vMs�„v,1 tAf�o��en`S• !'i V V f.f�SS u o�iU t� !0 1 S\A.�Su.v. V'�• Cu------�- C SOI Li 7 T. MY 00 This set of pans and specifications mus be kept on the job at all times and ft is un On as to make any changes or, alterations nn same without written permission iron the building Dept., City of Cert The stamping of this plino, an approval of thupand specifications SHALL NOT be held to permit or to 6e ar, e violation of any provrsrona r env City Ordinance or )tate Law, • City of Cupertino Q Plan Check Transmittal • Permit# Project Address Owner Description 04100019 Control# Plancheck# 1 FileDate 10/5/2004 BATHROOM UPGRADE/ 20061 SUISUN DR KOOROSH AFLATOONI REMODEL Plan Check Status (attach comments and return to Building with plan set) Additional Plan Check Fee. U Hours, Planning Fees Housing Mitigation Fee Amount Heart of the City Plan -.... . Dept check# Date Due Date Staff Comment Date Approval? Buildin 1 10/5/200910/19/2004 POH 10/5/2004 C� n Assessor 1 110/5/2004110/19/20041 epi Additional Plan Check Fee. U Hours, Planning Fees Housing Mitigation Fee Amount Heart of the City SENT 10/5/2004 Specific Plan Fee Amount 1 (WC, , *ITY OF CUPERTINO CUP EIIiT�No PERMIT APPLICATION FORM APN # Fee Description Date: h Z!y Building Addre sti;st,„ CAA Mailing Address (if di erent from building address): a0061 V6Ka, BBOILERI Boiler <= 100,000 Btu Owner's Name: J0 BBOILER2 Phone #: X OO (Zos v( fF too NL BBOILER3 Llo 8-36 8- -344, 2 Contractor: Wo BBOILER4 License #: Contact: Phone: 4109 _ c(4k - 606- Cupertino Business License#: MECHANICAL Fax: 4o%—q'}l, 66% . Construction Tax -Building Permit Info: BCONSTAX Ind/Off/Comm/Quasi ❑ Elect ❑ Plumb ❑ Mech ❑ 'Bldg Job Description: BCONSTAXH Hotel and Motel Residential ❑ BCONSTAXR Commercial ❑ Sq.Ft. Floor Area: BELEC1000 $/Sq.Ft.: Cost of Proje t:k BELEC1001 Occupancy Group: Type of Con BELEC200 Please check this bol if the pro' ct is a - - BENERGY second-sto additions ❑ Project Size: Standard ❑ Large ❑ Major ❑ BENERGYADD L_ .4 Quantity Fee ID Fee Description Fee: Grou BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to IM Btu MECHANICAL BBOILER4 Boiler > IM 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 BUH DING 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 X-2-7_2- 00 1 of r r L Iwo' CUPEI,TINO *ITY OF 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 StomvRain 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 13REMBUSWAY Remodel Busways ELECTRICAL BREMFD{T 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 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 2 of.3 CIT O CUPERTINO CITY OF CUPERTINCO 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 Sin le 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 Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING . ELECTRIC Electricals foot ELECTRICAL EPERMITFEE Elec Permit Issuance _ ELECTRICAL MPERNIFEE Mechanicalsq. foot MECHANICAL MPERMITFEE Mech Permit Issuance . _ MECHANICAL PPERMITFEE _ Plumbin Permit Issue PLUMBING PPLBG Plumbin Fees foot - ' PLUMBING ZADDCHG ._Address Chane BUILDING 1