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04100086 (3) crrY orf corLaI' - NT32ACT6 YNTOR bN nulLnlrvc Dlvl"UN 1 L121V11T �, ;,3 . u ,,,:. ,•., .;>�. '.,r�., ___ BUILDING ADDRESS: OKER PERMITN0410 43 KIM ST OWNER:SNAME: PERMIT ISSUE DATE ABOLLAZL KHOSROWHOYGI 2385 LINCOLN AVE 10/13/2004 lfIONE: SANITARY NO. CONTROL NO. (800) 639-4527 BUILDING PERM I INFO ARCIIITECI'IENGINEER: BLDG ELECT PLUMB MECH uoo LICENSED CONTRACTOR'S DECLARATION {[}I(('�O�q�Iy3\I{t{{'DCIk�t'L��CI IJ{�(L�OOp❑ ZC I hc¢hy from that 1 am ,the B0 intact ptgfor ons Or Cop¢r 9(rnmmcncmg MALE ISYS 4�ICS n< with Sc 7t]yMgnf Dlvixion}Cir the Ouse;ncisetid for passions Codc,and mylicmnsm < ;nranm WINDOW REPLAC ra �z Data Glass___S 1_}P�.Lic.p�.. zrW Date — 1 / / Commnm �— �' //�� ARCHITECTS DECLAR S)N - APR 2 9 2005 ImN'�IanJ my plans shall Mused as politic rcmrJs DyU '' s' L;ecnuJ Professional `Og OWNER-BUILDER DECLARATION �p fj�tJ ®�� <.e I hereby affirm that I am exempt from the Contractor's License Law lira the tgrl.�ryp 'ILfIS �f . o O following aason.(Section 7031.5.Business and Professions Code:Any city or aunty $7726 uwhich requirts a permit ext construe,,alter.Improve.demolish,or repair any Structure �x< prior to its iauance,also requires the applicant for such permit w fie a signed s carr om hot he is licensed pusup.toth=provision of the Contractor's Law lcbaptet9 Sq.Ft. Floor Area Valuation d`•ra (commcnciagwith Scctinn7000)of Divifioo3 of the Bos{nepind Professions Cod0or that he is exempt mctofrom and the bacons for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit anbje=ts the applicant to a civil Penalty or be Occupancy Type mo"Inore than eve hundred dollars(5500). Q 1.as owner of the property,or my employees with wages as thch sole compensation. will do the work.and me aUuctute is not Intended or offered for sale(Sec.7044.B usinesa Required Inspections and Professions Code:The Contractor's Li¢nse Law does not apply Io as owner of q p property who builds or Improve th=rean,and who does such work himself air through his Own employees,provided that such improvements are not intended or offered for sale.If, however Ne building Cir Improvement is Sold within one year of completion,the owner- builder will have the burden of proving Nat he did not build or improve for purpose of sale.). 0 1,as owner of me property,am uclusivcly contracting with licensed contractors le construct the project(Sec.7044.Business and Profusions Codc:)The Contractor's Li- cense Law does nm apply to an owner of property who holds or improves intend.add. who contracts for such projec¢with a contractor(s)licensed pursuant tome Contractor's License Law. ❑I am exempt under See. .B&PC for this muco Owner Dale WORKER'S COMPENSATION DECLARATION ® 1 hereby of old Under penalty of perjury one of the following deeldmtinnO I have and will maintaia a Certificate of Consent o ulbins rm for Worker's Cum,xi sation,as provided for by Section 3700 of Ne labor Code.for the performance of the work for which this permit is issued. ❑1 have and will maintain Worker's Compensation Insurance,as¢quired by section 37M of the Latter Cude,for the performance of the work for which this pemlit is issued. My Worker's Compensation Insumne canicr anIF I mber am: 5 lir: S�-CERT 'F,.OFEX. rm;y. �// 15 KERS» CERTIFICATEOP COMPENSATION ERAN WORKERS' COMPENSATION INSURANCE rrhls section need nut be completed if ilia,permit is fm one hundred dollars(SI W) I,,lass.) I merrily door in the parro more of the work rot which this permit is issued.I shall not employ any person in any manner lin as to become table.to the Workers Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,split,making this Cc nilicale of I"xcmpliOn,you should become subject to the worker's Compensation provisions of the tabor Codc,you must 7 forthwith comply with such provisions or this permit shall M deemed revoked. z2 CONSTRUCHON LENDING AGENCY 'P ' 1 hereby affirm that then is a eonstrvction lending agency lot he performance of W > the work for which this permit is issCCJ(Sec.3097,Civ.C.) W QLcndrO Name III. Address U O 1 carry that I have read this application and sex¢that the above inlnmordun is W F-' CO,OCt.1 agree to romply with all city and county ordinances and state laws rclaing to �•!� O V building conurucuon,and hemby autharirc d,rescmt ivcx of this City to enter UP09 the r W have mentioned properly for Inspection purposes. (Wit)agree m save,indcmni ly and keep Cornices the City of Cupertino against / F'I,,, Idbi lilies.judgmena,costs and expenses which may in any way crane against Mid Ci ty / U Z in c.occqucnce of the granting of this permit. �-^ APPLICANT UNDERST DS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 50 R"LGU IONS. - �i � �3^�(-1 Re-roofs Sigwwre of AppllcentiCummcfol Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or futon building tkcupml entre Or handle heiaNuob material as,defined by the Cupc Non Municipal Cod=.Chapter 9.12,and he Health and Safety Code.Section 25532(x)'! !!'' All roofs shall be inspected prior to any roofing material being installed. E]Ycs bA. - i Will mea bnntnr ware MBdin ammo amnsc=quipmen taraevmeawhmn If a roof is installed without first obtaining an inspection, I agree to remove exp s p ecath foozoous air contaminants as defined by the Bay Arca Air Quality Managemem all new materials for inspection. Di.,trim ,,....JJ ❑Ycs Iy , I bavc read the havardousmaerials requirements under Chapter 6.95 of the Califon nia Health&Safety Codc,Season 25505,25533 and 25534,I undcrsund that if me building dons not currently have a teraid,that it is my raponsihility,to roily the upounrom of the to, whir asbe mctpd u.,ata Ccr atoof rxcupancy. ° }tr}� ma Signature of Applicant ate (. X.z,,,�h�.e y�F�1,,,1,z `3—0(l All roof coverings to be Class "B" or better .,�4 1/ FINAL MEASURE PAC E : 24� Z L7 2385 Lincoln Avenue, Hayward,CA 94545 t ❑ 1871 So. Chris Lane, Anaheim, CA 92805 ED �0 J THE Phone (800) 639-4527 y ) 0Q�7 r WINDOW BROKER Fax (510) 723-5065 # CA L/CENSE#785713 OWNERS: �( �0--Y_O W h O \ RES PHONE: DATE: STREET._SLS '`I I'"1 S} US PHONE: CITY: CUnCJ E`^E,n STATE: P ay Window ® Single story: V2 Wood siding: =��N�o - ❑ Patio door handle(s): Eave projection: (in.) ❑Two story: ❑Vinyl siding: ❑White ❑ Brass Roof type: ❑ Enclosed ® Stucco: Inside trim: ❑Slope Security bars - Re-install: ❑Yes rade ❑ Paint grade Angle: ❑ 30° ❑45° No. days �Retrofit ❑ Lawn sign okay Color: M White ❑Almond APPR XI TE GLASS NO. LOCATION TYPE WIDIW HEIGHT TEMP e OPTIONS GRIDS COMMENTS 1 3 , v V 4 o.s ev V6 7 V . 6 Nuvs�y s p 10 „J �(. �u1r �, �"Ce .2- 11 12 �� r1517 Specia; Instructions: Total U.I. Windows: Doors: he type and operation of each window have been fully explained and I accept the windows ntified on this Bays: measure sheet as being the windows I am ordering. Customer signature: Measured by: April 2MI 1 ItITY OF CUPERTINO CITY Of PERMIT APPLICATION FORM CUPERTINOWF p APN# ?5 / Z 0 ©d 7 Date: I O - ) 3 . 0� Building Address:Sg3 S+ Mailing Address (if different from building address): Owner's Name: Phone #:Cq O D1 7 6 I— O I gQ (�odoLzl t�sYo��� of 0 Contractor: � Q rolCe.v License #: dd iJ W9382 Yn{act: c� 1 Phone: 510 37-}-5527 Cupertino Business License#: Rl ck 9 &avvsbt Fax: Building Permit Info: Bldg d3' Elect ❑ Plumb ❑ Mech ❑ Job Description: `` L Residential Lywl,dOVIDS :ice, Commercial ❑ _ Sq.Ft. Floor Area: — U $/Sq.Ft.: Cost of Pro' ct: a Occupancy p: Gr u Type of C nstruction: X Please cbeck th project is a J second-sto addition: ❑ Pro'ect Size: Standard LSI' Large ❑ Major ❑ 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 27q(,6 1 of 3 �� 72, aft *ITY OF CUPERTINOSI 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 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 rinklerBackflo PLUMBING BPSTORM Stoim/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING • BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER WaterHeater/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 BREMFIXT _ Lighting Fixtures ELECTRICAL BREMFURN Relocation of Fumace MECHANICAL BREMFURNOV Relo Fumace> 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 CITY OF CUPERTINA CITY OF PERMIT APPLICATION FORM CUPEkTiNO Quantity Fee ID Fee Description Fee Group ' BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL J 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 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 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 Chane BUILDING 0 it 3 of 3