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06090209 (2) CITY OF CUPERTINO *¢•7d�A7"zri��e.^�.eryp a♦a Ile -Ge4 a^� m;_iyk�' ��'N<u r=`sac" a . BUILDING DIVISION PERNIITIAI BUILDING ADDRESS: FATEKH VERGASOV rmm,rND'06090209 21921 MCCLELLAN RD OWNER'S NAME: PERMIT ISSUE DATE FATEKH VERGASOV 09/21/2006 NE: SANITARY NO. CONTROL NO. ARCHITECTWENGINEER: BUILDING PERMIT INFO BLODO EO PLO MECH log LICENSED CONTRACTOR'S DECLARATION Job Description J Gr 1 h reby afflrm that 1 ata licensed under provisions of Chaplin 9(Mmmercing U ithS"dm7010)of Division 3 of six Buthaa and Professions nd Code. my Heart=is With Tauns faandefecL REROF-T/O & REPLACE. WITH PLYWOOD & 30 FELT endE LimmaoClassLk.a CLASS A BAT INSULATION-AT EXT WALLS REPL SIDING F Dau seComrmr ARCHfIECT'S DECLARATION i I understand my plans shall he used As public mnNr A. W Licensed Professional OWNER-BUILDER DECLARATION F@ I hcuby afro,that 1 am uempt from the COMMO r;License Law far the 0 6 following mason.($"tion 7031.5,Business and Ploftem nm Cade:Any city m county ..12 9 which reforms;a permit he emamueL alcor.improve,demolish,nr repair any suucture -Zi prior w its issuance.slwrequires the applicant far such permit M fileasigned suumem that he LLIicensed pursuant la Ne Provisions of Ne CanV"Nrs License Law(CNpter9 Sq.Ft.Floor Area Valuati412000 E (commencing with Section 70DO)of Division 3 of the Business and Professions Code), 5`<$ that he Is exempt Ihemefrom and dhe bash for Ne alleged exemption.My violadon of Section 7031.5 by any applicant fm a permit mbjecu Ne aPPikmt,a civil beauty ofppN Number Occupancy Type trot mart Nan five hundred dollars(SSWL 3 5 714 011 . 0 0 ❑I,uowrcr of she pmpety,mmY wplayea with ntuuti,b ink compnmdaq And do Newon,and Ne he Cm uwes Limmum AW den Act apply 7014.Buawa Required Inspections aro property Cade:The Cmueuwh Ldwho law dao rel apply lf rt rough of 9 P is com employ bullata mimprow dor"n,wdwho AM IiMendeWaved muelrar through 4f, menemployva,lding or improvement suehimprow,muartnal roundedmpllfered for oats If, Wid. Nebuilding or .ofplasolde did ma Wild of completion,Ne owe of builder will have Inde burden of proving Not he did rel bulk m improve(ar purpose of ssleJ. ❑L as awnn of the propeny,am uclusively contracting with licensed commitment In construct Ne project(g".70U, usinm P or MVI Cade:)Th Coovaelof W- censa law does am apply u an of y who builds or improv Nemo,and. am commis for, projecu Naso rU)licensed puraaaarm NC CAmateme. License Law. ❑Iain exempt undo Sec. .BBPCf Nit9/m��on Owrcr Dau GJ WO COMPENSATION DECLARATION I herebyani r penslty of perjury am of the following declarations: I have and will maintain a Cesifoam of Consent In self-mouse for WorlcesCompen- se0an,As provided for by Section 3700 of the labor Code,for doe performance of the, work for which this Permit is issued. 0 1 have and will maintain Workers Compensation Insurance,As required by Senim 370D of the Labor Code,for the performance of the Work:for which this permit is issued. My Workers Compensation Irrarance artier and Policy number am: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURA (Thamnlmmed retbecunPkto "bare fmonchuMmdde ara(SIom or leu) 1 certify Net In the perfammence e( ark fo Ich thh permit h issued.I Nell ata employanypemninany comm m m suthewcalmCompuua n Laws of Califamh.Dau ApPlkanl NOTICE TO APPWCA 1 zldl Nis CcrtlBcate of Facmpdon,you should become subject u she r' mpensalion provhiana of the Labor Cade you must 'OZO foMwithcomplywl h slam"is permit shall I,deemed reveled. „zm� C N UCIION LENDING AGENCY [.r I hechy alarm that doe,h a caaamunkn lending agency for the Performance of yv> Ne wait fm which Nit permit h meed(Sec.3007,Civ.C.) W QLendafs Name az Landers Address U0 1 cenify that I have read this application And auto that d,above information h IL F cartoon.I agree to comply with all city and county ordinances and sum laws relating 10 0 U building construction, hereby authorise mpruenmives of this city to enter upon the r[I] about-mcmiuncd pro r1Y Tari cd on purports. LL (We)a{ree sive.in try and keep harmless du City of Cupcm a against nE'i to Iiabilitiea.Judgm .Casa spend"which may In my way mane against said City U z in consegmnes the gran of lith permit. � J / s"r APPLICANT ER ND AND WILL COMPLY WITH ALL NON-POINT Issued by: Date ` V SOURCE �P, f— O/_� !/77 G Re-roofs Sign pllaHDate HAZARDOUS US MATERIALS DISCLOSURE Type of Roof ti,applicant m fuuue building accupmmore too,re or handle hamrdou matorisi as by the CYPenlaa Mu 'pal Code.Chapter 9,11,and she Health and Safety Cade,Senion 25532(.)? All roofs shall be inspected -or to any roofing material being installed. ❑Yu No Will the applicant or mw,building Occupant um equipment or dcvie s which If a roof is ins[alle witho first obtaining an inspection,l agree to remove emit WaNnu air cmaminanU u Omd by the Bay Arca Alr Quality Man49Cmenl all new materials or,ins coon. District? ❑ya No j JISr, Nehm rd mauriaismquimmenuunderChepmr6.95ofthe Csrifor- ala HeCodr, �ma 25503,73533 and 2!!34.1 undersand Nvtiftite Wilding (!/ does nhad cram,that Il u my responsibility to nosily Ne=.Pant of Ne royulmetpriarroi,aeanceaacenirte.tearaapuuy. Signatu pelican[ Date All roof coverings to be Class"B"or better Ow Named agent Dow Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 4UPEkTINO Building De artment JOB ADDRESS: 2/ 2/ Ae. C/elZ� ,e PERMIT OWNER'S NAME: e t,Q 30 PHONE # GENERAL CONTRACTOR: 0/ FAX# I am not using any subcontractors: `�2 Signature Date Please check applicable subcontractors and complete the following information SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood • Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Tep Septic Tank Sheet Metal Sheet Rock Tile O -2/-06 ntractor Signature Date CITY OF CUPERTINO 1 of 1- PERMIT RECEIPT OPERATOR: suem or COPY # 2 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . 35714011. 00 DATE ISSUED. . . . . . . : 09/21/2006 RECEIPT #. . . . . . . . . : 36148 REFERENCE ID # . . . : 06090209 SITE ADDRESS . . . . . : 21921 MCCLELLAN RD SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : FATEKH VERGASOV ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : FATEKH VERGASOV CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY . . . . . . . . . . : FATEKH VERGASOV ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 TELEPHONE . . . . . . . . : ISE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW HAL ______ _____________ __________ __________ __________ __________ __________ BENERGY PERMIT FEE 83.16 39.92 0.00 39.92 0.00 BPERMFEE VALUATION 2, 000.00 83.16 0.00 83.16 0.00 BSEISMICRE VALUATION 2, 000.00 0.50 0.00 0.50 0.00 BPLANCHKI PERMIT FEE 83.16 83.16 0.00 83.16 0.00 __________ __________ __________ ---------- TOTAL PERMIT 206.74 0.00 206.74 0.00 METHOD OF PAYMENT AMOUNT NUMBER _________________ ____________ __________________ OTHER 206.74 VISA TOTAL RECEIPT 206.74 • Community Development Department Building Division City of Cupertino 10300 Torre Avenue • Telephone: (408)777-3228 Fax: (408)777-3333 Building Department Subject: Re-roofing policy for the City of Cupertino 1. Prior to permit issuance,you must agree to comply with 1997 UBC Standards and manufacturers specifications on re-roofing. 2. New roof coverings shall not be applied without first obtaining all inspection and written approval from the building inspector. A final inspection and approval shall be obtained from the building inspector when the re-roofing is completed. 3. All roofs shall be inspected prior to any roofing installation. 4. To receive a final sign off from the City, the following steps are required: d 1) Pre-inspection and/or tear off approval. V 2) In-progress inspection approval. k/ 3) Final inspection approval. %J a) Spark arrester installation. 5. V If plywood is installed,a plywood nail inspection is required. • 6. Any roofing which is applied without first obtaining an inspection, will require the removal of all new material down to the sheathing, so a proper City inspection can be performed. 7. NOTE: If you call for a plywood nail inspection and the job is not ready, you will be charged a re-inspection fee of$176.18. The re-inspection fee must be paid before another inspection can be scheduled. IMPORTANT: 1. Flat roofs must have a minimum of V4" per foot slope and demonstrate that there is no ponding. 2. An I.C.B.O. report is required to be on the job site at the time on inspection. I understand and will comply with the /above stated policy on re-roofing. Homeowner's Name: �J �' cy� ✓ E� l�wse Job Site Address: 2/ / 2/�Q /tel� �� `Q Roofing Company Name: T � Applicant's Signature: Date: • Greg Casteel Building Official Revised 11/2/04 OWNER-BUILDER VERIFICATION 1. (Check one) I or my immediate family (parent,spouse or child)will perform • A. All the work authorized by this permit B. A portion of the work C. None of the work If B or C is checked,complete 2 or 3 below. 2 A state licensed contractor will be hired to do: A. _ All of the work., . B. A portion of the,work(complete section below) Contractor - Address/City'" Phone #. State License # Type of work to be performed 2/2q/ Mc�P cc, i v Gq TST L/ -37-1 ao 9So/ • 3. _ I will utilize unlicensed persons) other.than,my immediate family to perform all or portions of the authorized work. I understand that I.may-beAn employer(see reverse side). A Certificate of Insurance covering workers' compensation must be on file at the City of Cupertino Building Department office . Person/Firm Addreswuty Phone-Number- Type of work to be erformed ............................................................................................................................_....................................................... I declare under penalty of perjury that the above is true.and.correct. I have read and understand the Owner-Builder Information(reverse side). Property Owner's Signature: Date: job Address: Permit# Any changes to the information vrovided on this form shall be submitted to the 6tv of Cuvertino Build Devartmert. • CITY OF CUPERTINO CUPEfZTINO PERMIT APPLICATION FORM wzo qp,PN 11 / Date: 1-04 Building Address:2/ ailing Address (if different from building address): Owner's Name: F4,?Ieo� / t /��L�y ��� Phone#: Contractor: D/Qf1 l� (� /� License #:�'J 7 Contact: 1� Phone: 6.f0 VdI577 Cupertino Business License#: Fax: Building Permit Info: T, QQ g,61az G2 t? f l� w/ P ==, � _, ..7/ 'e o f�Lf aL�� Y �3b b�` /, d'ar ��f/ Bldg E� Elect ElPlumb ElMech EltO* Job Description: rep C EQ_ Residential ❑ Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: 2 B A Occupancy Iup- i Type of Construction: Please check this box if the project is a N second-story addition: ❑ ro'ect Size: Standazd Lar e ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOIL,ERI 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 1 of 3 Q��- CITY OF CUPERTINO CU EkT t PER PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING 13NUCOMME 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 BREMAIRHAN A/C Units <= 10,000 cfrn MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> I OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Mise 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 CUPERTINO CUPEkTINO PERMIT APPLICATION FORM uanti Fee ID Fee Descri tion Fee Grou BREMSIGNAD Rmdl Si s Add Branch ELECTRICAL BREMSIGNS Remodel Si s, Mar uee ELECTRICAL BREMTHEATR Theatrical Li htin Fix ELECTRICAL BREMVENFAN Vent Fan Sin le Duct MECHANICAL BREMVENSYS Ventilation S stems MECHANICAL BSCBLVD Scb S ecific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL S ecial Ins ection BUILDING BSWIM Swimmin Pool BUILDING BTEMP Tem orar Power ELECTRICAL BTEMPPERM Tem orar Bld Permit BUILDING BTEMPSVCS Tem Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanical s . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbin Permit Issue PLUMBING PPLBG Plumbin Fees foot PLUMBING PLLONGRNGC Plan in LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING 3 of 3