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07020006
CITY OF CUPERTINO BUILDING DIVISION PERMIT � hTT1� BUIL5I GSESS: PERMIT NO. 8 LAURETTA DR AMERICAN BRANDS 07020006 OWNER'S NAME: CONSTRUTIUN PERMIT ISSUE DATE YENNI RISTA-SANTOSO 1029 BLOSSOM HILL RD STE 1 06/20/2007 SANITARY NO. CONTROL NO. NE: (4 08) 21(,-4945 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH i p p LICENSED CONTRACTOR'S DECLARATION Job Description %m P I hereby affirm that I am licensed under provisions of Chapter 9(commencing Z U with Section 7000)of Division 3 of the Business and Professions Code,and my license is 333 ' ICC PATIO ROOM - REAR RESIDENCE h`4 y in full force and effect rz License Class Lam• FDate Contractor Lu.a ARCHITECTS DECLARATION ,a V I understand my plans shall be used as public records C13 Licensed Professional y OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the C OO following reason.(Section 703 1.5,Business and Professions Code:Any city or county <09 which requires a permit to construct,alter,improve,demolish,or repair any structure a�a prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 ;;q.Ft.Floor Area 2 O O O 0 zis (commencing with Section 7000)of Division 3 of the Business and Professions Code)or y that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty ofNumber Occupancy Type not more than five hundred dollars(E500). 326550 0_- W 0 I,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended oroffered for sale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If, however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). 0 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon,and, who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. 0 I am exempt under Sec B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 0 I have and will maintain a Certificate of Consent to self-insure for Workces Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 0 1 have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number arc: Carrier. %!5L4C,L(Ud(41%S tai Policy No.: 1"105;1-1:6—a= CERTIFICATE OF EXEMPTION FROM WO COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less.) I certify that in the performance of the work for which this permit is issued,1 shall not employ any person in any manner so as to become subject to the Workcrs'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must ,J`L forthwith comply with such provisions or this permit shall be deemed revoked. z O CONSTRUCTION LENDING AGENCY [~i►�-� 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec.3097,Civ.C.) nWi Q Lender's Name a z Lender's Address U C) I certify that I have read this application and state that the above information is LL ►• correct.I agree to comply with all city and county ordinances and state laws relating to Ubuilding construction,and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against h�cp] liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. Date APPLICANT UN ERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE ATIO�� 6l? Re-roofs Signature of Applicant/Contractor Dao Type of Roof HAZARDOUS MATERIALS DISCLOSURE yp Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roofs ;hall be inspected prior to any roofing material being installed. 0 Yes Ql+o Will the applicant or future building occupant use equipment or devices which If a roof i:;installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. District? ❑Yes j jut 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Cade,Sections 25505,25533 and 25534.1 understand that if the building does not currently have a tenant,that it is my responsibility to notify the occupant of the requircmcnts w ' st be ryet�r cc of a Certificate of Occupancy. Signature of Applicant Date —_ All roof coverings to be Class"B"or better Owner or authorized agent Dao UPERTINO CIT ,Jv NON DR PERMIT P'61b`ft 0 5 6 BUILDING ADDRESS: pERMI'r ISSUE DATE MR & MRS NAT SENPARK CIR 06/08/2007 PER'S NAME: CONTROL NO. ( 408) 234 SANITARY NO. PHONE: BUILDING PERMIT INFO BLDG ELECT PLUMB MECHQ ARCHITECT/ENGINEER: PGRADE TO 200 AMP Job Description I o z LICENSED CONTRACTOR'S CLA afTII�DECLARATION 9(commencing 1 tri 0 I hereby affirm that I am licensed under provisions Z rU with section 70001 of Division 3 of the Business and Professions Code,and my license is -c H in full force and effect ' Lc.# v�z License Class m f f tp Date ARCHrMCTS DECLARATION -) lans shall be used as public records j a-� I understand my p . a )yU O y Licensed Professional a OWNER-BUILDER DECLARATION i a I here ) affirm that 1 1. exempt from the Contractor's License Law for a Valuation p e following reason.(Section 7031.5,Business and improve, dcmt li.h.or.Any repair zty or County any structure $2700 0, which requires a Perini'to construct,alter•imp g Sq.Ft.Floor Area J Prior w its issuance,also requires site aPP licant for such permit to file a signed statement a that he is licensed Pursuant to the Provisions of site Contractor's License Law(Chapter 9 Occupancy Type C=$ (commencing wish Section 7000)of Division 3 of the Business and professions Code)or A N Number a that he is exempt tltemfmm and the basis s subject-,the applicant the alleged to a civiln.Any rpc penalty f 3 4 214 y Section 7031.5 by any applicant for a pe J not more than five hundred dollars(5500). Required Inspections 0 1.as owner of the property,ttr my employees with wages as thew sole compensation. will do the work.and the structure is not intended or offered for sale(Sec.tooin 44,OOwnnerOf and professions Code:The Contractor's License Law jch work does not himself Y or property who buildof,improves vid d that s„cn,and who does S, It i�ittprovements art not ntended ored f�sale.IL own employees,p. ar of tom lesion,the owner- however,the building or improvement is sold within one Year P builder will have the burden of proving that he did not build or improve for purpose of sale.). with licensed contractors to I,as owner of the Property am exclusively contracting contractors U- 0 1, the project(Sec.7044,Business and Professionsildorimproves thereon,and. cense Law docs not apply to an owner o property pursuant to the Contractors who contracts for such projects with a contractors)licensed License Law. B dt P C for this reason 0 I am exempt under Sec Date__� Owner WORKER'S COMPENSATION DECLARATIO hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a Certificate of Consent to self-insure for Workers COMP"^- cation•as provided for by Section 3700 of the Labor Code.for the Performance of the work Cor which this permit is issued- 0 f have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the Performance of the work for which this permit is issued. My Workers Compensation Insurance carrier and Policy number arc: Policy No.: Cartier. CERTIFICA,IE tF EXEMpTION FROM WORKERS' COMPENSATION INSURANCE (This section need Rothe completed if the permit is for one hundred dollars($100) or less.) ,.��'"� .. permit is issued.1 shall not I certify that fn the perfo manor°f he oork for which come subj tato the Workers Compensation employ any person i Y Laws of Califo ,'.'Date Applicant to of Exemption,you should NOTICE TOA CANT:If,after m ati is You must become subject to the WoiYdr's Compensation provisions of the Labor Code. Z forthwith comply with such provisions or this permit shag be deemed revoked. z� y CONSTRUCTION LENDING AGENCY performance uC �� I hereby affirm that there is a construction lendingagency for the tar > the work for which this permit is issued(See.3097,Civ.C.) (7a Lender's Name a Z Lenders Address s'a'c that site shove information is I certify that I have read this application and tU>. correct I agree to comply with all city and county ordinances and state laws relating e building construction,and hereby authorize representatives of this city to enter upon site t] U about-mc e)age Property for inspcc'ioa purposes. _dr Gia (We)agree to save,indemnify and kith harmless the city rue against said �QaCity Date U off / H� liabilities,judgments,costs and_expcnscs which may in any wayaccrue ag in consequent c granting o this permit. V,Z.i in onl UNDERST I AND WILL COMPLY WITH ALL NON-POINT IssueAby: y S CEREGULATIO --0 Re-r')Ofs D"�material Type of Roof Signature of ^ M ALS DISCLOSURE ard HAZAR �yll tlreapplicant ar future building e.Chapter 9.12tore •anddthe Health and Safety as defined by Ute Cupertus ino Municipal Code.Chap All I oofs shall be Inspected prof to any roofing material beinggree to remove Cafe,Section 25532(x)? �(° Dyes Qdn If a roof is installed without first obtaining an inspection, agree Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all r.ew materials for inspectlon. District? 0Yes y o 1 have read the hazardooro25505 materials 33 and 25534.1 understand that if the building qui:.c., DarChptcr 6.95 of the Califor- Date domes o H eath&SaftYCodc, y y snot the _— Jots mitt curcntly have tenant that it my responsihilit to maul Occupancy- gig tature of Applicant requirements which m tx me or i�yance of aaCcaifef All roof coverings to be Class"B"or better CITY OF CUPERTINO 3 ITEMS OF 3 PERMI`I RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk : Lot: APN 34214036 . 00 DATE ISSUED. .. . . . . . : 06/08/2007 RECEIPT #. . . . . . . . . : BSC00001581 REFERENCE ID # 07C60056 SITE ADDRESS . . . . . : 10245 LEBANON DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER MR & MRS NATH ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2679 RECEIVED FROM . . . . : AMIR ELECTRIC CONTRACTOR . . . . . . . : GHF,SEM RAHMANI LIC # 25403 COMPANY . . . . . . . . . . : AMIR ELECTRIC ADDRESS . . . . . . . . . . : 344 LASSENPARK CIR CITY/STATE/ZIP . . . : SAN JOSE, CA 95136 TELEPHONE . . . . . . . . : (4(,8) 234-9903 FEE ID UNIT QUANTITY 1,MOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ----------- ---------- ---------- ---------- BELEC200 METERS 1. 00 29 .43 0. 00 29 .43 0. 00 BSEISMICRE VALUATION 2, 700. 00 0. 50 0. 00 0 .50 0. 00 EPERMITFEE FLAT RATE 1. 00 38 .37 0. 00 38 .37 0. 00 - -------- ---------- ---------- ---------- TOTAL PERMIT 68.30 0. 00 68.30 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 68-. 30 #1411 --------------- TOTAL RECEIPT 68.30 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 103 UFER 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL CITY OF C'UPERTINO aclor CUPE�TINO PERMIT APPL [CATION FORM �01O pow APN# Date: Building Address: MailingAddr s$ (if different from building address): Owner's Name: r�r � ��-/---' Phone�#� Contractor: Am i!11 �'{C ✓'i License Contact: ^^ Phone:19�-23' -`�'ta3 Cupertino Business License#: 6 V 4ascol 0.4kh"ll, Fax: S' � Building Permit Info: a 06- .a te �J r✓1 Bldg ❑ Elect Plumb ❑ Mech ❑ Job Description: Residential 5d Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: 7d©, Occupancy Group. Type of Constructer Please check this box if the project is a CML- second-story addition: El Project Size: Standard ❑ Large ❑ Ma-or ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER ether Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boil-,r> 500K to IM Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Coinm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Co istax—Resi/Mobile BUILDING BELEC1000 El,-c 600V <= lOOOA ELECTRICAL BELEC1001 E lec 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD I'snergy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3 CITY OF CvUPERTINO ;*ITYOF PERMIT APPLICATION FORM CUPEkTINO Quanti Fee ID Fee Description Fee Group BMISCELL b41scellaneous Fee BUILDING BMITIGATC Corr in. Housing Mit. Fee BUILDING BNUCOMME N,-w Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP l,'ew Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW At nospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE I 11dg Permit Fees BUILDING BPFIXTURE Pb1g Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Incl 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 Lav rn S rinkler/Backflo PLUMBING BPSTORM 'S'torm/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 Zeinspection 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 -ighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Rel Furnace> l OK btu MECHANICAL BREMHEAT Neater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rent Non-Res Appliance ELECTRICAL BREMPOLE Pc le/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT R,-.pair/Alter Heating MECHANICAL BREMRESAPP Reriodel Res Appliance ELECTRICAL 2 of 3 CITY OF CUPERTINO aWOF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rnidl Signs Add Branch ELECTRICAL BREMSIGNS Rerr odel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Ve it Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL SpecialInspection 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 Elea Permit Issuance ELECTRICAL MPERMFEE Mechanical sq. foot MECHANICAL MPERMITFEE Meeh Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING 3 of 3 Community Development 10300 Torre Avenue ,io iMCupertino CA 95014 Telephone(408)777-3228 CIMOF Fax(408)777-3333 -UPERTINO Buildin De artment JOB ADDRESS: PERMIT # 102- '-0 0--- OL0600z%.OWNER'S NAME: PHONE # GENERAL CONTRACTOR: .,4ym Q LC i - __.._.._e_ . # I am not using any subcontractors: l a 9112naturDate Please check applicable subcontractors and com tete 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 Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date