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07030024 CITE'OF CUPERTINO - BUILDING DIVISION PERMIT ��1 `T�:AC +aRl ` }RM�4TIf3N: BUILDING ADDRESS: PERMIT NO. 1330 FLOWER CT GOSAL BEATING&AIR 07030024 OWNER'S NAME: PERMIT ISSUE DATE SANJIDEH KOOROS AND PARVIN K 2679 CHERRY BLOSSOM WAY 7 ONE: SANITARY NO. CONTROL NO. (510) 4,11-2318 ARCHITECUENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 100 LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that I am licensed under provisions of Chapter 9(commencing :Z with Section 7000)of Division 3 of the Business and Professions Cade,and my license is FURNAC ? CHANGEOUT/ADD A/C RE PLCMT 4 TONS t ,a„ in full force and effeec�t Jj ` v�2 License Class !'-2-6 Lic.# m Date Contractor ARCHITECTS DECLARATION un erstand my plans shall be used as public records )qU n,y Licensed Professional H t OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractofs License Law for the p O following reason.(Section 7031.5.Business and Professions Code:Any city or county <.9 which requires a permit to construct alter,improve,demolish,or repair any structure Z y prior to its issuance,also requires the applicant for such permit to rile a signed statement Valuation that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area F G (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $8500 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 of 1n7�tT Number Occupancy Type not more than five hundred dollars($500). 366180-38 . V V ❑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 or offered for sale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner of 9 P 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.). rl 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 docs 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. 1 am exempt under Sea B&P C for this reason Owner. Date _ WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: J 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. ❑I 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 Workefs Com nsatic utance carrier and Policy number are: Carrier Z Policy No.: 2 / CERTIFICATE OF E7 PTION FROM W RKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is forane hundred dollars($100) or less.) I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to me jest to the Workcrs'Compensation Laws of Califos�e Dat� Applicant C ti F . NOTICE TO APPUCANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must 0 forthwith comply with such provisions or this permit shall be deemed revoked. z rA CONSTRUCTION LENDING AGENCY [-� I 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.) aA Lender's Name z Lender's Address U O 1 certify that I have read this application and state that the above information is ► correct.I agree to comply with all city and county ordinances and state laws relating to 0 U building construction,and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes. t7. (We)agree to save,indemnify and keep harmless the City of Cupertino against E" liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. ►- APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued t y: Date —� SO CE REGULATIONS . .� _�t� 31K107 Re-roof 3 �L^. Signature of Applicanc tractor DateType of Roof HAZARDOUS MATERIALS DISCLOSURE 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)? t� All rooi s shall be inspected prior to any roofing material being installed. ❑Yes �No r If a roo is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which .,nit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? Cl Yes TO 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building docs not currently have a tenant,that it is my responsibility to notify the occupant of the requirements which must be met prior to issuance of a Certificate of Occupancy. S ignatu-e of Applicant Date All roof coverings to be Class"B"or better Owner or authori-zcd gcn Dare Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 17UPERTINO Building Department JOB ADDRESS: _ PERMIT # 07 0 3 6 OWNER'S NAME: C /�� PHONE # — 7 2 GENERAL CONTRACTOR: G 0SX1 1Z�l 7-� t h FAX # I am not using any subcontractors: ti S-.gnature ate Please check applicable subcontractors and com lete 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 Own /Contractor Signature Date CITY OF CUPERTINO 9 ITEMS OF 9 PERM--T RECEIPT OPERATOR: christya COPY # 1 Sec: Twp: Rng: Sub: B--k: Lot: APN . . . . . . . . . 36618038. 00 DATE ISSUED: . . . . . . : 0:3/06/2007 RECEIPT #. . . . . . . . . . B:3000000611 REFERENCE ID # . . . : 0` 030024 SITE ADDRESS . . . . . : 1:330 FLOWER CT SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER SANJIDEH KOOROS AND PARVIN K ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5302 RECEIVED FROM . . . . : R-ECEIPT INTERFACE CONTRACTOR K:�'SAR SINGH LIC # 22229 COMPANY . . . . . . . . . . : GO�SAL HEATING&AIR CONDITIONING ADDRESS . . . . . . . . . . : 2579 CHERRY BLOSSOM WAY CITY/STATE/ZIP UNION CITY, CA 94587 TELEPHONE ( 310) 441-2318 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BENERGY PERMIT FEE 1. 00 34. 86 0. 00 34 . 86 0. 00 BREMAIRHAN NO.UNITS 1. 00 10.26 0. 00 10.26 0. 00 BREMFURN NO UNIT 1. 00 14. 31 0. 00 14 .31 0 . 00 BREMRECEPT NO. OUTLETS 1. 00 1.20 0 . 00 1.20 0 .00 BSEISMICRE VALUATION 8, 500. 00 0. 90 0 .00 0. 90 0. 00 BUSLIC FLAT RATE 1. 00 107 . 00 0. 00 107 . 00 0. 00 EPERMITFEE FLAT RATE 1. 00 38.37 0 . 00 38. 37 0. 00 MPERMITFEE FLAT RATE 1. 00 38.37 0 . 00 38.37 0. 00 PPERMITFEE FLAT RATE 1. 00 38. 37 0. 00 38.37 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 283 . 64 0 .00 283 . 64 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 283 .64 9025 --------------- TOTAL RECEIPT 283 . 64 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 508 FINAL MECHANICAL CITY OF C'UPERTINO 07 J FU N ACE/AC CUPEi�TINO PERMIT APPLICATION FORM APN# * Date:�/�/�� Building Address: 13-50 7-50 rZc)w�� / Owner's Name: �,� �� -/ Phone# 2 C-7 7� Ste' Contractor.,C C 2 Phone: License #: Contact: Phone: Cupertino Business License#: Building Permit Info: Bldg ❑ Elect Plumb rl Mech Job Description: AWD XD-1) Residential Commercial ❑ For Residential Installations: Attic ❑ 1" floor ❑ 2nd floor❑ Adhere to min set back requirement ISS For Commercial Installations: eplacement same weight ❑ Additional weight(structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Prpject: Type of Construction: Occupancy oup: ,Y e d V --1 Strapped F On Platform Bonded C Sq.Ft. Floor Area: New Location Ef Replacement Qty. if Applicable Fee ID Fee Description Fee Group / BENERGY Energy BUILDING BREMFURN furnace MECHANICAL BREMACOVER j�/C Unit> 10,000 efin MECHANICAL BREMAIRHAN f�,/C Units<= 10, 000 cfin MECHANICAL BREMRECEPT Recptl, Switch& Outlets ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM ,seismic Commercial BUILIDNG EPERMITFEE l:lec Permit Issuance ELECTRICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPLANCHK flan Check Fee BUILDING BPGAS Jas Piping System Fee PLUMBING BUSLIC Business License BUILDING