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07030301CITY OF CUPERI INU BUILDING DIVISION PERMIT r LDING ADDRESS: 21901 GARDENVIEW LN NER'S NAME: ALI ALAMDAR INE: ARCHITECT/ENGINEER: 0 o LICENSED CONTRACTOR'S DECLARATION ut rr, I hereby affirm that I am licensed under provisions of Chapter 9 (commencing Z w with Section 70(1()) of Division 3 of the Business and Professions Code, and my license is t in full force and effect. 'd ^ ? License Class Lie. rY - in Date Contractor F' U ARCHITECTS DECLARATION ,a 7 < I understand my plans shall be used as public records )WU U. y Licensed Professional O a OWNER -BUILDER DECLARATION aI hereby affirm that I am exempt from the Contractor's License Law for the p O following reason. (Section 7031.5, Business and Professions Code: Any city or county SL which requires a permit to construct, alter, improve, demolish, or repair any structure a n prior uo its issuance, also requires the applicant for such permit to file a signed statement - ? < that he is licensed pursuant to the provisions of the Contractor's license Law (Chapter 9 h= (commencing with Section 7000) of Division 3 of the Business and Professions Code) or I R $ F that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500). ❑ 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 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 .17 L as owner of the property. am exclusively contracting with licensed contractors to constroct 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 comractor(s) licensed pursuant to the Contractor's License Law. ❑ 1 am exempt under Sec. /l B & PLC for this reason Owner d7 t ' Kf t a ✓� �`� _ Date / Z d j ORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: �O z2 (1r Q �z UO �U H a Uz r -r 1 have and will maintain a Certificate of Consent to self -insure forworkees 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 Worker's Compensation Insurance carrier and Policy number are: Cartier. Polity No.: CERTIFICATE OF EXEMPTION FROM WORKERS' 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 fo hic*isi ssued, I shall not employ any person in any manner sou subrsCompcnsation Laws of California. Date Applicant NOTICE TO APPLICANT: If, aftc ing this Certit.atcoxemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby arum that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) Lender's Name Lender's Address I 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 building construction, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL CO Y WITH ALL NON -POINT SOURCE REGULATIONS. Z a" Signature of ApplicanUContract Dttte 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)? ❑ Yes ON. 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 District? F1 Yes KNu I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Code, Sections 25 25533 and 25534.1 understand that if the building does not currently have tenant, t it i myy responsibility to notify the occupant of the reyuirements which be met p or ' tSCance of a CertiGcato of Occupancy. ?i 2 Owner Yf authortzed agent Date LION ELECTRIC CO 1211 FARK A' UPGRADE ELECTRIC PANEL TO PERMIT NO. 07030301 PERMIT ISSUE DATE 03/27/2007 SANITARY NO. CONTROL NO. BUILDING PERMIT INFO BLDG ELECT PLUMB MECH G V U rix .0 J _ �,.___....�ob.j?escriptlon Sq. -Ft. Area ber Issued I y: Re -roof 3 Type of Roof ,'Required Inspections vaivat)on uccupancy type Elate _ DZ? �� All root's shall be inspected prior to any roofing material being installed. If a roo r is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant All roof coverings to be Class "B" or better Date 4 ITEMS OF 4 CITY OF CUPERTINO PERMIP RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 36219089.00 DATE ISSUED.......: 03/27/2007 RECEIPT #......... BS000000807 REFERENCE ID # ...: 07030301 SITE ADDRESS 21901 GARDENVIEW LN SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OWNER ALI ALAMDAR ADDRESS 21901 GARDENVIEW LN CITY/STATE/ZIP ...: , OPERATOR: bethe COPY # : 1 RECEIVED FROM RECEIPT INTERFACE CONTRACTOR HPMID R HOZHABRY LIC # 26941 COMPANY LION ELECTRIC CO ADDRESS 1211 PARK AVE, #104 CITY/STATE/ZIP ...: SPN JOSE, CA 95126 TELEPHONE (408)242-6769 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT ---------- THIS REC ---- NEW BAL ---------- BELEC200 ------------- METERS ---------- 1.00 ---------- 29.43 0.00 29.43 0.00 BPERMFEE VALUATION 900.00 83.16 0.00 83.16 0.00 BSEISMICRE VALUATION 900.00 0.50 0.00 0.50 0.00 EPERMITFEE FLAT RATE 1.00 38.37 0.00 ---------- 38.37 ---------- 0.00 ---------- TOTAL PERMIT ---------- 151.46 0.00 151.46 0.00 METHOD OF PAYMENT AMOUNT ----------------- --------------- CHECK 151.46 --------------- TOTAL RECEIPT 151.46 VOICE ID DESCRIPTION -------- --------------------------- 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL REFERENCE NUMBER -------------------- 152 VOICE ID DESCRIPTION -------- ---------------------------- 501 FINAL ELECTRICAL ENERGY 'q CITY OF CUPERTINO CITY OF CUPERTINO PERMIT APPLICATION FORM 0 g030 ---b I _CPN # 3 b 1, -- k 9 _,0 `t Date: 3, Z'-? -0'7 Building Address- Mailing Address (if different from building address): 21 q. o \ G.a �d .n LAI -- w -Owner's Owner's Name: Phone #: L j- L j j S Contractor: . _ License #: 1 - S -p 3 t Contact:Certino Business License#:' j2oc�LicatLal-� Phone: Lu��)S l -1G6 Cupertino 'A-7 S6$ , Fax: Building Permit Info: Bldg ❑ Elect Pq Plumb ❑ Mech ❑ Job Description: T� Pdr+U,__JV 4,- ate' 9YV*1._ Residential ® Commercial ❑ Sq.Ft. Floor Area: 4W Sq.Ft.: Cost of Project: r do Occupancy Groin Type of Construction:Please check this box if the project is a `cAa second -story addition: c,,,--A--A f-1 T nrap f-1 Mninr F-1 Iiid/Off/Comm/Quasi rIVIvuLall.G. OLcuiuui., ` _0_ Quantity._Fee ID BAPPLOTHER Fee Description Other Appliances Fee Group MECHANICAL BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boil --r > 100K to 500K Btu MECHANICAL BBOILER3 Boiler > 500K to IM Btu MECHANICAL BBOILER4 Boiler > 1M to 1.75 M Btu MECHANICAL BBOILER5 3oiler > 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Iiid/Off/Comm/Quasi BUILDING BCONSTAXBQ BCONSTAXH C :)n. Tax for BQ Zone Hotel and Motel BUILDING BUILDING BCONSTAXR C )nstax — Resi/Mobile BUILDING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 :Zlec 600V > 1000A ELECTRICAL BELEC200 Elf c Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD BINVESTIGA Energy Add Multi Investigation fee BUILDING BUILDING 1 of 3 Cf 'OF CUPEkTINO .CITY OF C'UPERTINO PERMIT APPLICATION FORM 77_Q_u_an_fi_ty Fee ID BMISCELL Fee Description Miscellaneous Fee Fee Group BUILDING BMITIGATC Conim. Housing Mit. Fee BUILDING BNUCOMME 1\ ew Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW A mospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Permit Fees BUILDING --Bldg BPFIXTURE Pblg Fixture PLUMBING BPGAS G2 s Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD PI m Check Add Multi BUILDING BPLANCKREP Pl,m Check Re eat 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 Jdt of Drain & Vent PLUMBING BPWATER Ins-:all/Alter Water Pie PLUMBING BPWHEATER Nater Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER AiC Unit > 10,000 cfin MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace > lOK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD I astallation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Ren 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 RRFMRF.4APP REmodel Res Appliance ELECTRICAL 2 of 3 CITY OF CUPEkTINO .CITY OF CUPERTINO PERMIT APPLICATION FORM Quanti Fee ID Fee Description Fee Group BREMSIGNAD Rnidl Signs Add Branch ELECTRICAL 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 S eismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP 'rem orary 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 Mechanical sq. foot MECHANICAL MPERMITFEE Mech 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 I ZADDCHG Address Change BUILDING 3 of 3 MY OF ''UPEkTINO Community Development No Final .Inspections unt 1 this form 10300 Torre Avenue is complete. Please prc, ,,ide a list of Cupertino CA 95014 all subcontractors and their Telephone (408) 777-3228 City Business License numbers. Fax (408) 777-3333 Building Department JOB ADDRESS: ,J 1 r, PERMIT # OWNER'S NAME: `.�. ,._�. J�_. PHONE # <�, -- GENERAL CONTRACTOR: 1 FAX # I am not using any subcontractors: Signature Please check annlicable subcontractors and complete the following information: Date Owner/ Contractor Signature Date 4 SUBCONTRACTOR BUSI14ESS 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 4