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07030003 -7-777777777777777 CITY OF CUPERTINO BUILDING•DIVISION PERMIT �1 'TLGC?R� ZEIN' BUILDING ADDRESS: PERMIT NO. 10456 JOHNSON AVE. ASIF KAFEL 07030003 OWNER'S NAME: PERMIT ISSUE DATE ASIF KAREL 10456 JCIHNSON AVE 03/01/2007 ONE: SANITARY NO. CONTROL NO. BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH i p p LICENSED CONTRACTOR'S DECLARATION Job Description v I hereby affirm that I am licensed under provisions of Chapter 9(commencing .z� withScction7IXl0)ofDivisian3ofthc8usinessandPrafcssiunsCodc,andmyliccnscis REPLACE MAIN ELECTRICAL PANEL 125AMPS in full force and effect. r License Class Lic.# F Dare Contractor ARCHITECTS DECLARATION 7 a< I understand my plans shall be used as public records >yU n.f- Licensed Professional 0, OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the COOfollowing reason.(Section 7031.5,Business and Professions Code:Any city or county < which requires a permit to construct,alter,improve,demolish,or repair any structure Z} 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 at- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $500 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 oft Number Occupancy Type not more than five hundred dollars($500). 3752604-', V V 0 1,is owner of the property,or my employees with wages as thea 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 docs not apply to an owner of q 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.). e,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. 0 I am exempt under SB&P C for this reason Owner- kzie Date WORK PENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declaratio,rW. - ----- -•• - - - _I I have and will maintain a Certificate of Conscnt to self-insure for Worker's 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 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: Carrier. Policy 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 for which this permit is issued,1 shall not employ any person in any manner 5o u re t to the Workers'Compensation Laws of califomia.Date Applicant NOTICE TO APPLICA f,a r making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. Z" CONSTRUCTION LENDING AGENCY Er►�-. 1 hereby affirm that there is a construction lending agency for the performance of . f� the work for which this permit is issued(Sec.3097,Civ.C.) ALender's Name Lender's Address Z U C) I certify that 1 have read this application and state that the above information is (L n- 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 a above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against Hliabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. Date O' APPLICANT UNDERSTANDS D WILL COMPLY WITH ALL NON-POINT Issued by �� �� SOURCE REGULATIONS. �4zr__z Re-roofs Signature ofApplicant/Comr for te Type 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)? All roofs ;hall be inspected prior to any roofing material being installed. C]Yes �No 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 .mit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? 0 Yes UK. 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 does not currently have a to ant.that it is my responsibility to notify the occupant of the requirements which ust t prior w issuance of a Certificate of Occas an Signature of Applicant Date All roof coverings to be Class "B"or better Owner or authori7.ed ,:n Date CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: amyw COPY # 1 Sec: Twp: Rng: Sub: Bl}:: Lot: APN . . . . . . . . . 37E26045 .00 DATE ISSUED. . . . . . . : 0301/2007 RECEIPT #. . . . . . . . . : BSC00000581 REFERENCE ID # . . . : 07C30003 SITE ADDRESS . . . . . : 10456 JOHNSON AVE. SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . . AS]F KAREL ADDRESS . . . . . . . . . . : 10456 JOHNSON AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : REC'EIPT INTERFACE CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY . . . . . . . . . . : AS]F KAREL ADDRESS . . . . . . . . . . : 10456 JOHNSON AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY I.MOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- -- -------- ---------- ---------- ---------- BELEC200 METERS 1. 00 29 .43 0. 00 29 .43 0. 00 BSEISMICRE VALUATION 500. 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 68.30 095 --------------- TOTAL RECEIPT 68.30 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 103 UFER 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL OWNER-BUILDE R VERIFICATION 1. (Check one) I or my immediate family (;arent,spouse or child) will perform A. =�All the work author;zed by this permit B. _ A portion of the wo3.� C. _ Done of the work If B or C is checked,co replete 2 or 3 below. 2. A state licensed contractor will be hired to do: A. _ All of the work B. — portion of the wo.-� (complete section below) I Fc- ontractor Address/City Phone # State License # Type of work to I 3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or portions of the authorized work. I understand that I may be an employer (see reverse side). A Certificate of Insurance covering workers' compensation must be on file at the City of Cupertino Building Department office. Person/FirmAddress/City Phone Number Type of work to be performed .................................................................................................................................. I declare under penalty of perjury that the at ove is true and correct. I have read and understand the Owner-Builder Information(reverse side). Property(Owner's Signature: / Date: 3. /o Job Add�ess: �6 ') Q Y Al���N r Permit# .I I Any chances to the information provided on this form shall be submitted to the City of Cupertino Build Department. i i Community Development W 10300 Torre Avenue a1; Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 17UPE�TINO Building Department JOB ADDRESS: i t )ONAlJ,� y /�v` PERMIT 70 3 66 0 OWNER'S NAME: J-i PHONE # 5 v 75_f- 4,G GENERAL CONTRACTOR: FAX # I am not using any subcontractors: 3 r 7 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 Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date ev CITY OF C UPERTINO CITY OF PERMIT APPLI=CATION FORM CUPEkTINO _CPN# 7 Date: M�R 2009 ,7 7J' -- 16- Building CBuilding Address: Mailing Address (if different from building address): Owner's Name: - Phone#: Contractor: License#: Contact: Phone: 65a.-75 y -Aio Cupertino Business License#: A f 1 r Fax: Building Permit Info: ^/ Bldg ❑ Elect lam' F lumb ❑ Mech ❑ Job Description: Residential kq eJe �c L Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: D „ Occupancy Group: Type of Construction: Please check this box if the project is a second-story addition: El eroject Size: Standard ❑ Large ❑ Major ❑ Quantity Fee ID lee 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 Boile-> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX IncJOff/Comm/Quasi BUILDING BCONSTAXBQ Cosi. Tax for BQ Zone BUILDING BCONSTAXH 3otel and Motel BUILDING BCONSTAXR Constax—Resi/Mobile BUILDING BELEC 1000 Ele;c 600V<= l 000A 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 CITY OF CUPERTINO a PERMIT AP PL[CATION FORM CUPEkTINO '?uantity Fee ID Fee Description Fee Group BREMSIGNAD Rm,il 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 ;>cb Specific Plan BUILDING BSEISMICOM Se'smic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL pecial 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. 3lectrical sq foot ELECTRICAL EPERMITFEE Ekc Permit Issuance ELECTRICAL MPERMFEE 1V echanical 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 L A ZADDCHG kc1dress Change BUILDING 3 of 3