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07050035 CI eY OF C IPERTINO BUILDING DIVISION PERMIT BUILg11rU 73G�DDRPERMIT No. FS6ASCOIGME DR ALAAELDIN AHMED 07050035 OWNER'S NAME: PERMTT ISSUE DATE ALAAELDIN AHMED 1 10573 GNSCOIGNE DR 05/04/2007 DNE: SANITARY NO. CONTROL NO. ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH O p LICENSED CONTRACTOR'S DECLARATION Job Description %V p I hereby affirm that I am licensed under provisions of Chapter 9(commencing �ZU with Section 7000)of Division 3 ofthc Business and Professions Code,and my license is ADDING SHOWER TO EXISTING BATH-NO ELECTRICAL, OR . s y in full force and effect ? License Class Lic.if LIGHTIN.�. F Date Contractor ARCHITECTS DECLARATION 7 a< I understand my plans shall be used as public records )qV e U.y Licensed Professional OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the po following reason.(Section 7031.5,Business and Professions Code:Any city or county <0 which requires a permit to construct,alter,improve,demolish,or repair any structure } prior to 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 >tl.Ft.Floor Area $3000 Valuation r I=- (commencing with Section 7000)of Division 3 of dte Business and Professions Code)or i 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 abl Number Occupancy Type not more than five hundred dollars($500). 3752800 : l�C1' ❑1,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 docs 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 arc 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.). I,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. ❑1 am exempt under SB&P C for this reason y Owner Date _]KORKEI2'9 faONl DECLARATION . I SAt4ITAR 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 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. ❑1 have and will maintain Workces 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 am: 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 ppppppeccc��rmit is issued,I shall not employ any person in any mamner so as s�yxt Workers'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after m emp n u should become subject to the Worker's Compensation provisions of the Labor Code,you must ,J O forthwith comply with such provisions or this permit shall be deemed revoked. z" CONSTRUCTION LENDING AGENCY E-+ I hereby affirm that there is a construction lending agency for the performance of fx > the work for which this permit is issued(See.3097,Civ.C.) ALender's Name z Lender's Address V C) 1 certify that I have read this application and state that the above information is LI, correct.I agree to comply with all city and county ordinances and state laws relating to 0 U building construction,and hereby authorize rcpresentativcs of this city to enter upon the nWi above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against S4�� to liabilities,judgments,costs and expenses which may in any way accrue against said City �J U Z in consequence oC the granti rs permu. Date `�� APPLICANT UNDERST DS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE REGULATIONS, (• a Re-roofs C7 Signature of Apphea Oeontizatur"— Datc HAZARDOUS MATERIALS DISCLOSURE Type of Roof 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. ❑Yes J0 No Will the applicant or future building occupant use equipment or devices which If a roof iE installed without first obtaining an inspection,I agree to remove .mit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. District? ❑Yes $J No 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 %,L-a tenant that it is my responsibility to notify the occupant of the requirements which t be met prior to issuance of a Certificate of Occupancy. Signature A Applicant Date C (41 r All roof coverings to be Class"B"or better Owner ora bate CITY OF CUPERTINO 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: suew COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 37528009. 00 DATE ISSUED. . . . . . . : 05/04/2007 RECEIPT #. . . . . . . . . : BS000001213 REFERENCE ID # . . - : 07050035 SITE ADDRESS . . . . . : 10573 GASCOIGNE DR SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER ALAAELDIN AHMED ADDRESS 10573 GASCOIGNE DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : RECEIPT INTERFACE CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY ALAAELDIN AHMED ADDRESS 10573 GASCOIGNE DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 TELEPHONE . . . . . . . . : FEE ID UNIT QUANTITY PMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BPERMFEE VALUATION 3, 000 .00 83 .16 0 .00 83 . 16 0.00 BPFIXTURE UNITS 1 .00 9. 00 0 .00 9.00 0.00 BSEISMICRE VALUATION 3, 000 .00 0.50 0 .00 0 . 50 0 . 00 PPERMITFEE FLAT RATE 1 .00 38 .37 0 .00 38 . 37 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 131 . 03 0 .00 131 . 03 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 131.03 VISA-AHMED --------------- TOTAL RECEIPT 131. 03 CITY OF C'UPERTINO tA CITY OF PERMIT APPL][CATION FORM CUPEkTINC) APN# Date: 3 5/ � �/(,.*-�� Building Address: Mailing Address (if different from building address): Owner's Name: f Phone#: / ` Atacre(dA 'A V\ �e� 40 - �C/- l z Contractor: 0/g License #: Contact: Phone: 4org - E6/-I SAZS Cupertino Business License#: rM, 1n Fax: Building Permit Info: —/ Bldg El Elect El lumb 2 Mech ❑ Job Description: /Gj, Y%o c,'-�C t-i-'Z aA 4r- Residential b� Residential 00df 5 fi1rC /P� t' �`,fi -1� Commercial El Sq.Ft. Floor Area: </� Sq.Ft.: Cost of Project: 71 ;—_ Occupancy Group: � CACC' Type of Construction: Please check this box if the project is a second-story addition: ❑ Project Size: Standard N' Large ❑ Major ❑ Quantity Fee ID :Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> l OOK to 500K Btu MECHANICAL BBOILER3 Boilor> 500K to 1M Btu MECHANICAL BBOILER4 Boile-> 1M to 1.75 M Btu MECHANICAL BBOILER5 B)iler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX In(VOff/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Coustax–Resi/Mobile BUILDING BELEC 1000 Elm 600V <= l OOOA ELECTRICAL BELEC1001 El ec 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V<= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD I nergy Add Multi BUILDING BINVESTIGA ;nvestigation fee BUILDING I of 3 CITY OF C'UPERTINO CUPE(�F PERMIT APPLICATION FORM Quantity Fee ID :Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM Nev- Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME In 3pection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Eldg Permit Fees BUILDING BPFIXTURE Pb1g Fixture PLUMBING BPGAS Ga; Piping System Fee PLUMBING BPINTERCEP Inc. Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE R,,-Pipe Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lave n S rinklerBackflo PLUMBING BPSTORM torm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER V�ater Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cftn 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> I OK btu MECHANICAL BREMHEAT ([eater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc 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 Ropair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 CITY OF CUPERTINO CITY or PERMIT APPL[CATION FORM CUPERTINO '2uantity Fee ID Fee Description Fee Group BREMSIGNAD Rm,ll Signs Add Branch ELECTRICAL BREMSIGNS Rerr odel Signs, Marquee ELECTRICAL BREMTHEATR Thcatrical Lighting Fix ELECTRICAL BREMVENFAN Ve tit Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL pecial Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Tempora Power ELECTRICAL BTEMPPERM Temporary BIPermit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC -3lectrical sq foot ELECTRICAL EPERMITFEE Eluc Permit Issuance ELECTRICAL MPERMFEE N-echanical sq. foot MECHANICAL MPERMITFEE Meeh Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Phunbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING 3 A 3 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 wo.-k 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 wo:-k (complete section below) Contractor Address/City Phone # State License # Type of work to 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. Persoq irm Address/City . Phone Number Type of work to be erformed ....................................................................................................................................................... . I declare under penalty of p Jury that the above is true and correct. I have read and understand the Owner-Builder Information reverse side). / Property Owner's Signature: � Date: 'Z � l G ' Job Ad dress: C�� "Ce%9'n rh ap- Permit# Any changes to the information provided on :his form shall be submitted to the City of Cupertino Build Department. �w doo , f CD n W nO ui �-0 o p C+ -- ro � � '_'� � f71 � V L l 1'V n `'►� rU rU o c Q O �O :3 -- 7C' D0 , 0 c+(D r0 S Q. 33- � O c+ O '-G rip c Q �� C � )14civw /V - i tea" -� (_'r. rD -3C+ O T C+ Ln ro D :3 Cil LA qD 0 ~' n -3 Z' x- ro Q Q m x O ---� O z _. .-� Q1, r � D � a � I ti 0 p ol 7 Q (D r0 s � � v r:. CD o CDD (� w v, _41 cn o Pti o cu :X7 ao UQ CL cb cn p <.; -� a c� o C7 ul C) c� nT r1 ✓' C7 s` r� '?. Cl m v- p co (7, :-.. m 3 C, N S CJ --4 i177 CD O y N mCD cv 'e < �� O [D .-=i N 2 El co °' °; -- � n O w o o c C vj ? cn CD � i � i n ro 01 :. D -p W �.- n � 0 Q `+ G1 n (+ s? �- O Z �UD £ !4 n ri ri) * ic �' F �' Lb Q �-- O ro X_ �? n O --� Q -- 3 � � �- -� <+c0 M 3- -s co� s -* 0. '-< (D n T, < lo— p � � kwM R 1� Now ro S X 0 O Ln CA Ln aD 77 C) :3-3 S -p X- rD Q Q r+ M S x ® j 4 o 0 is :15 z N on Q Q ro a r Community Development 10300 Torre Avenue r Cupertino CA 95014 Telephone(408)777-3228 C TY C1F Fax(408)777-3333 "UPEkTINO Building Department All Cupertino building permits must meet certain conditions related to maintaining environmental quality and public peace and safety. The two most common conditions are described below. STORMWATER POLLUTION CONTROL. State law requires that Cupertino, 12 other Silicon Valley cities, Santa Clara County and the Santa Clara Valley Water District cortrol stormwater pollution. Educating local residents and businesses and enforcing E;tormwater pollution control laws are key parts of the City's compliance efforts. Stormwater pollution prevention: It's up to us In northern Santa Clara Valley, storm drains flow directly to local creeks and San Francisco Bay, with no treatment. Storriwater pollution is a serious problem for wildlife dependent on our waterways, for people living near streams and baylands, and for the local water supply. Common sources of stormwater pollution include: • Dripped oil, fuel, and antifreeze from vehicles and heavy equipment; • Construction debris, including dirt, concrete and paint; • Landscaping runoff containing pesticides or weed killers; and • Any material dumped or spilled into streets or storm drains The property owner and the contractor Ehare ultimate responsibility for activities occurring at a construction site and will be held responsible for any environmental damage caused by subcontractors or employees. For more information on construction-related stormwater requirements, see the Stormwater Quality Regulations section of the City of Cupertino web site at: http•//www cupertino.org/city :)vernment/departments and offices/ environmental services COMMUNITY NOISE CONTROL The basic noise control requirements for construction sites are as follows: Typical construction work hours are: - Weekdays - 7 a.m. to 8 p.m. - Weekends - 9 a.m. to 6 p.m. • Construction other than street construction is prohibited on holidays. • Residential daytime noise levels from complaint site - 60 dBA • Nonresidential daytime noise levels from complaint site - 65 dBA For more information on noise control, please see Chapter 10.48 of the Cupertino Municipal Code, which can be accessed at http://www.amlegal.com/cupertino ca/ Greg Casteel Building Official Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 -UPERTINO Building Department JOB ADDRESS: /0 6 ��r� U, PERMIT# ,�s. cti OWNER'S NAME: o,,, PHONE #41 _6 if GENERAL CONTRACTOR: FAX# I am not using any subcontractors: ci� �` — Si,nature Date 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 . -- _ y/ U er/Contractor Signature Date