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09010090 CITY OF CUPERTINO BUILDING DIVISION PERMIT � R � � * BUILDING ADDRESS: PERMIT NO. 18861 BARNHART AVE BAHRAM VAZINDE OWNER'S NAME: PERMIT ISSUE DATE OHO : A CONTROL NO. 999 ARCHITEC IENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 u O p LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description 7j with Section 7000)of Division 3 of the Business and Professions Code,and my license is :goy in full force and effect. REPLC WNDW, REPLC PARTL ROOF Z Lice CI Lic.N Contractor ^F ARCHITECTS DECLARATION ? I understand my plans shall be used as public records dU G t; Licensed Professional rn 3 OWNER-BUILDER DECLARATION M 1 hereby affirm that I am exempt from the Contractor's License Law for the i G O following mason.(Section 7031.5,Business and Professions Code:Any city or county y 2 9 which requires a permit to construct,alter,improve,demolish,or repair any structure y prior to its issuance,also requires the applicant for such permit to file a signed statement _< that he is licensee!pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation yt- (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 $2000 Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy not more than five hundred dollars($500). P y Type [11,as owner of the property,or my employees with wages as their sole compensation. 37516056 . 01 will do the work,and the structure is not intended or offered for sale(See.7044,Business and Professions Code:The Commcmrs License Law does net apply to an owner of Required Inspections 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 sakJ. I,as owner of the property,am exclusively contracting with licensed contractors m construct the project(Sec.7044.Business and Professions Code:)The Contractors Li- ccnse Law does not apply to an owner of property who builds or improves themon,and. who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. ❑1 am exempt undo Se B&P C for this mason Owner. Dale WORKER'S COMPENSATION li5ECLARAIION I hereby affirm under penalty of perjury one of the following declarations: 1 have and will maintain a Certificate of Consent to self-insure for Worker's Compen- on,as provided for by Section 3700 of the Labor Code.for the performance of the cork 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 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 formic hundred dollars($100) or Irss) I certify that in the performance of the work for which this permit is issued.1 shall not employ any person in any manneiso as to beco�c subject to the Workers'Compensation Laws oC California.Date T �T— 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 0 forthwith comply with such provisions or this permit shall be deemed revoked. Z C n CONSTRUCTION LENDING AGENCY F.h h�—h I hereby affirm that there is a construction lending agency for the performance of ai the work for which this permit is issued(Sec.3097,Civ.Q �W A Lender's Name Z Lender's Address V 0 I certify that 1 have read this application and state that the above information is corrccL 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. W (We)agree to save,indemnify and keep harmless the City of Cupertino against p,.,to liabilities,judgments,costs and expenses which may in any way accrue against said City C)Z in consequence of the granting of this permit. APPLICANT UNDERSTANDS A D WILL COMPLY WITH ALL NON-POINT Issued by:A�511X Date SOUR REG LATIONS. Re-roofs Signature orAppricaruConuacuii Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant stom or handle hazardous material as defined by the Cupertino Munici 1 Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes No Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove -it hazardous air contamina;7. tied by the Bay Area Air Quality Management all new materials for inspection. trict? C3 Yes 1 have read the havardous materials requirements under Chapter 6.95 of to Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building does not currently have a tenant,that it' my responsibility to notify the occupant of the �Amquhmmcros hick ust be met prior iss of crrifcae of Occupancy, Signature of Applicant Date /V� All roof coverings to be Class". 'or better Owner or authorized agent Date- CITY OF CUPERTINO 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 37516056 . 01 DATE ISSUED. . . . . . . : 01/21/2009 RECEIPT #. . . . . . . . . : BS000007005 REFERENCE ID # . . . : 09010090 SITE ADDRESS . . . . . : 18861 BARNHART AVE SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : BAHRAM VAZINDEL ADDRESS . . . . . . . . . . : 18861 BARNHART AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : BAHRAM VAZINDEL CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY BAHRAM VAZINDEL ADDRESS 18861 BARNHART AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 2, 000 .00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 2, 000 .00 0 .50 0 .00 0 . 50 0 .00 1REROOFRES SQ FEET 8 . 00 104 . 00 0 . 00 104 . 00 0 . 00 1WINREP EACH 8 1 . 00 367 . 00 0 . 00 367 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 472 . 50 0 . 00 472 .50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CASH 472 . 50 --------------- TOTAL RECEIPT 472 . 50 coq DI 0133 CITY OF CUPERTINO ADDITION/REMODEL CUPEt�TINO PERMIT APPLICATION FORM APN# � /_ ` t Date: i C' Ict BuildinI Add s ►'1 s• (_r Mailing A (if different from building address): Owner' Nam Phone# : G l / 1 & (,� 7i! �, I Contract r: Phone (� Fax#: Contractor License#: Cupertino Business License#: Contact: Phone#: Fax#: Building Permit Info: Bldg. LJ Elect. ❑ Plumb. ❑ Mech. ❑ Hillside ❑ Job Description: Addition-What is being added?(Be Specific): What is being remodeled (not including addition)? r'-e� c C'u-, C...'yA J-0 L,.-: Pl c�. ;C0 "roo S Remodel Includes Re-Roof. Yes n No ❑ If yes list number of squares Remodel Includes Structural: Yes ❑ No ❑ Do you have the pre-application planning approval? Yes ❑ No ❑ If yes, please provide a copy of your planning approval letter. Planners name: Square Footage: Addition: Porch: Deck: Garage: Detached Attached Remodel: Kitchen Bath Other Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ IUIII B, IV-HT, V-B E5--- V -q Valuation: ,--- Please check this box if the project is a second-story addition ❑ Project Size: Express ❑ Standard ❑ Large ❑ Major ❑ Please complete relevant portion of the Green Building Checklist& attach it to the application or if applicable, Green Building Points Achievgd6 include in plan set& the sheet index. �' ***For Office Use Only*** Over-the-Counter ❑ Revised 01/07/09 CITY OF CUPERTINO ADDITON/REMODEL FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type Sq Ft 1 REMRES2 Remodel Residential B Greater than 1000 sq ft 1 REMRES3 Remodel Residential B Greater than 2500 sq ft. 1REROOFRES Residential Re-roof Each B 100 SF REMODEL PLNCK ISTPLNCK(1-3 for Standard Plan Check B NOT FOR OVER THE remodel) COUNTER PLAN CKS. WINDOW/SLIDING 1R3SFDREM GLASS DOOR 1 WINREP Replacement windows B (ea 8 windows) 1 WINNEWNSTR New Window (non- B structural) 1 WINMEWSTR New Window (Structural B Shear Wall/Masonry) 1 WINBAYSTR Bay Window (Structural) B SKYLIGHTS 1R3SFDREM 1 SKYL<l0 SF Skylight less than 10 sf B 1 SKYL>1 OSF Skylight greater than 10 B sf or structural 1STAIRS Stairs-first flight/ea addt'1 B 1 EPERMITFEE Electrical Permit Fee E 1MPERMITFEE Mechanical Permit Fee M 1 PPERMITFEE Plumbing Permit Fee P 1 ELCPLNCK Stand Alone Electric Pln E Ck(hourly) CITY OF CUPERTINO ADDITON/REMODEL FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type Sq Ft 1 MECPLNCK Stand Alone Mechanical M Pln Ck (hourly 1PLMPLNCK Stand Alone Plumbing P Pln Ck (hourly) 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee / 1BSEISMICRE Seismic Residential B 1 TRAVDOC Travel &Documentation B 1 BUSLIC Business License B I P 8 lig �5 CP ,4r V sF ss 2x i` Community Development 10300 Torre Avenue ' Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 rUPEkTINO Building Department JOB ADDRES : PERMIT # OWNER'S NAME: Vc,21,h X PHONE # � GENERAL CONTRACTOR: 5 FAX # I am not using any subcontractors: 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