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12050189 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10659 MINETTE DR CONTRACTOR:TARIQ AHMED PERMIT NO: 12050189 OWN'ER'S NAME: TARIQ AHMED 10659 MINETTE DR DATE ISSUED:05/25/2012 OWNER'S PIIONE: 6508237082 CUPERTINO,CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOBDESCRIPTION: RESIDENTIAL COMMERCIAL❑ License Class Lica REMOVE WATER HEATER TANK AND REPLACE WITH TANKLESS Contractor Date WH, INSTALL TWO SKYLIGHT IN EX. BATH AND TWO 10 1 hereby affirm that I am licensed under the provisions of Chapter INCH TUBE SKYLIGHTS IN HALLWAY (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. 1 hereby affirm under penalty ofperjury one of the following two declarations: 1 have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.F1 Floor Area: Valuation:$1100 I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this APN Number:37532035.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.1 agree to comply with all city and county ordinances and state laws relating WITHIN 180 80-DAYS OF PERMIT 1SSUAN E O to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS OM LAST CALLED ISP TI indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the —7 5Zg /z granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RF:ROOFS: Signature Date All roofs shall be inspected prior to any roofing material bent;installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for inspection. A OWNER-BUILDER DECLARATION 1 hereby affirm that 1 em exempt from the Contractor's License Lew for one of Signature of Applicant: Date: the following two reasons: ALI,ROOF COVERINGS TO BE CLASS"A"OR BETTER 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&Professions Code) I,as owner of the property,am exclusvely contracting with licensed contractors to IIA%ARDOUS MATERIALS S DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will I hereby affirm under penally of perjury one of the following three maintain compliance with the Cupertino Municipal Cad rRapter 9.12 end the declarations: Health&Safer} Code,Section 25532(a)s uld 1 stor r hxnble hazardous I have and will maintain a Certificate ofConsentio sclf-insure for Worker's material. Addilionally,should 1 use a dipmenl or eviees which emit hazardous Compensation,u provided for by Section 3700 of the Labor Code,for the air conleminanls as defined 4hythperlino, �AreA' ualtt};Management District l performance of the work for which this permit is issued. will maintain compliance wis1 nicipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Se5 53 and25534. Section 3700 of the Labor Code,for the performance of the work for which this /� b �� Z permit is issued. Owner or authorized agent: l/ Dale: I certify that in the performance of the work for which this permit is issued,I shall not employ any person many manner so as to become subject to the Worker's Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. w'ork's for which this permit is issued(See.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION 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 mentimcd property fo inspec'on purposes.(We)agree to save ARCHITECT'S DECLARATION indemnify and keep less the City of 0tino against l iabililics,judgments, costs,and expens- w icn ma, cc�d gay�st said City in consequence of the I understand my plans shall be used as public records. granting of this a I Ad -ional ,the Applicant understands and will comply with all non-p in ourc egul ons p the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Dates 12— r Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 C U P E RT I N O Telephone: 408-777-3228 Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST - JOB ADDRESS: 10659M1 INV qN�4 PERMIT# ? -:'j OWNER'S NAME: —TA RI r.AFD PHONE# GENERAL CONTRACTOR: S!5 E :5A3ercr4 BUSINESS LICENSE# 6695 ADDRESS:/F-8-Z Sr USr C-r. CITY/ZIPCODE: SAJrA (LA,?A 9Sb5O *Our municipal code requires all businesses working in the cit-Wo ha-n aa"6ity 6-n upertino business license. NO BUILDING.FINAL OR FINAL OCCUPANCY INSPECTION(S)-WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALLe BCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. i am not using any subcontractors:� ,l S/)-4 � 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 Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION 10300 TORRE AVENUE-CUPERTINO, CA 950143255 CUPERTINO (408)777-3228"FAX(408)777-3333- buildinora)cuoertino.org Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE ADDRESS J ) Cete62TI1,E_b APN 3�� - 3'2 - O 3> BP# OWNERNAME 1C OWNERADDRESS -r A-4-' �I --c I. CA i1bl DESCRIPTION OF WORK: SK S nit 6w' ST A-r MS .� ��'" ea �f> A 0" To6 -rwu We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address Indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIREC IONS:Please read and initial each statement below to signify you understand or verify this information.) 1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an"Owner- Builder'building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provi coverage for those injuries. I am willfully acting as an Owner-Builder and am aware of the limits of my in . coverage for injuries to workers on my property. fI understand building permits are not required to be signed by property owners unless they are responsible for the nstruction and are not hiring a licensed Contractor to assume this responsibility. 3. I understand as an"Owner-Builder" I am the responsible party of record on the permit. I understand that I may prof t myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her na instead of my own. I understand Contractors are required by law to be licensed and bonded in California and to list their license nu ers on permits and contracts. 5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the totValue of my construction is at least five hundred dollars($500), including labor and materials, I may be co dered an "employer"under state and federal law.. 6. 1 understand if I am considered an "employer" under state and federal law, I must register with the state and federal government,withhold payroll taxes, provide workers'compensation disability insurance, and contribute to unerWoyment compensation for each"employee." I also understand my failure to abide by these laws may subject Zme, serious financial risk. 7. 1 understand under California Contractors'State License Law, an Owner-Builder who builds single-family re idential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by ice7j subcontractors and the number of structures does not exceed four within any calendar year, or all of the work I rformed under contract with a licensed general building Contractor. 8. I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for ior personal injuries sustained by any subsequent owner(s)that result from any latent construction defects in the workmanship or materials. On,nerBuilderForm 20/O.doc revised04114110 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10659 Mlnette Dr DATE: 05/25/2012 REVIEWED BY: Sean APN: BPM: 'VALUATION: $1,100 "PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Repair PRIMARY SFD or Duplex PENTAMATION pRWHEATR USE: PERMIT TYPE: WORK Remove tank water heater and replace with tankless water heater. Install 2 skylights in existing SCOPE bathroom and.(2) 10 inch tube skylights in hallway. ,14ech. Pion Chrck Plumb.Plan Check 0.0 hrs $0.00 Dec. Plar,Cheek .Veih. Permit Fee: Plumb.Permit Fee: /PPERMIT Elm Permit Fee. Other,Ilech-huh. Other Plumb Insp. 0.0 hrs $44.00 Otho Dee. Irup. ET alech_ buzz Fee- Plumb.Insp.Fee: Elee hrep. Fee: NOTE: This estimate does not include fees due to other Departments(ie.Planning,Public Works,Fire,Sanitary Sewer District,School Distri etc). nesefees are based on the prefinmin In ormadon available and are only an estimate. Contact the Dept for addn7 info. FEE ITEMS /Fee Resolution 11-053 Elf 7/1/111 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 1 # Plumbing Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 $26.00 1PRWHEATR Water Heater PME Plan Check: $0.00 1 # Skylight Permit Fee: $0.00 $392.00 1SK1z<10SF <= 10 s.f. Suppl. Insp. Fee:O Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $44.00 Construction Tax: Administrative Fee: IADAEN $41.00 Q Work Without Permit? O Yes Q No $0.00 0 Advanced Planning Fee: $0.00 Select a Non-Residential (D Travel Documentation Fee: I MVDOC $44.00 Building or Structure Strone Motion Fee: 1BSEISWCR $0.50 Select an Administrative Item Blde Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $130.50 $418.001 TOTAL FEE: $548.50 Revised: 05/0112012 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333•buildinG(citcuoertino.oro 12 CUPERTINO b U C5—o l ❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT, PROfECT ADDRESS APN a 03SOWAi WErr� PE, CUeT/N CA 9sboi 379 - 3 2 -0-35- OWNER NER NAME PRONE E-NAIL 1� 1rt 6-c� fsa3 - io�Z AX ziuni ab o 1 (Ohm STREETADDRESslq c F Q CITY. STATE.ZIPrnJ FAX CONTACT NAMEPONE E-MAIL � V -rAI(� /b a -523 STREET ADDRESS CITY,STATE ZIP FAX -TT- QTln1D CA J!iOftl ❑OWNER WNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ET'GINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSENUMBER LICENSE TYPE BUS,LICA COMPANY NAME E-MAIL FAX STREETADDRESS CITY.STATE,ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE WMBER BUS,LIC 4 COMPANY NAME EMAIL FAX STREET ADDRESS CITY.STATE,ZIP PHONE DESCRIPTION OF WORK PF=ftACI&4 NA,-reP- -T -Ick ss - MNST lis T T Nlv 1 r 2�Ir /lral] Q TU f�US ��` 7U STN C r, w E:XU; PROPOS�rD USE CONSTR 'PE nsT JES vi / USE TYPE OCC. SQ.F . VALUATION(S) EXISTG NEW FLOOR / DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN I OM REMODEL AREA REMODEL AREA ODELAREA PORCH ARE\ DECK AREA ECK,PORCH AREA GARAGEAREA: DETACH ATTACH 9DWELL.' .'ITS: IS A SECOND UNIT ❑YES SECONDSTORY ❑YES BEING ADDED' fjlNp AD DIT 1YN0 T PRE-APPLICATION ❑YES IF YES,PROVIDE Y OF THE BLDG AN ❑YES RECEIVED 9y: TOTAL VALUATION: PL\6'NLVG APPL✓ TO'<0 PLA NNING AP ALL EICNLER HOME^ }Q NO By my signature below,1 certify to c of the to ng: 1 air the property owner or authorized agent to act on the preperry owner's behalf. I have read this application and the information 1 h provi d is co ct. I'have read the Description of Work and verify it is accurate. 1 agree to comply with all applicable local ordinances and state laws relating build, constru I authorn)'x representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMEIIZTAL OORMATION REQUIRED PUN CHECK TYPE ROUTING SLIP _New SFD or Multifamily dwellings: Apply for demolition permit for OVER-THE{OGNTERBUILDING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building � permit for new building. ❑ EXPRESS PLANNING PLAN REVIEW (Jw t C G _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS CIE yr Tom if any Hazardous Materials are being used as pan of this project. ❑ LARGE ❑ FIRE DEPT _Copy of Planning Approval Letter or Meeting with Planning prior to ❑ XWOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_201l,doc revised 06121/11 f 6le v-e—AO qD Y(j " �vyr �i� looms 6JI r. "Am F� __ PECEIVED MAY 2 5 2012 J Nt� 3 4 BY: foo grd rf ulre DZ O° cF,N 17oiIwo B F. , - Laze 000 WAT" 7-1 p 4 3' _ CUPERTINO Building Department COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION-CUPERTINO MAY 2 5 2012 APPROVED �u '�) �� This set of plans and specifications MUST be kept at the REVIEWED FOR OMPLIANCE job site during construction. It Is unlawful to make any changes or alterations on same,or to deviate Reviewed By: therefrom,without approval from the Building Official. ESI iTl y The stamping of this plan and specifications SHALL NOT be held to permit or to be an approval of the violation _—_— - PKot7osab of any provisions of any City Ordinance or State Law. FFI "";;CE 6Y �N COPY DATE 5 2PERMIT NO. 12-65:61 , CITY OF CUPERTINO 7 ITEMS OF 7 J PERMIT RECEIPT OPERATOR: SylviaM % COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 1I . . . . : 37532035 .00 DATE ISSUED. . . . . . . : 05/25/2012 RECEIPT #. .( . . . . . . . : BS0'00016911 REFERENCE �ID # . . . : 12050189 SITE ADDRESS . . . . . : 10659 MINETTE DR SUBDIVISION . . . . . . : I CITY . . . .I. . . . . . . . . : ,CUPERTINO IMPACT AREA . . . . . . :i OWNER .// . . . . . . ... .o: TARIQ AHMED ADDRESS . . . . . . 10659 MINETTE DR CITY/STATE/ZIP . .1. : CUPERTINO, CA 95014 RECEIVED FROM / . : TARIQ AHMED CONTRACTOR . . . . . LIC # *OWNER* COMPANY . . . . . . : TARIQ AHMED ADDRESS . . . . . !. . . . : 10659 MINETTE DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 TELEPHONE . . . . . . . . . FEE ID UNIT , QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- -ADMIN HOURS 1 .00 41.00 0. 00 41.00 0.00 1BCBSC VALUATION 1, 100.00 1.00 0. 00 1 .00 0. 00 1BSEISMICR VALUATION 1, 100 .00 0.50 0. 00 0 .50 0. 00 1PPERMITFE FLAT RATE 1 .00 44 . 00 0.00 44 .00 0. 00 1PRWHEATR UNITS 1 .00 26 . 00 0. 00 26 .00 0.00 1SKYL<10SF EACH 1.00 392. 00 0.00 392 .00 0.00 1TRAVDOC FIAT RATE - 1 .00 44 . 00 0. 00 44 .00 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT 548.50 0 .00 548. 50 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 548.50 chk --------------- TOTAL RECEIPT 548.50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- --------------------=------- -------- ---------------------------- 518 WATER HEATER.