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09070015CITY OF CUPERTIINO BUIL DING DIVISION PERMITN-FiTI�N BUILDING ADDRESS: PERMIT NO. 10417 ANSON AVE ALI'S C0NST OWNER'S NAME: REMODEL I NG PERMIT ISSUE DATE cop Z oZ p. 4 0. % p, [— �O Il `A gin Km� FFG at .7 O r.i Ls, Q ::)z UO wH OU Ha CA U ARCHITEC IENGINEER: LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professiu Code, and my license is in full force and e� �/tt `72 �A License iceClassa Lic.tM PP JJ 7 Date ContractorT—r ARCHrrEC1-S DECLARATION I understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the following reason. (Section 7031.5, Business and Professions Code: Any city or county which requites 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 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 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 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 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 Sec B & P C for this reason OwnerDate WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ f 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. ❑ 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 C mp sation Insurance ca .er and Policy u er arc: Cartier; Policy No.: CERTIFICATE OF EXEMPTION FROM W RKERS' 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, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date 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 forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm 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 1 certify that I have rad 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 authorim 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 gran g f this permit. APPLICANT UNDER ASi ND W COMPLY WITH ALL NON -P9 SOURCE REG /Sir// oa ,��^f/ k3� // r Signature or ` Date HAZARD S ATERIALS DISCLOSURE Will the applicant or fu tlding occupant store or handle hazardous material as defined by the Cupertino u ' tpal Code. Chapter 9.12, and the Health and Safety r rade, Section 25532(a)? ❑Yes No 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? ❑ Yes &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 docs not cEffcnWhaiu.drat it is my responsihility to notify dtc oaupant of the requiremensm�et prior t issuance of a Cerufhca o Occ�tcy_laq Owner or 408) 8a8-6474 Job Description fal. Nit1161Wfa? BUILDING PERMIT INFO ELECT PLUMB MECH DEMO EXTNG POOL & BACKFILL - ALI'S CONSTR & RMDLD PD FOR ZENEWL OF BUS LIC Sq. Ft. Floor Area Valuation APN Number Occupancy Type 32641001.00 N Issued by: Re -roofs Required Inspections Type of Roof All roofs :;hall be inspected prior to any roofing material being installed. If a roof i;; installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant All roof coverings to be Class'%.'' or better Date CITY OF -UPEI�TINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: PERMIT # -7 to YZ7 3ft ✓i 5O V q / © � 00 t--S- OWNER'S NAME: CM VAC ka PHONE # 410 8 c - GENERAL CONTRACTOR: j I � I FAX # _ I am not using any subcontractors: s '� ate Please check avvlicable subcontractors and come t the followinz information: s ` Owner/ Contract gnature SUBCONTRACTOR BUSIl`1 SS 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 s ` Owner/ Contract gnature CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT Sec: Twp: Rng: Sub: B11: Lot: APN ........: 32E41001.00 DATE ISSUED.......: 07/06/2009 RECEIPT #.........: BS000008119 REFERENCE ID # ...: 09070015 SITE ADDRESS .....: 10t17 ANSON AVE SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OWNER CHliNCHAL SAHAI ADDRESS ..........: 10t17 ANSON AVE CITY/STATE/ZIP ...: CUPERTINO CA, OPERATOR: patg COPY # : 1 95014-1304 RECEIVED FROM ....: MEHRDAD ZAMANI CONTRACTOR .......: ALZ ZAMANI LIC # 28677 COMPANY ALT'S CONSTRUCTION & REMODELIN ADDRESS 681 E BROKAW RD CITY/STATE/ZIP ...: SAN JOSE, CA 95112 TELEPHONE ........: (408) 898-6474 FEE ID UNIT QUANTITY INOUNT PD -TO -DT THIS REC ---------- NEW BAL ---------- ----------------------- 1BCBSC VALUATION ---------- 6,000.00 ---------- 1.00 ---------- 0.00 1.00 0.00 1BSEISMICR VALUATION 6,000.00 0.60 0.00 0.60 0.00 1DEMOPRE SQUARE FEET 0.00 490.00 0.00 490.00 ---------- 0.00 ---------- TOTAL PERMIT ---------- 491.60 ---------- 0.00 491.60 0.00 METHOD OF PAYMENT ----------------- CREDIT CARD TOTAL RECEIPT : AMOUNT --------------- 491.60 --------------- 491.60 REFERENCE NUMBER -------------------- VISA VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 704 DEMO CITY OF CUPERTINO DEMO CUPEI�TINO PERMIT APPLICATION FORM APN# 3; L-Lp `� Date: JLA, 0 �y Building Address: Arl-5ot, AVe-_ Permit Type Mailing Address (if different from building address): Demo -Residential B Owner's Name: C Phone/ og) Z(� _ c�0� Contractor: , f Phone : -4ps1 — o (g y ALI �� cons�rVl��Q✓1 %C�DL� Fax: Dcy Contractor License #: 'B q 05 ALL PERMIT TYPES Cupertino Business License #: -08T7,7,? B Contact: �� Z0,171a ," Ce4l Phone('/ .-- 6 Lf Fax: z) y,5_q z Z Residential Sq Footage Commercial ❑ Sq Footage Job Description: 2)6,010 / 4e- t Valuation: / od \ Project Size: Express ❑ Standard K Large ❑ Major ❑ Please complete relevant portions of the Green Building Checklist & attach it to the application or if applicable, include on the plan set & the sheet index. Quantity Fee ID Fee D(!scription Fee Group Permit Type 1DEMORES Demo -Residential B 1SFDWL-DEM Ij 1DEMOPRES Pool Denio Residential B 1SFP00L-DEM 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICRE Seismic Residential B Revised 01/07/09