13030050 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 825 HOOSHANG CT CONTRACTOR:'JA/M e PERMIT NO: 13030050
OWNER'S NAME:
PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class I—ib Lic.k q -2- 5050 REMODEL TWO(E)BATHROOMS,ONE DOWNSTAIRS
NEAR
Contractor Ad(vvte Mn «a n 6�Date / d 3 ENTRY HALL At ONE UPSTAIRS IN THE MASTER
I hereby affirm that I am licensed under the provisions of Chapter 9 BEDROOM.
(commencing with Section 7000)of Division 3 of the Business&Professions COPPER RE-P E ENTIRE HOUSE
Code and that my license is in full force andeffectr N 'TADV
I hereby affirm under penalty of perjury one of the following two declarations:
I 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.Ft Floor Arca: Valuation:$12000
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:35902004.00 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
cored l agree to comply with all city and warty ordinances and state laws relating WIT 0 DA ERMIT ISSUANCE OR'
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 18 A L CALLED INSPECTION.
indemnify and keep hamdess the City of Cupertino against liabilities,judgments, p
costs,and expenses which may accrue against said City in consequence of the ued by: Date: J tl
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
re
Signature �/] ne t/m Date 3/�(Zlda All roofs shall be inspected prior to any roofi p,�uateeing installed.If a roof is
installed without first obtaining c ton,I agr o remove all new tnaterials for
inspection.
❑ OWNER-BUILDER DECLARATION
Signature of App tart: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL OF 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)
1,as owner of the property,am exclusively,contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Scc.7044,Business&Professions Code). 1 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 penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: / 3 lICI
permit is issued.
I certify that in the performance of the work for which this permit is issued,I shall
not employ my person in any manner so as to become subject to the Worker's CONSTRUCTION LENDING AGENCY
Compensation laws of California. If,after making this certificate of exemption,I `
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. work's for which this permit is issued(Sec.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 mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional -
9.18.
Signature - Date
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
10 ADDRESS: 825 HOOSHANG CT DATE: 03/11/2013 REVIEWED BY: MELISSA
APN: 359 02 004 BP#: I 'VALUATION: $12,000
*PERMIT TYPE: Building'Permit PLAN CHECK TYPE: Alteration/Repair
PRIMARY P 'NTAMATION 1R3SFDREM
USE: SFD or Duplex PERMIT TYPE:
WORK REMODEL TWO E BATHROOMS ONE DOWNSTAIRS NEAR ENTRY HALL & ONE UPSTAIRS IN
SCOPE THE MASTER BEDROOM. COPPER RE-PIPE ENTIRE HOUSE
�ne � 'A' -z M }r✓
hfec h. Plan Check Plumb.Plan Check 0.0 his $0.00 F,lec.Plan Check
hlec/t. Pernut Fee: Plumb.Permit Fee: IPPERMIT Grec. Peonia Fee:
Other,Ife(h. In.sp. Other Plumb Insp. 0.0 hrs $45.00 Other Elec.lnsp.
,14ech.base. Pee: Phanb. Lisp.Fee: Elec.Insp.Fac:
NOTE:This estimate does not includejees due to other Departments(ie.Planning,Public Works,Fire,Sanitary Sewer District,School
District eta). These ees are based onthe relimina information available and are onlyan estimate Contact the Dept or addn I info.
FEE ITEMS (Fee Resolution 11-053 Eff. 711112) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 100 s.f. Remodel,Bath(<=300 sf)
Suppl.PC Feer Q Reg. 0 OT 0.0 hrs $0.00 $600.00IREMRESBAT
PME Plan Check: $0.00 1 # Plumbing
Permit Fee: $0.00 $13.00 1 IPRREPIPE Re-Pipe Interior
Suppl. Insp.FeelD Reg. 0 OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $45.00
Construction Tax:
Administrative Fee: (ADMIN $42.00 .0
Work Without Permit? 0 Yes Q No $0.00 0
Advanced Planning Fee: $0.00 Select a Non-Residential 0
T_ IBuilding or Structure 0
Travel Documentation Fee: ITRavDoC $45.00 14
Strong Motion Fee: IBSEISMICR $1.20 Select an Administrative Item
Bld¢ Std s Commission Fee: IBCBSC $1.00
1 � s rrt fi"11i4I' a $134.20 $613.00 TOTALFEEi $747.20
Revised: 01/01/2013-
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 825 HOOSHANG CT CONTRACTOR:JAIME MALDONADO PERMIT NO:13030050
GENERAL CONTRACTOR
OWNER'S NAME:
MENLO PARK,CA 94025 PHONE NO:(650)444-7066
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIALE]
License Class_ Lic.# !f gi 5-0 5 REMODEL TWO(E)BATHROOMS,ONE DOWNSTAIRS
A y e w.c r{a k&d:ndd eD NEAR
Contractor Date ENTRY HALL&ONE UPSTAIRS IN THE MASTER
I hereby affirm that I am licensed under the provisions of Chapter 9 BEDROOM.
(commencing with Section 7000)of Division 3 of the Business&Professions COPPER RE-PIPE ENTIRE HOUSE
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations: REVISION#1-REVISE M.BATH-ISSD OTC 4/8/2013
I 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.Ft Floor Area: Valuation:$12000
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:35902004.00 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.I agree to comply with all city and county ordinances and state laws relating WITIIIN 180 DAYS OF PERMIT ISSUANCE OR
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 D ROM LAST CALLED INS ION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the Issued by: Date: T ��3
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
� RE-ROOFS:
Signature /
DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS 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. I will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized
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 Worker's CONSTRUCTION LENDING AGENCY
Compensation laws of California. If,after making this certificate of exemption,I
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. work's for which this permit is issued(Sec.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 mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date