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11040143 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1149 KENTWOOD AVE CONTRACTOR:NEKO ELECTRIC PERMIT NO: 11040143 OWNER'S NAME: ANDY ULLAH 22430 CUPERTINO RD DATE ISSUED:04/20/2011 OWNER'S PHONE: 4084067307 CUPERTINO,CA 95014 PHONE NO:(408)446-4141 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class 93 ZV77 Lic.# 2 r MECH RESIDENTIAL COMMERCIAL ` Contractor �eV'U �'�tL�J�t• Date ,2 2'11 I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:UPGRADE NEW 200AMP ELECTRICAL PANEL (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. erertby affirm under penalty of perjury one of the following two declarations: rTilve 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. I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$800 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:35931019.00 Occupancy Type: APPLICANT CERTIFICATION I certif�that ave read this application and state that the above information is -___.r,orrcct.Iagree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally,the applicant understands and will comply with all non-point source reulg� o Municipal Code,Section 9.18• '+ ii'' Issued 4 Date: Signatur '�� ,�... Date '7'`4-11 Ci OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is eby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. 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, Signature of Applicant: Date: Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1 hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534. not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If,after making this certificate of exemption,I Owrfer or a4borized agent: become subject to the Worker's Compensation provisions of the Labor Code,I must ate: 22 �11 forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION *ing of this permit.Additionally,the applicant understands and will comply ill non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.�s. Licensed Professional Signature Date CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35931019. 00 DATE ISSUED. . . . . . . : 04/20/2011 RECEIPT #. . . . . . . . . : BS000013237 REFERENCE ID # . . . : 11040143 SITE ADDRESS . . . . . : 1149 KENTWOOD AVE SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . . ANDY ULLAH ADDRESS . . . . . . . . . . : 1149 KENTWOOD AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : MOTAMAREM MESBAHI CONTRACTOR . . . . . . . : ALI PAKNAHAL LIC # 31642 COMPANY . . . . . . . . . . : NEKO ELECTRIC ADDRESS . . . . . . . . . . : 22430 CUPERTINO RD CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 TELEPHONE . . . . . . . . : (408) 446-4141 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 800 . 00 1. 00 0. 00 1.00 0. 00 1BSEISMICR VALUATION 800 .00 0.50 0. 00 0 .50 0. 00 1EPERMITFE FLAT RATE 1 . 00 42 .00 0. 00 42 .00 0. 00 1ERT<200 UNITS 1 . 00 42 . 00 0. 00 42 .00 0. 00 1TRAVDOC FLAT RATE 1 . 00 42 .00 0. 00 42 .00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 127.50 0. 00 127.50 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 127.50 VISA --------------- TOTAL RECEIPT 127.50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 103 UFER 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: ll Y9 kev1 om,c-1 t o c PERMIT# OWNER'S NAMEPHONE# 40 GENERAL CONTRACTOR: Alc K YA H A BUSINESS LICENSE# 3 �l ADDRESS: .111yle- q5etCITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AN BCONTRA AVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontra s: Si ure Date Please check applicable subcontractors and complete the following information: V 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 C) GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333•building(aDcugertino.org MISC CUPERTINO ❑PLUMBING ❑MECHANICAL LECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS / (�Gf APNf� a �I o �l OWNER NAME PCL/ ( PHONE ` E-MAM )r( / J^ STREET ADDRESS + + ) J n � ("�" AV/ CITY,STATE,ZIP t MECi CONTACT NA / y `( ` PHONE E--7IJ 1 STREET ADDRESS CITY,STATE,ZIP FAX ❑OWNER Cl OWNER-BUILDER ❑ OWNER AGENT &C69:i:�CTOR ❑CONTFACTOR AGENT ❑ ARCHITECT Cl ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME ) / LA INA W A ) LICENSE NUNn 7 LICENsET7 1-e BUS.LIC a COMPANY NAME / EMAIL j JAX C' 1 1 1 q( STREET ADDRESS (� y11: her �(1 CITY,STATE,ZIP ttCv�t,Yt L' _ �� o( PHONE e � 19 L!� ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC COMPANY NAME E-bIAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF FD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN STRUCTURE: ❑ Commercial URBAN DMAFACE AREA ❑ Yes ❑ No FLOOD ZONE ❑ Yes ❑ No DESCRIPTION OF WO TOTAL VALUATION: RECEI�C�EIkBG By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have gte a is correct. I have Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating for utf ilding construction. I authorize repre ntatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: . 2 ` SUPPLEMENTAL INFO TION REQUIRED MEPMiscApp_2011.doc revised 03/16111