11050155CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 10370 ALPINE DR I CONTRACTOR: ABLE EXTERMINATORS I PERMIT NO: 11050155 I
OWNER'S NAME: RAZAVIGHODS HOSSEIN 68 N SUNSET AVE DATE ISSUED: 05/19/2011
C
1
?R'S PHONE: 4088286499
LICENSED CONTRACTOR'S DECLARATION
License Class Lic. 42n2 / ✓ C� &?
Contractor f"'��X%. /JVt_. Date d
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect. t%
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/ f}
performance of the work for which this permit is issued.
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
permit is issued.
APPLICANT CERTIFICATION
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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
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.
Signature i �■ —Date
L_ OWNER- BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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)
1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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.
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
permit is issued.
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
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
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
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
°' °rnnify and keep harmless the City of Cupertino against liabilities, judgments,
and expenses which may accrue against said City in consequence of the
g._ :.sing of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature Date
SAN JOSE, CA 95116
PHONE NO: (408)251 -6500
BUILDING PERMIT INFO: BLDG f— ELECT F PLUMB r—
MECH r RESIDENTIAL F COMMERCIAL r—
JOB DESCRIPTION: REMOVE 8 SQ FT AREA OF STUCCO & PLYWOOD, RIM
JOIST
DUE TO DRYROT & TERMITE DAMAGE
Sq. Ft Floor Area: I Valuation: $800
APN Number: 32615076.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 PAYS OF PERMIT ISSUANCE OR
180 DAYS F�l' LAST CALLED INSPECTION.
Date:
RE- ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous 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 the
Health & Safety Code, Sections 25505, 25533, and 25534.
OffjlLr or authoor�zed ag�t:
th
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of cork's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
CtJp NO (408) 777 -3228 • FAX (408)777 -3333 • buildingecupertino.org
El NEW CONSTRUCTION ❑ ADDITION E %ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS 10,370 AZ `, A44�� d yJ APN 1
OWNER NAME 'l `n PHON, O p r E-MAIL
STREET ADDRESS f- CITY, STATE, ZIP i
CONTACT NAME PHONE E-MAIL
STREET ADDRESS CIT STATE, 7JIP FIAX
POWNER ❑ OWNER - BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACrORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME , LICENSE NUMBER ICENSE TYPE BUS. LIC # y �,� /)
,4 ,_4rc ' r .f4",'t✓ t 0 57,E b 3 .3"r, nwau .:s F v
COMPANY NAME _ I � _ rt E-MAIL, FAX" 'R
STREET ADDRESS CITY, STATE, ZIP PHONNE 4
ARCHITECT/ENGrNEER NAME LICENSE NUMBER BUS. LIC #
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY, STATE, ZIP ,.— PHONE
DESCRIPTION OF WORK
ST
EXISTtNGUSE PROPOSED USE CONSTR TYPE # STORIES OFFICE USE NL
i YLATIN
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: qDETACH N DWELLING UNFFS: IS A SECOND UNIT ❑ YES SECOND STORY BEING ADDED? ❑ NO ADDITION?
PRE - APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLANNER'S NAME: RECEIVED BY" - jf* TOTAL VALUA
PLANNING APPL N ❑ NO PLANNING APPROVAL LETTER ..-3
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 provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to uildin co uction, I authorizer re ntatives of Cupertino to enter the above- identified property for inspection purposes.
Signature of Applican UAgent: Date: g ��
SUPPLEMENTAL INFORMATION REQUIRED eLnxciili cicrYPE ROUTING SLIP
New SFD or Multifamily dwellings: Apply for demolition permit for K- COUNTER PLANREVIEw
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. ❑ EXPRESS ❑ PLANNINGPLANREVIEW
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ S'iANDARD' ❑s PUBLIC:WORICS
form if any Hazardous Materials are being used as part of this project. ❑ LA'RGE'; ❑ FIRE DEPT'
_ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEIWERDISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
BldgApp_201 1. doc revised 03116111
FM-1 CITY OF EUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
NOTE: Thesefees are based on the preliminary information available and are knly an estimate. Contact the Dept for addn7 info.
FEE ITEMS (fee Resolution 09-051 fff li /01
ADDRESS: 10370 ALPINE DR
DATE: 05/19/2011
REVIEWED BY: bobs.
APN:
BP #:
"VALUATION: $800
°PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
PENTAMATION 1 GENRES
PERMIT TYPE:
WORK
remove 8 sq ft area of stucco and plywood, rim eoist due to dryrot and termite damage.
SCOPE
PME Plan Check:
NOTE: Thesefees are based on the preliminary information available and are knly an estimate. Contact the Dept for addn7 info.
FEE ITEMS (fee Resolution 09-051 fff li /01
FEE
QTY /FEE
MISC ITEMS
Plan Check Fee:
$0.00
DEI&4,Restucco
$0.00
TUCOAPP
Suppl. PC Fee: G Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee-0 Reg.
0 OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Acoustical Fee:
Q Yes E) No
$0.00
Q
Work Without Permit? Q Yes 0 No
$0.00
Planning Fee:
$0.00
Select a Non - Residential
Building or Structure
i
Strop. Motion Fee:
IBSEISMICR
$0.50
2.0 hrs
$252.00
Inspections
IINSPMis Standard Inspections
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$1.50
$252.00
TOTAL FEE:
1 $253.50
Revised: 04/29/2011
; UPERTINO
CONTRACTOR / SUBCONTRACTOR LIST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014 -3255
Telephone: 408 - 777 -3228
Fax: 408 - 777 -3333
JOB ADDRESS: �10 7L7 LF
PERMIT # 15
OWNER'S NAME: M A,5L)tJ
PHONE #
GENERAL CONTRACTOR: 1-19a5
BUSINESS LICENSE #
ADDRESS:
CITY /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 AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors: 1 l
Signature Date
Please check applicable subcontractors and complete the following information:
Owner / Contractor Signature
Date
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