09080076CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20061 SUISUN DR CONTRACTOR: TBD - TO BE DETERMINED PERMIT NO: 09080076
O' wi'i'S NAME: KOOROSH ALFATOONI DATE ISSUED: 08/10/2009
OWNER'S PHONE: 4083688442
❑ LICENSED CONTRACTOR'S DECLARATION
License Class
Contractor
Lic. #
Date
I hereby affirm that 1 am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Businecs & Professions
Code and that my license is in full force and effect.
1 hereb,, 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.
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
1 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 Z)f this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmiess the City of Cupertino against liabilities, judgments,
costs, and expenses which may acerae against said City in consequence of the
graraing of this permit. Additionally, the applicant understand, and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
S. — Date
0 OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for one of
the following two reasons:
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 exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code)
1 hereby affirm under ptaalty of perjury one of the following three
dec;arations:
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
Sect:cn 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 emlaoy any person in any manner so as to become subject to the Worker's
Compensation laws of Caiifornia. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, 1 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 abov c information is
correct. 1 agree to comply with all city and county ordinances and state laws relating
to ' "ng construction, and hereby authorize representatives of this city to enter
uta c above mentioned property for inspection purposes. (We) agree to save
in&T.i..ity and keep harmless the City of Cupertino against liabilities, judgments,
cost:, 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.
Date 0000/69
PHONE NO:
BUILDING PERMIT INFO: BLDG r— ELECT r— PLUMB
MECH f— RESIDENTIAL I— COMMERCIAL
JOB DESCRIPTION:PUT IN NEW HARDWOOD, REPLACE CABINETS
IN KITCHEN,
REPLACE KITCHEN WINDOW TO HIGH EFFICIENCY, REPLACE
APPLIANCE AND ADD SUN TUNNEL
iq. Ft Floor Area:
aPN Number: 36928004.00
Valuation: $10000
Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by:
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
1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safetv Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should 1 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 255059 25533, and 25534.
Owner horized agent: 9
Date: i�/
v CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professiona
r" J11f1� 11t1`lJ2J1"rI`J11 - I ! F1 r JJ -Ir.
1
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I
SINGLE FAMILY DWELLING REMODEL
w Usage Class
Permit Number "
i
09080078
-
II/III B. IV-HT,V-B NEW
Status "
-
C - Closed
SQUARE FT.
Master Number
Calculated Value
JQ1 Notes
j Project
434 lel
Apply Date "
08/10/2009
40 Operator
Permit Issue Date
I
08/10/2009
Operator
Certificate Issued
12/03/2009
Operator
Certificate Type
I
CO - CERTIFICATE OF OCCUP
Certificate Number
Address" I 20081 SUISUN DR
City/State/Zip CUPERTINO
0 APN 38928004.00
IQi Unit
patg ]4'Y '1 C! il4'llli i_rrr BtiC r"I
patg I Owner Name %I KOOROSH ALFATOONI
SUM Use Default ❑
Address Home - 20081 SUISUN DR
F
1
I Permit " Property Zoning Applicant Contractor " Defined Fields
I —
Permit Details
Permit Type . 1R3SFDREM IQI
i
SINGLE FAMILY DWELLING REMODEL
w Usage Class
11/111 13, IQI
j
II/III B. IV-HT,V-B NEW
j Applied Value x
10000
SQUARE FT.
9G
Calculated Value
0 IE)i
US C-404 Type
434 lel
ALT: RESIDENTIAL
Permit form "
AUTOPERM - PERMIT
0wnership
1 - Private
Project Size
COUNTER - OVER THE COUNTER
Permit issued 0811012009
Pnf at Fha ni irnnta nr �nw tnarW rnndiHnnc fnr chic narmiF
City/State/Zip CUPERTINO
CA 95014
CA 95014
Purpose/Special Conditions
PUT IN NEW HARDWOOD, REPLACE CABINETS IN KITCHEN,
REPLACE KITCHEN WINDOW TO HIGH EFFICIENCY, REPLACE
APPLIANCE AND ADD SUN TUNNEL
SCANNED/ FILMED 8%2011
I[OAdd Default Text
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20061 SUISUN DR
I
CONTRACTOR: TBD - TO BE DETERMINED
PERMIT NO: 09080076
OWNER'S NAME: KOOROSH ALFATOONI
DATE ISSUED: 08/10/2009
OWNER'S PHONE: 4083688442
PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION
r— F_ F -
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lie, tt
F_ F_
MECH RESIDENTIAL COMMERCIAL
Contractor Date
1 hereby affirm that I am licensed under the provisions of Chapter 9
JOB DESCRIPTION:PUT IN NEW HARDWOOD, REPLACE CABINETS
(commencing with Section 7000) of Division 3 of the Business & Professions
IN KITCHEN,
Code and that my license is in full force and effect.
REPLACE KITCHEN WINDOW TO HIGH EFFICIENCY, REPLACE
APPLIANCE AND ADD SUN TUNNEL
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 3 700 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
Sq, Ft Floor Area:
Valuation: $10000
permit is issued.
APPLICANT CERTIFICATION
APN Number: 36928004.00
Occupancy Type:
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 if this city to enter
! upon the above mentioned property for inspection purposes. (We) agree to save
PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally, the applicant understands and will comply
180 DAYS FROM LAST CALLED INSPECTION.
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
E Signature Date
Issued by: Date:
d
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for one of
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
the following two reasons:
installed without first obtaining an inspection, 1 agree to remove all new materials for
I, as owner of the property, or my employees with wages as their sole compensation,
inspection.
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
Signature of Applicant: Date:
I, 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
r deeiarations:
I have and will maintain a Certificate of Consent to self -insure for Worker's
HAZARDOUS MATERIALS DISCLOSURE
Compersation, as provided for by Section 3700 of the Labor Code, for the
I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued.
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain
1 have and will maintain NYorker's Compensation Insurance, as provided for by
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Section 3700 of the Labor Code, for the performance of the work for which this
Safety Code, Section 25532(a) should 1 store or handle hazardous material.
permit is issued.
Additionally, should I use equipment or devices which emit hazardous air
I certifi'rhat in the performance of the work for which this permit is issued, I shall
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
not employ any person, in any manner so as to become subject to the Worker's
Health & Safety Code, Sections 25505, 25533; and 25534.
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
Owner horized agent:
Date:_`�[/Q/,0q
forthwith comply with such provisions or this permit shall be deemed revoked.
r
APPLICANT CERTIFICATION
CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is
I hereby affirm that there is a construction lending agency for the performance of work's
correct. 1 agree to comply with all city and county ordinances and state laws relating
for which this permit is issued (Sec. 3097, Civ C.)
to building construction, and hereby authorize representatives of this city to enter
Lender's Name
upon the above mentioned property fer inspection purposes. (We) agree to save
indemnity and keep harmless the City of Cupertino against liabilities, judgments,
Lender's Address
cost-, 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�rce regulations per the Cupertino Municipal Code, Section
ARCHITECT'S DECLARATION
9.18. �/ .
i understand my plans shall be used as public records.
t
Signature , Date *L0OQ
Licensed Professional
CITY OF CUPERTINO
` ADDITION/REMODEL
CUPEkTINO PERMIT APPLICATION FORM
() 1 6 &0-7 ( o
O H ` C �
APN # 0,M0
Date: _ap � F./ G ` G
Is a 2" unit being added? Yes ❑ No E If yes, please fill out the permit application for 2 nd unit.
Building Address: aoo61 r(' -
Mailing Address (if different from building address):
Owner's Name:
Phone #
lac (osL� q�
Ufa$
Contractor:
Phone #:
Fax #:
Contractor License #:
Cupertino Business License #:
Contact: <oa(oS�.�-�
Phone #:
Fax #:
Building Permit Info:
Bldg. -JS Elect.'] Plumb."E Mech.--& Hillside ❑
Job Description:
Addition -What is being added?(Be Specific): A
What is being remodeled (not including addition)? _
91,
Remodel Includes Re -Roof: Yes ❑ No If yes list number of squares
Remodel Includes Structural: Yes ❑ No
Do you have the pre -application planning approval? Yes ❑ No ❑ - -JJ S— U h,,J
If yes, please provide a copy of your planning approval letter. Planners name: -�
Square Footage:
Addition: Porch: Deck: Garage: Detached Attached
Remodel: Kitchen Bath Other
Type of Construction (Usage Class):
Occupancy Type: 0 wry
1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV -HT, V -B NO/
Valuation: N 10 k -
Please check this box if the project is a
second -story addition ❑
Project Size: Express ❑ Standard& Large ❑ Major ❑
Please complete relevant portion of the Green Building
Checklist & attach it to the application or if applicable,
Green Building Points Achieved:
include in plan set & the sheet index.
***For Office Use Only***
Over -the -Counter ❑
Revised 06/10/09
K .
•f'Te{
CITY OF
CUPEkTINO
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESS: IXWC k S wkS~ r C*?e-+ G4-
PERMIT #
i
q6 I�r
SUBCONTRACTOR
OWNER'S NAME: i -p ,�N U
PHONE # 46$ --AA— 844"2,
GENERAL CONTRACTOR:
FAX #
I am not using any subcontractors:
Signature
Please check applicable subcontractors and complete the following information:
Date
V-- &110/01
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
Ornamental Sheet Metal
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
V-- &110/01
Owner/ Contractor Signature Date