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10100048 CITY OF CUPERTIN O BUILDING PERMIT BUILDING ADDRESS: 18850 NEWSOM AVE CONTRACTOR:ADAMS GLOBAL PERMIT NO: 10100048 CONSTRUCTION 01VNER'S NAME: HAZEM RASHED 10573 GASCOIGNE DR DATE ISSUED: 10/06/2010 i- _.ER'S PHONE: 4084609497 CUPERTINO,CA 95014 PHONE NO:(408)661-1525 jo LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB License Class Lic.# � u r A MECH RESIDENTIAL COMMERCIAL Contractor Tr d� � ��,r Date 1a141ZGP I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: BATHROOM REMODELING&WATER HEATER (commencing with Section 7000)of Division 3 of the Business&Professions REPLACEMENT,NO Code and that my license is in full force and effect. ELECTRIC OR LIGHTING,NO MECHANICAL 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. 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:$3000 permit is issued. ��yi�J APPLICANT CERTIFICATION APN Number:37530020.00 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 of 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. 6 v Issued by Date:Ir-41-'IdSienawre Date ❑ OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of 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,I agree to remove all new materials for 1,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: 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 I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE 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 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 I have and will maintain Worker'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 I store or handle hazardous material. 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 I certify that in the performance of the work for which this permit is issued,I shall 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 or authorized agent: forthwith comply with such provisions or this permit shall be deemed revoked. Date: /u ___7' l7 A�1� 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.I 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 ups the above mentioned property for inspection purposes.(We)agree to save is ify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address cow..,,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 1 understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO FEE ESTIMATOR-- BUILDING DIVISION ADDRESS: DATE: REVIEWED BY: APN: BP#: `VALUATION: 1$3,000 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY ;r I r ; � PENTAMATION USE: SFD or Duplex . rC)1t _ PERMIT TYPE: 1 RPFIX WORK SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Fixture or Trap 1BPFIXTURE 2 # $16 Water Heater 1 PRWHEATR 1 # $25 TOTALS: $41.00 Plumb.Plan Checl: 0.0 hrs $0.00 __ , . .r< E,< FnuPermit Fee: IPPERMIT IF (,W? t„-t =y ., Other Plumb Insp. 1.0 hrs $42.00 oa tit, , lf:�i�; 1,��� Plumb.Insp.Fee: 1PLMBINSP $126.00 t,tCc h-fy, /,cc NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn 7 info, FEE ITEMS (Fee Resolution 09-051 a. 7%1.%10) FEE QTY/FEE MISC ITEMS Plan t o 1 t,u% supp/, PC PME Plan Check: $0.00 Perini! f'-c PME Unit Fee: $41 00 PME Permit Fee: $16800 .tc:c,ttsflcctl fief°il� I-c< . Work Without Permit? 0 Yes 0 No $000 Travel Documentation Fee: ITRAVDOC $42.00 Strong Motion Fee: $050 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $252,50 $0.00 TOTAL FEE: 1 $252.50 Revised: 9/29/2010 CITY OF CUPERTINO 7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk : Lot: APN . . . . . . . . : 37E30020 .00 DATE ISSUED. . . . . . . : 10/06/2010 RECEIPT #. . . . . . . . . : BSC00011659 REFERENCE ID # . . . : 10100048 SITE ADDRESS . . . . . : 18E50 NEWSOM AVE SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . . HA2EM RASHED ADDRESS . . . . . . . . . . : 18E50 NEWSOM AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : ADFMS GLOBAL CONSTR CONTRACTOR . . . . . . . : ALFA ELDIN AHMED LIC # 25883 COMPANY . . . . . . . . . . : ADFMS GLOBAL CONSTRUCTION ADDRESS . . . . . . . . . . : 10E73 GASCOIGNE DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 TELEPHONE . . . . . . . . : (4C8) 661-1525 FEE ID UNIT QUANTITY FMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- -- -------- ---------- ---------- ---------- 1BCBSC VALUATION 3, 000 . 00 1 .00 0. 00 1. 00 0 .00 1BPFIXTURE NO OF FIXTURE 2 . 00 16 .00 0. 00 16 . 00 0 .00 1BSEISMICR VALUATION 3, 000 . 00 0 .50 0.00 0 .50 0 . 00 1PLMBINSP HOURS 1. 00 126 .00 0.00 126 . 00 0 . 00 1PPERMITFE FLAT RATE 1. 00 42 .00 0 .00 42 . 00 0 . 00 1PRWHEATR UNITS 1. 00 25 . 00 0 . 00 25. 00 0 . 00 1TRAVDOC FLAT RATE 1. 00 42 . 00 0 . 00 42 . 00 0 . 00 -- -------- ---------- ---------- ---------- TOTAL PERMIT 252 .50 0 . 00 252 . 50 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 252 .50 #1152 --------------- TOTAL RECEIPT 252 . 50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 302 TUB & OR SHOWER 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING 512 FINAL HANDI-CAP INPUT RLSOLIrms Energy IAD!Health M.Indoor Air Quality and Finishes 1.Use Low/No-VOC Paint 1 IAQ/Health pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0 3.Use Low/No VOC Adhesives 3 IAQ/Health pts y=yes 0 4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 0 5.Use Engineered Sheet Goods with no added Urea Formaldehyde 61AQ/Health pts y=yes 0 0 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 7.Seal all Exposed t�ioleboard or MDF 4 IAQ/Health pts y=yes 0 8.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 0 9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes 0 1 D.Install Whole House Vacuum System 3 IAQ/Health pts y=yes 0 1 1 1 N.Flooring 1.Select FSC Certified Wood Flooring 8 Resource pts y=yes 0 2.Use Rapidly Renewable Flooring Materials 4 Resource pts y=yes 0 3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 0 4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y=yes 0 5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 0 6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0 1 1 t Total Points Available: U01 1301 57 Total Points Project Received: 0 0 0 G:da4el�fog g:nbuildingguidelines/remodelerstgreenpointsfina1212 04protectedxls Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONT CTOR/ SUBCONTRACTOR LIST JOB ADDRESS: r5Dd PERMIT# U O U OWNER'S NAME: 4..3 t PHONE# 40 g— d4'01— GENERAL 6 —GENERAL CONTRACTOR: BUSINESS LICENSE# ADDRESS: CITY/ZIPCODE: v/ *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: ignature Date or Please check applicable subcontracts and comp]ete 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 .01 Owner/Contractor Signature Date RESIDENTIAL PROJECT COVER SHEET Assessor's Parcel Number: 3?SO-J0 , 6 2—e Name of owner. �a 7 e--&%n k „ . Project address. T/ _ S-�G�I-P r J 4_� VIP_ Contact person. 11 06 2,e-� Phone. 4of 4(6 vFax. Net square footage of lot. Existing Proposed Square footage: First floor: Second floor: Garage: TOTAL: Are there at least two 10 foot by 20 foot clear spaces i:iside the garage? N Is privacy protection planting required for the project? ly— Build it Green Total Points On what floor(s) is work being done? Brief description of work. Code editions: 2007 CBC -N)2007 CFC N)2007 CMC (Y-N) 2007 CPC -N)2007 NEC (Y -N) Effective 1/1/MCA CUP['iTITw t�.,i7(;k ” •a'A'()HDINANGP- DA FE 446 _ y _ SI(,iTJt I1 his s�,t , t Tri ! ��, i I n< M��`;' t yntan cT,r ,r ;:,m�with i�� .. �tfcr,�,. �i;i aun f•�r- Dep TF�F> statpmyri'i , fi�aiF�rtn,,� �•c:rfu ti x ,s�— Plan Review Process Work Book Page-8-Revised 8/05/C 8 � M �I 30 cn • o � 3 0 N `0/000 ? CITY OF C'UPERTINO ILE ADDITION/REMODEL CUPERTINO FEE SCHEDULE APN# 7 &0 0,2_0 Date: �O1�110 Is a 2"d unit being added? Yes ❑ No ❑ If Yes, lease fill out the permit application for 2"d unit. Building Address: 19750 le,WSO 144 11 V e/ 14o/ G-A Mailing Address (if different from building address): Owner's Name: #A ,Z9 Phone# : 11C �. 46 0 Contractor: dates �0 I n ,( Phone#: � (96tY C- I �irl Fax#: Cupertino Business License: State Contractor License#: X 3 19/ r" Contact: dob^ A o4w Phone#: a — (V/— /5',Z S'' /`t Fax#: Landscape Ordinance Compliance: Landscape area in sq. ft. (includes all irrigated areas): If 2,500 sq. ft. or less, compliance with the Landscape Water-Efficiency Checklist is required. If more than 2,500 sq. ft., a complete Landscape Project Submittal is required. Compliance Method: ❑ Plant Type [] Water Budget Building Permit Info: Bldg. Rl,-- Elect. ❑ Plumb. [�-/ Mech. ❑ Hillside ❑ Job Description: Addition-What is being added?(Be Specific): What is being remodeled (not including addition)` �G,/y /QootM I ltJa�ee llewG Remodel Includes Re-Roof: Yes No If yes list number of squares Remodel Includes Structural: Yes ❑ No 9"*' Do you have the pre-application planning approval? Yes ❑ No ❑ If yes, please provide a copy of your planning Lpproval letter. Planners name: Square Footage: Addition: Porch: Deck: Garage: Detached Attached Remodel: Kitchen Bath Other Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-li Valuation: Jy jmoo Please check this box if the project is a 2ro'ect Size: ExpressETStandard ❑ Large ❑ Major ❑ second-story addition ❑ Please complete relevant portion of the Green Buil ding Checklist& attach it to the application or if applic able, Green Building Points Achieved: ` include in plan set & the sheet index. Revised 05/18/10