09090076 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 11672 VINEYARD SPRING CT CONTRACTOR:ELEGANT KITCHEN AND PERMIT NO:09090076
BATH INC.
OWNER'S NAME: SAM&NADA GEHA 681 E BROKAW RD DATE ISSUED:09/11/2009
.NER'S PHONE: 4082558556 SAN JOSE,CA 95112 PHONE NO:(408)441-0982
LICENSED CONTRACTOR'S DECLAR/ATION BUILDING PERMIT INFO: BLDG f— ELECT F PLUMB r-
1
License Class Lic.# �I 3
A MECH r RESIDENTIAL f— COMMERCIAL F_
L both l� �
Contractor F
k w.�k'y�i.•7 �,��c 1..� Date jf' CP
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REMODEL MASTER BATH AND DOWNSTAIR
(commencing with Section 7000)of Division 3 of the Business&Professions BATH(145SQ);NO
Code and that my license is in full force and effect. RE-ROOF OR STRUCTURAL
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.
1 have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$12000
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APN Number:36654010.00 Occupancy Type:
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 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 regulations per the Cupertino Municipal Code,Section
9.18. Issued b)q- Date:
Q 1
S;-nature Date '
❑ OWNER-BUILDER DECLARATION RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
I hereby affirm that 1 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.
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, 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
I 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
contaminants as defined by the Bay Area Air Quality Management District I will
permit is issued. 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 Owner oA authorized agent:
become subject to the Worker's Compensation provisions of the Labor Code,I must Date: �—
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
1 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
the above mentioned property for inspection purposes.(We)agree to save Lender's Address
nify 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
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Date
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 36654010 . 00
DATE ISSUED. . . . . . . : 09/11/2009
RECEIPT #. . . . . . . . . BS000008655
REFERENCE ID # 09090076
SITE ADDRESS . . . . . : 11672 VINEYARD SPRING CT
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA
OWNER SAM & NADA GEHA
ADDRESS 11672 VINEYARD SPRING CT
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : KAMRAN ASLANPOUR
CONTRACTOR KAMRAN ASLANPOUR LIC # 30333
COMPANY ELEGANT KITCHEN AND BATH INC.
ADDRESS 681 E BROKAW RD
CITY/STATE/ZIP . . . : SAN JOSE, CA 95112
TELEPHONE (408) 441-0982
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 12, 000 . 00 1 .00 0 . 00 1 . 00 0 . 00
1BSEISMICR VALUATION 12, 000 . 00 1 .20 0 . 00 1.20 0 . 00
1REMRESBAT SQ FEET 1. 00 1140 . 00 0 . 00 1140. 00 0 .00
---------- ---------- ---------- ----------
TOTAL PERMIT 1142 .20 0. 00 1142 .20 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 1, 142 .20 VISA
---------------
TOTAL RECEIPT 1, 142 .20
CITY OF CUPERTINO
ADDITION/REMODEL
CUP TY OF O PERMIT APPLICATION FORM
APN # Date:
Is a 2" uniteing added? Yes L] No LJ yes, please fill out the permit application for 2" unit.
Building Address: i��2 v;��c c.r�J S�✓.',^� ck- y art,
Mailing Address (if different from building address):
Owner's Name: Phone#
b
Contractor: Phone#: 9� –
L �� Fax#:
Contractor License#: 3
Cupertino Business License#: 3 c, 3 33
Phone#:
Contact:
K4— v_,(�v Fax#:
Building Permit Info: Mech. [✓]� Hillside ❑
Bldg. aElect. 2r Plumb.
Job Description:
Addition-What is being added?(Be Specific):
�
CL�. of P�``> \ S�•� �Y-- � `��1
What is being remodeled (not including addition)? "e, `�� 13 ti E
Remodel Includes Re-Roof: Yes ❑ No Er If yes list number of squares
Remodel Includes Structural: Yes ❑ No ❑"
Do you have the pre-application planning approval? Yes ❑ No ❑
If yes, please provide a .opy of your lannin approval letter. Planners name:
Square Footage:
Addition: _ Porch: Deck: Garage: Detached Attached
Remodel: Kitchen Bath C b 3S Other
Type:1-B
onstruction(Usage Class): Occupancy Type:
1-A, II/III/V-A ❑ II/III B, IV-HT, V-B
Valuation-$a/ a , Please check this box if the project is a
Valuation:
second-story addition ❑
Project Size: Express Standard ❑ Large ❑ Ma or❑
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*** Revised 07/06/09
Over-the-Counter ❑
CITY OF CUPERTINO
ADDITION/REMODEL
OF
CUPERTINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Group Permit Type
Sq Ft
ADDITIONS 1R3SFDADD
1 PLLONGRNGR Long Range PL
Plannin Residential
lR3INSP Dwellings Inspections B
1R3PLNCK Dwellings plan check B
1R3REPINSP Dwellings Repeat B
Inspection
1R3REPPLNC Dwellings Repeat Plan B
Check
1 R3HINSP Dwellings Hillside B
inspection
1R3HPLNCK Dwellings Hillside plan B
check
1R3HREINSP Dwellings Hillside B
Repeat Inspection
1 R3HREPLNC Dwellings Hillside B
Repeat Plan Check
1 R3ALTINSP Dwellings Alternate B
Materials Inspection
1R3ALTPLNC Dwellings Alternate B
Materials Plan Check
1PCESS Cesspool P
1PPRSEWG Ea. Private Sewage P
Disposal System
1 PRSEWER Sewers P
1BPSPRINK Lawn Sprinkler/Backflow P
IBPWSVCS Main Water Service P
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
j 1BSEISMICRE SeismicResidential B
1RER00FRES Residential Re-roof Each B
100 SF
CITY OF CUPERTINO
ADDITON/REMODEL
FEE SCHEDULE
Quantity Fee ID Fee Description Fee Group Permit Type
Sq Ft
DECKS 1R3SFDADD OR
1R3SFDREM
1DECKWOOD Deck (Wood)-Each B
(Each)
1 DECKRAIL Deck Railing-Each B
(Each)
GARAGES 1R3SFDADD OR
DETACHED 1R3SFDREM
1 GARDTW<=1 K Wood Frame up to B
1,000 SF (each)
1 GARDTM<=1 K Masonry up to 1,000 SF B
(each)
1 BCONSTAXR Construction Tax Res
(new detached garage)
PATIO'S OPEN 1R3SFDADD OR
1R3SFDREM
1PATIOWOOD Wood Frame up to 300 B
SF
1PATIOMETAL Metal Frame up to 300 B
SF
1PATIOOTHER Other Frame up to 300 SF B
PATIO'S CLOSED 1R3SFDADD OR
& SUN ROOMS 1R3SFDREM
1PATIOENCLW Enclosed Wood up to 300 B
SF
1PATIOENCLM Enclosed Metal up to 300 B
SF
1PATIOENCLO Other Enclosed Patio up B
to 300 SF
1COVPORCH Porch Covered-Each B
(Each)
REMODELS 1R3SFDREM
1 REMRESKIT Kitchen Remodel up to B (Deduct "$"for ea plan
300 SF check
1REMRESBAT Bath Remodel up to 300 B "
SF
1REMREOTH Other Remodel up to 300 B "
ISF
RESIDENTIAL PROJECT COVER SHEET.
Assessor's Parcel Number: �v Cs—
Name of owner. e,-,, a c\ W, �`` (�e L0.
Project address. 6 Z �i^e C
Contact person. rK Phone.
Fax.
Net square footage of lot.
Existing Proposed
Square footage: First floor:
Second floor:
Garage:
TOTAL:
re there at least two 10 foot by 20 foot clear spaces inside the garage? �N
Is privacy protection planting required for the project? Y N
On what floor(s) is work being done? cn,3 f�-r °L,,
Brief description of work. °vV- n
Code editions:2008 CBC ( -N)2008 CFC -N)2008 CMC PN)
- 2008 NEC -N)
2008 CPC X7 N)
L01
Effective 1/1/08 CSS
o�
0o
Plan Review Process Work Book Page-8-Revised 1/1/08
14
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