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10080207 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21436 HOLLY OAK DR CONTR,►CTOR:ALPS CONSTRUCTION& PERMIT NO: 10080207 REMODELING "" 'NER'S NAME: BIN LI&EARL PENG 681 E BF OKAW RD DATE ISSUED:08/27/2010 ,,,f NER'S PHONE: 4084804699 SAN JOIE,CA 95112 PHONE NO:(408)898-6474 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r License Class Lic.# MECH r— RESIDENTIAL r COMMERCIAL r Contractor DatejW I hereby affirm that I am licensed under the provisionpter 9 JOB DESCRIPTION:2ND FLOOR MASTER BEDROOM&MASTER (commencing with Section 7000)of Division 3 of the B &Professions BATHRC OM,HALLWAY,BATHROOM WINDOW REPLACEMENT Code and that my license is in full force and effect. 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 F nor Area: Valuation:$1500 permit is issued. APPLICANT CERTIFICATION APN Number:36202033.00 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 18) DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. , / ,---' _--- � Date: S;,.! ture C DateIssued by:J�(, / �-� ❑ R-BUILDER DECLARATION RE-ROOFS: I hereby affirm at I am exempt from the Contractor's License Law for one of All roof;shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installer without first obtaining an inspection,I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, inspecti m. will do the work,and the structure is not intended or offered for sale(Sec.7044, Signatu'e of Applicant: Date: Business&Professions Code) 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 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. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compli;ince with the Cupertino Municipal Code,Chapter 9.12 and the Health& Safety ode,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 Additicnally,should I use equipment or devices which emit hazardous air permit is issued. contan inants 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 11 become subject to the Worker's Compensation provisions of the Labor Code,I must Owner!afflf �rorized agent: 1 Date: � �0 forthwith comply with such provisions or this permit shall be deemed revoked. ✓///[ CONSTRUCTION LEND AGENCY APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is I hereb 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 whi permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lende•'s Name the above mentioned property for inspection purposes.(We)agree to save .unify and keep harmless the City of Cupertino against liabilities,judgments, Lende°s Address costs,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 I under stand my plans shall be used as public records. 9.18. Signature Date Licemed Professional CITY OF CUPEF.TINO 3 ITEMS OF 8 PERMIT RECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot. : APN . . . . . . . . : 3620203;, . 00 DATE ISSUED. . . . . . . : 08/27/2010 RECEIPT #. . . . . . • . . : BS00001:_316 REFERENCE ID # . . . : 1008020'? SITE ADDRESS . . . . . : 21436 HOLLY OAK DR SUBDIVISION . . . . . . . CITY CUPERT I NO IMPACT AREA . . . . . . . OWNER BIN LI Y EARL PENG ADDRESS . . . . . . . . . . : 21436 HOLLY OAK DR CITY/STATE/ZIP . . . : CUPERTI:JO, CA 95014 RECEIVED FROM MEHRDAD A ZAMANI CONTRACTOR ALI ZAMkNI LIC # 28677 COMPANY ALI' S CDNSTRUCTION & REMODELIN ADDRESS 681 E BROKAW RD CITY/STATE/ZIP SAN JOSE, CA 95112 TELEPHONE (408) 898-6474 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ----- 1BCBSC VALUATION 1, 500 . 00 2 .00 0 .00 2 . 00 0 .00 1BSEISMICR VALUATION 1, 500 .00 1. 00 0 .00 1.00 0 .00 1WINREP EACH 8 5. 00 760 .00 0. 00 760. 00 0 .00 ---------- ---------- ---------- ---------- TOTAL PERMIT 763 . 00 0 .00 763 .00 0 .00 r Nil `` CITY OF CUPERTINO CITY OF CUPEkTINO GENERAL BUILDING PERMIT APPLICA7,ION FORM APN # Date: Building Address: 1�-�6 WQ�I �� G x�:l1c C�S� IV Mailing Address (if different from uilding address): Are Hazardous Materials being used as part of this project? Yes No HOA: (Exterior work on Yes ❑ No ❑ If yes, provide letter from HOA Owner's Name: Phone#: � 6 Phone: E Contractor: can s-6-4 c-E- Fan: u r v Contractor License#: p �3 Cu ertino Business License#: Phone: Contact: / i 2A Fan: Residential Commercial Job Description: (nim Building Permit Info: Plumt Mech ' Bldg L'q. Elect ❑ ❑ ❑ Type of Construction (Usage Class): Occupancy Type: V1 I 1-A, 1-B ❑ II/III/V-A ❑ II/111 B, IV-HT, V-B v= Valuation: Square Footage: Project Size: Express Standard ❑ Lar. e ❑ Major ❑ Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it to the application or if applicable, inclade in plan set & the sheet index. Points Achieved: For help, contact Build it Green at www.builditgreen.oc Revised 07/14/09 CITY OF CUP:ERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: DATE: REVIEWED BY: APN: BP#: 'VALUATION: $1,500 FPERMiT TYPE: Building Permit PLAN CHECK TYPE: Alteration/Addition/Repair PRIMARY SFD or Duplex OVER THE PENTAMATION 1 SFDW USE: COUNTER. 0 Yes 0 No PERMIT TYPE: WORK SCOPE OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. sJ R-3 (Custom) II-B,111-B,IV,v-B 0 $0.00 $0.00 TOTALS: 0 $0.00 f r $0.00 MECH,HO,URLY 'Yes f o P�I7MB, T()UR>i,Y` aJ:'c "Van('1% ri.: Yir,n�h. ("�.rn(�hr�<_i. F.i,:2'. Flair C�hcrk ll ,.h. 1'rrr>>r.';c.. ('In�nt�_ Pc;rrtrr 1,..;:: Vkc. 1'.jruul I`— �: r _ Ir;°n� /}literl,k'cIn-sp I!,�,l; l�z,,r; 1��c- l'i�r;ul� lr<E;. h:_�r. i�(irc 10SI) !.'LV 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 £'�f. 7,1/10) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 5 # Window/Sliding Glass Door Suppl. PC Fee: E) Reg. 0 OT 0.0 hrs $0.00 $380.00 1WINREP Replacement PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee{' Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Cu;t�lrtrti(%r 7 �.�_ Acoustical Fee: 0 Yes 0 No $0.00 0 Work Without Permit? 0 Yes E) No $0.00 0 Planning Fee.- $0.00 Select a Non-Residential Q 7n� c/ I><icv1111wo"lon Fiv.ti. Building or Structure 0 i Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.50 $380.00 TOTFEE: AL ; $381.50 Revised: 8/17/2010 , - IA t -- 4 4 2r� C3RD l IN0 COO HE CITY 3r VDINA —~ )ATE_ A- GN L D et of plans and s � pecih; ns t apt on the Icb at all tir l , andMU< J W \ "31tom kean 1 Chang or afteratio,, ame Wit Out wntterrl iuiiclin ermis>ion trop stamping �artmert, City of Cupert ; P 9 his Plan ands 1ALL NOT e het(: Pecdicatr oval of t�'perm or to be viol ttfnn of any Pmvrs�o � pf an C of ;.a.e I_aov. ------------------ BY- Cl, -� (� W LA et 1151 tN ACC()HDAN,' CUPERTINOi ✓17r irif (,y TY Vd GODE;;AN DATE {;F1DiNANt C SIGNED set of plan a J, tse kept on the job at tic,is lawful t ries and o make an n carne without Y c g `or alter, t' B.,ildin written p mission.tr:�rr,` st;�rn ping Department Ci ;f Cu p rhj of this F�fan an rt' NOT b+a helri SPeci icafions �r n of the sol=t� perr t., he an r;rty Vii,, y .•r<,VISri1nR _ c . o VA 1 :. . Isz. Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: Q Y0( PERMIT# 62 OWNER'S NAME: L PHONE# - GENERAL CONTRACTOR: AL BUSINESS ICENSE # ADDRESS: CITY/ZIPCODE: Ole q 5112 "Our municipal code requires all businesses working in the city to have a City of Cupertino siness license. NO BUILDING FINAL OR FINAL OCCUPANCY INSP CTION(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: ,�"'-' 4 /? 0 Signature Date Please check applicable subcontractors an c mplete the following information: SUBCONTRACTOR BUSINESS Nj,ME 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