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15110166CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10400 FARALLONE DR CONTRACTOR: JM CONSTRUCTION PERMIT NO: 15110166 OWNER'S NAME: HUSSAIN JAVED AND SHAKILA r jt' 562 DIVISION ST DATE ISSUED: 11/23/2015 OWNER'S PHONE: 4087250290 CAMPBELL, CA 95008 PHONE NO: (408)379-9852 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ eg r License REPAIR DAMAGE TO GARAGE WALL FROM CAR (LIKE Class 1 Lic. # FOR � l Contractor J M IO5-fil&tu rhdd Date )-3 LIKE). 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. 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 Sq. Ft Floor Area: Valuation: $1500 rformance of the work for which this permit is issued. i ve and will maintain Worker's Compensation Insurance, as provided for by e ion 3700 of the Labor Code, for the performance of the work for which this APN Number: 36929013.00 Occupancy Type: e it is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws,relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the �� JG Issued by: lll"'!!! �`7 �l Date: granting of this permit. Additionally a applicant understands and will comply ; with all non -point source regulationr t e uperti Municipal Co e, Section 9.18. �3 /� RE -ROOFS: Signature ate G 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. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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) I, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal de, Chapter 9.12 and the Health & Safety Code, Sections d 2-34. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the of the work for which this 10y5,,2533 �(\ �( 3 performance 14 caner or authorized agent: Date: 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 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date CUPERTINO CONSTRUCTION PERMIT APPLICATION COV )IUNI T `( DEVELOPKIIENT DEPARTMENT • BUILDING DIVISION 10300 T ORRE AVENUE • CUPERTINO, CA 95014-3255 ) (408) 777-3228 - FAX (408) 777-3333 • buildino(ccuDe1 tino.ora / f l 0 f 4j ❑ NEW CONSTRUCTION ❑ ADDITION . 5['.LTERATI0N / TI ❑ REVISION / DEFERRED ORIGINAL PER_MTT PROTiCf hDDPESS M ^A „ A f� PC I 43N n ! OWNER NAIL V Cb 5574/) ow I PHONE. 0) - 7a� O* E-?✓4IL S 1 r'EET AEDDRSS /�01 i5t I ON CITY, STATE, ZIP -95-01 I FAX CO?v TACT NAME v� ✓ , i I PriOhi `� J S 1 REE-1 ADDRESS B 6 1 v iS10� � CITY, STATE, ZIP ^ , /rrPVAX 7lJ � 0WNER ❑. OV7vP,-BUIIDER ❑ 01WER.AGEN7 X CONT 4Ci0R ❑COITRkCTORAGTT ❑ ARCI,'Tr-,CT ❑ BNG12\7HER ❑ DEy=LOPER ❑ ENAh? CONTRACTOR NAS e"ADA ,,V T� LICENSENUA"ER 73166 I LICENSE TYPE ( I nUS.LIC2 C01✓3AIvY NAhz TM &� m6 I F-NA.IL -DAVC- w FAX STREET ADDRESS�� CI -i 1', STATE, ZIP �f // A �� I PriOI�E- R� v I %Q� l ARC"UTECTFENGD,yZER NAl✓,E I LICENSE Nuiv :tiER BUS. LIC m COMPANY NA a I E-1111 i, I F?.X STREET ADDRESS I CITY, STATE, ZIP I PHO1111r DESCRIPTION OF WORK 6A& pui uP EJISUNG USE PROPOSED USE CONSTR TYPE A STORIES i USE I TYPE I OCC. SQ.FT. VALUATION (S) .)a -TG NEW FLOOR DEh O TOTAL REA I AREA A= -A I MET AREA BATHROOM MUCFMN OTTER REMODELAREA. TREMODELAREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKTORCH ASEA GARAGE AREA: DST;,CH ❑ ATTACH I n DWELLING U1\7rS: IS A SECOND UNIT ❑ YES SECOND STORY ❑Y =S BEING ADDED? 0 N ADDITION? ONO PRE -APPLICATION ❑ ITS 11 YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES C I\�D ' �`.) TQgL VALUATION: PLANNING ADPL m ❑ NO PLAN?\'II\G APPROVAL LETTER EICHLER HOME? ❑ NO --.Y.._ By my signature below, I certify to each of the following: I am the pro rjy o\\-ner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct ve read ,.e Description of Work and veri-f it is accurate. I ?-gree to comply with all applicable local ordinances and state laws relating to b ' cin const cti . , thoriz represent?tip°es'of Cupertino to enter the above-/identifled property for inspection purposes, Signature of Applicant/Agent: Date: SUPPLEMENTAL I73FORMATION REQUIRED =�.�I1a ,cl LiPr •: ? OSER S1�COL-'ITER ,:� BUII.DL'�GPL3T� Rn�7L' iiT�- F - New SFD or Multifamily d wellin1;s: Apply for demolition ptrrnit Tor is existing building(s). Demolition permit required prior to issuance of building �2 -A -u� _> permit for new building. EXPF�S$ C PL4'�I�LGYLd� 1ZE�ZEFi < = 4 — Commercial Bldgs: Provide a corr?pleted Hazardous Materials Disclosure d r\Ddt pinv oRxs Lor -I if any Hazardous Materials are being used as ,raft of this project. = _ _ Copy of Planning Approval Letter or Meeting with Planning prior to t r T r �2-�SJTTi�iRYSEiin�ISTRICT x - ; submittal of Building Pe,—,nit application. NL4fOR 1 Bid.-ZPP_2011.doc revised 06121/11 Main Level, A-2��' on 54'3" COMI'0UNIY DEVELOPMaIT DEPARTMENT BUILDING DIVISION - CUEERT INO This set of plans and specifications MUST be kept at the io!_ du..['i g construction. It is unlawful to make any or alterations on same, or to deviate tl,a,rc. roni, without approval from the Building Official. Th.,- at aping of this plan and specifications SHALL NOT be, i y id to permit or to be an approHbfn-,&he violation of any provisions of any City Ordinance or State Law. E3Y DJ%TE o • � 3 =� PEIRIAT NO. r W;'Wr; � � 7 JAVED_ SSAIN-1G%,&---- i Garage 19' 3" �o N all RECEIVED BY Main Level 11/5/2015 Page: 8 0 3 5 7 JM CONSTRUCTION • 562 Division Street Campbell, CA 95008 Phone: 408-379-9852 FAX: 408-379-9857 General Contractor License #736056 JAVED_HUSSAIN 2 4 M 8 11/5/2015 4 Page: 1 CUPERTINO 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: —ot PERMIT # OWNER'S NAME: PHONE # -7 96-° 6X9 d GENERAL CONTRACTOR: &- s -hd1U BUSINESS LICENSE # ! ®7 3�6 S� ADDRESS: -j v 1 g I c rJ (S4- CITY/ZIPCODE: E i (4 5,66 � *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: 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