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09030209 - PUB/ t r AN2A ow 60000 /V , T,,,4a JIAFbt SYSA07 khq yy�� 'ile Edit Actions Details Links favorites Help t ur X It Ilkem c� • Permit Information Permit Number ' 09 020 9 ' Status' i C - CIS osed — *� Master Number _ Notes Project - Location Information Address x 10625 N DE ANZA BLVD City/State/Zip ICUPERTINO CA i 95014 _ ---� L� ---- 2 APN 132610028.00 - l' Unit Lol -� Apply Date ` 03/26/2009 Operator patg Permit Issue Date 07/13/2009 Operator SylviaM - Certificate Issued 08/13/2009 Operator PALM Certificate Type Certificate Number Permit' ; Property 1; Zoning Applicant j' Contractor' 1; Defined Fields Permit Details Permit Type 11GENCOM COMMERCIAL GENERAL BUILDING Usage Class II/III B,� II/III 8, IV -HT V-B NEW Applied Value ` _ 10000 SQUARE FT. 0 Calculated Value_ -, 0 US C-404 Type 437 ALT: NON-RES, NON-HSKPG Permit Form' (AUTOPERM - PERMIT Ownership 1 - Private Project Size STANDARD - STANDARD 'ermit issued 07113J2009 Inter the purpose or any special conditions for this permit Ok,vner Entity Information Qwner Name' !HABIB KHAYYAT Use Default Address Home -10625 N DE ANZA BLVD City/State/Zip CUPERTINO CA 95014 V Purpose/Special Conditions -- - - INSTALL EVR PHASE II VEEDER ROOT VAPOR SYSTEM iFILMED-2011 al Add D efault T V i %/0 0 K Back lv�.r Contractors 1 r Pees 1 �a Plan Reviews la I nspections Print Permit Adjustments l [f�r Holds [" Copy Permit 10 Close PermitIML 1 Overrides Supplemental Fields , 10, Attachments CITY OF CUPERTINO BUILDING DIVISION PERNET BUILDING ADDRESS: 10625 N DE ANZA PERMII NO. OW NER's NAME: PERMIT ISSUE DATE CONTROL NO. ARCHrIECr/ENGINEER: BUILDING PERMIT INFO INSTALL EVR PHASE II VEEDER BLDG ELECT PLUMB MECH o 0 0 O LICENSED CONTRACTOR'S DECLARATION ROOT VAPOR SYSTEM Job Description P I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code. and my license is in full force and effect. ("1Q A� �2 License Class Lk:. R �3 `1' Date Contractor } ~ RCHITECTS DECk N I understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractors License Law for the following mason. (Section 7(131.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance. also requires the applicant for such permit to rile a signed statement that he is licensed pursuant to the provisions of the Conuactor's License Law (Chapter 9 Sq. Ft. Floor Area Valuation (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of APN Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (S500). ❑ I. as owner of the property. or my employers with wages as their sole compensation, Required Inspections will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code_ The Contractors License Law does not apply to an owner of property who builds or improve thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale If, - however, the building or improvement is sold within one year of completion, the owner - builder will have the burden of proving that he did not build or Improve for purpose of sale.). ❑ L as owner of the property, sum exclusively contracting with licensed contractors to construct the pmject (Sec 7044. Business and Professions Code:) The Contractor's L.i- eense Law does not apply to an owner of property who builds or improves theeon, and. who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law. ❑ I am exempt under Sec , B & P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I hove and will malnWn a Certificate of Consent to self-imum for Workers Compen- sation. 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 Workers Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is Issued ' My Worker's Compensation Insurance carrier and Policy number are: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS - COMPENSATION INSURANCE (This section rased not be compieted if the permit is forone hundred dollars ($100) or Irss) I certify that in the performance of the work for which this permit is issued. I shall not employ any person m any in so as to become subject to the Workers' Compensation Laws of Cslifomia. Date Applicant -y �=r NOTICE TO APPLICART. If, after making this Certificate of Exemption, you should become subject to the Workers Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be decreed revoked CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) Lenders Name Lender's Address I certify that I have mad this application and state that the shove information is correct. I agree to comply with all city and county ordinance and state laws relating to building construction, and hereby authorise representatives of this city to =ter upon the above -mentioned property for inspection purposes (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, Judgments, coats and expenses which may in any way accrue against said City in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT SOUR—�TION'S. f q S ature of Appliant/Conuactor Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hriardous material as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Code, Section 25532(a)7 ❑ Yes ,.QNo Will the applicant or future building occupant use equipment or devices which mit hazardous air contaminants as defined by the Bay Area Air Quality Management iauict7 ❑ Yes dlVu 1 have read the ha7ardousus materials requirements under Chapter 6.95 of the Califor- Icalth & Safety Code, Sections 255W. 25533 and 25534. I understand that if the building not currently have a tenant. that it is my responsibility to notify the occupant of the tmens which must be met prior to issuance of a Cenifiate of Occupancy. - 1 %y 09 br na authord aecnl Date Issued by: Re -roofs Type of Roof Date 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 " ' or better V� f CITY OF CUPEkTINO CITY OF CUPERTINO GENERAL BUILDING PERMIT APPLICATION FORM ogo3ozo� APN # Date: Building Address: Gum 2T� O C AP> "O SfAC,6jVQ0S 1 O G25 W . e; k,4ZA lbd ej�'- Mailing Address (if different from building address): 'Z-l'ME� — Owner's Name: j �,AB` gAY��T. Phone #: CS '772 HOA: (Exterior work only) Yes ❑ No ❑ If yes, provide letter from HOA Contractor: ? w t J AC-05 Fu :- C-o M V k r P P C>E,- Phone:-Aag - 7 0 G- q 840 S154RV t C£=n1C • Fax: Contractor License #: Cupertino Business License #: Contact: A fJ E L ,� � � Phone: sdfpg - fro ._ q SA 0 Fax: Residential ❑ Commercial Job Description: 67%ip. WASE ,M V� Building Permit Info: / Bldg ElElect ElPlumb Q" Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ IUIII B, IV -HT, V-B Valuation: Square Footage: 1©t o00 . a a Project Size: Express g;---Standard ❑ Large ❑ Major ❑ Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it to the application or if applicable, include in plan set & the sheet index. Points Achieved: For help, contact Build it Green at www.builditgreen.org Revised 02/05/09