14120073�l
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10558 STERLING BLVD
CONTRACTOR: PAB CONSTRUCTION
PERMIT NO: 14120073
INC
OWNER'S NAME: JALILI MOHSEN H ET AL
21060 HOMESTEAD RD STE 216
DATE ISSUED: 06/17/2015
OWNER'S PHONE: 4084996595
CUPERTINO, CA 95014
PHONE NO:
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
CONSTRUCT TWO STORY RESIDENCE (2435 SQ FT);
License Class Lic. # ��
ATTACHED GARAGE (444 SQ FT); COVERED PORCHES
Contractor l� G ,S NC ate 0 g
(278
SQ FT).
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: $500000
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
permit is issued.
APN Number: 37523030.00
Occupancy Type:
APPLICANT CERTIFICA"T"ION
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 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 LA LLED 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
by: Date: G r
granting of this permit. Additionally, the applicant understands and will complyed
with all non -point source r ula io per the Cupertino Municipal Code, Sec
9.18.
Signature_ Date 1
RE -ROOFS:
All roofs shall be inspec 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.
13OVVIY R -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,
wil I do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
1, 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 1 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 Cupe in nicipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 255 , 2, 3 , d 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized
Date: 0 4'Apermit 5
is issued.
agent: ,
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
Lender's Address
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 relztina
to bailding construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
ARCHITECT'S DECLARATION
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
/ 75
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 • FAX (408) 777 -3333 ^ building(Dcupertino.orq
,CC U P E RT I PI O �^-� r--�
I lAL.1.iL'\zr rnmc!TDT IrTTnNl I I AT)ri1TTnN 1 I At TPV ATIf1N l TI F-1 RFVTQTnN / TIFFFRRFT) OR1GTNAI. PF.RMlT#
PROJECF ADDRESS 0 �� C1 �" q ��1 .n(a
Blvd
APN f! q _7 2 6- ? - G3 0)
JP�ii�
OWNER NAME ]iv" ``!S i✓ l� (�v0�, PHO q - 6c.1
E-MAIL
STREET ADDRESS
5 � Q r. ^ Ave CIN ATE, ;1 i
n) �
FAX
`Q f , ` �� J
CONTACT NAME M O f 1 PHONE 1 Cs �_I q _6� l
��/�
E-MAIL
Po' � u nS 1'0 C C�' ►. �
STREET ADDRES /{[SD
1
��
CITY STATE, ZIP ;
FAX
@� ��
re
❑ OAINER ❑ OWNER-BUILDER ❑ OMWERAGENTT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER
❑ DEVELOPER� ❑ TENANT
CONTRACTOR NAME A / ` LICENSE NUMBER LICENSE TYPE
BUS. LIC 9
C , f
C( 7 n Q RD5,S 7
COMPANY NAME Q�n
�+
E -MAIL p0.� Cep) J II f%c /G{ C`� 1,C•FM
1. ll
-7 Q
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STREET ADDRESSA 1
CITY, STATE.
PHONE
l �C
U ��l e
ARCHITECTIENGINEER NAME LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E -MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
-PHONE
DESCRIPTION OF WORK Ne W N.A)'k �Q `.. 6 yn /_j ^ a,d
37
EXISTING USE PROPOSED USE C(1NSTI�E
N STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION (S)
G NEW FLOOR
AREA `Q� a AREA 4/d
EMO
DREA `QQ O TOTAL NET AREA
BATHROOM
REMODEL AREA
KITCHEN
REMODEL AREA
OTHER
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECKIPORCH AREA
GARAGE A: CIDETACH
tit /p
[]ATTACH
d DWELLING UNITS:
IS A SECOND UNIT El YES
7 SECOND STORY ❑YES
BEING ADDED? Rrv0
ADDITION? .2190
PRE - APPLICATION r, 'ES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
`RECEIVE Y a 't- t?
.'� -f4•.:
s
TOT VALUATION:
PLANNING APPLE O PL.41.^lA1G APPROVAL LETTER
EICHLER HOME? �'iJ0
r'+: L5.r3
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have pr vid il correct. I have read the Description of Work and verify it is i ccurate. I agree to comply with all applicable local
ordinances and state laws relating to bui in.- t ti n. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant Agent: Date:
SUPPLEMENTA bRff4AfioN REQUIRED
,=PI:AN,CHk.CKT]'F'E � .;.�
+ •."Y"`:Ti'`:-_�, � �ROUTII�GSL',1P �,�� -
New SFD or Multifamily dwellings: Apply for demolition permit for
r rr
OVER THE-COUI\TER'`r
x r fi x tµ ;I�-
HUILDIl\G PLA \ RE] LEW
existing building(s). Demolition permit is required prior to issuance of building
>'' a
a Y
r3`Jy} L'+
permit for new building.EYPRESS
<m`th
sfq; r r
r-'F 1. 1 4
PLAn17�G PLAT REVIEW* t
_Commercial Bldas: Provide a completed Hazardous Materials Disclosure
T
sTAI\DARD "" 3X7 I I
r
s PUBilewoRKS g {
h
form if any Hazardous Materials are being used as part of this project,
LA�2GEi�c ° r
t
tti
i�� i t �`
FFI2CDEPT .A�. fLr �1 � i;
_ Copy of Planning Approval Letter or Meeting with Planning prior to
t 3
MAIOR 7e
r
SATITARX;SE \ \ERDISTWCTt'
submittal of Building Permit application.
F g .
BldgApp_2011.doc revised 06121111
.Cep
I t;l 5
�� �C��'ZY OF CUP E]18TINO
It %�`' %r� FEE lESTMATOR - BUILDING DIVISION
OCCUPANCY TYPE:
ADDRESS: 10558 Sterling Blvd
DATE: 12/15/2014
REVIEWED BY: Sean
r
APN:
BP #.
*VALUATION: 1$500,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: New Construction
PRIMARY SFD or Duplex
USE:
2nd Unit? ° Yes No
PENTAMATION 1 R3SFDW
PERMIT TYPE: A
IR3INSP
Const ruct two stor residence 2435 s ft ; Attached ara e 437 s ft • Covered Porches 186 s ft .
�7OR
Suppl. Insp. Fee:(D Reg. Q OT
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FL.R AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
R -3 (Custom)
II- B,111- B,IV,V -B
3,058
$3,087.66
1R3PLNCK
$3,059.78
IR3INSP
Permit Fee:
$3,059.78
Suppl. Insp. Fee:(D Reg. Q OT
Q Q
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax: IBCONSTAXR
�
#new
units
$667.73
0
0
Work Without Permit? (0 Yes (2) No
$0.00
TOTALS:
3,058
$3,087.66
$3,059.78
Strom Motion Fee: IBSEISMICR
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the nreliminary information available and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11 -053 Eff 711113)
FEE
111:r11;h. 1'1no ( ho('h
1. .. Flan Check
Plan Check Fee:
1'(11 -1. Purtril Fcv
lao-[, Nnuir PC(.:
17
!)rhv,' )'!OM /) lh.V1).
Other Elec. In sr).
$0.00
P!' u1h. 117.,'1:. Fe'..
PIE(. Insp. !,'e:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the nreliminary information available and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11 -053 Eff 711113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$3,087.66
Select a Misc Bldg /Structure
or Element of a Building
Suppl. PC Fee: D Reg. 0 OT
Q,Q
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$3,059.78
Suppl. Insp. Fee:(D Reg. Q OT
Q Q
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax: IBCONSTAXR
�
#new
units
$667.73
0
0
Work Without Permit? (0 Yes (2) No
$0.00
Advanced Planning Fee: IPLLONGR
$428.12
Select a Non - Residential 0
Building or Structure
Strom Motion Fee: IBSEISMICR
$65.00
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$20.00
SUBTOTALS:
$7,328.29
$0.00
TOTAL FEE:
$7,328.29
ised : 10/01/2014
projet tussle:
Project Address:
Project Descripti
SECTION 'I
New Ouston
90555 Stedi
SFR
(� [No7�3
SIGNATURE DECLARATIONS
VERIFICATION
Complete all lines of Section 1= °Design Verification° and submit the completed checklist (Columns 1 and 2) with the
plans and building permit application to the Building Department.
The owner and design professional responsible for compliance with CalGreen Standards have revised the plans and
certify that the items checked above are hereby incorporated Into the project plans and will be implemented Into the
project in accordance with the requirements set forth in the 2013 California Green Building Standards Code as
adopted by the City of (pen §. ,, _
Ownees Signature Date
Cmsfs Name (Please Print)
Design Professional's Signature Date
Design Pro% ' nal's Name {Please Print)
1210412414
Signature of License Professional responsible for CalGreen compliance Date
Eric Kirk 408 -8013 -9901
Name of license Professional responsible for CalGreen compliance (Please Print) Phone
Emnil Address for License Professional responsible for CalGreen compliance
2 ® IMPLEMENTATION VERIFICATION
Complete, sign and submit the competed checklist, including column 3, together with all original signatures on Section
2 to the Building Department prior to Building Department final inspection.
t have Inspected the work and have received sufficient documentation to verity and certify that the project identified
above was constructed in accordance with this Green Building Checklist and in accordance with the requirements of
the 2013 Callomle Green Building Standards Code as adopted by the City of Cupertino.
pC oC� C
Signature of License Professional responsible for CalGreen compliance Date
6�-,�6( —F pb
Warne of License Professional responsible for Calereen oornpliance (Please Print) Phone
Page 3 of 5 CalGreen 2014.doe revised 01115114
k
CUPERTINO
n �rc�v nn�TCroT tnrTnwi
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 a FAX (408) 777 -3333 ^ building aDcupertino.org
F7 AnnrrrnKT n ATTT- RATTnN /TT n RFVTCT0N /TIFFFRRFT)
PROJECT ADDRESS �L J yq e APN !!
OWNER NAME Aq V\ � I
`
t
PH D J CE q - &5 /p �1
j J
E-MAIL J\CT l�• QV�i
STREET ADDRESS
CITY, STATE, ZIP FAX
CONTACT NAME 1-4\0 i� PHONE IJ (to � B1Pa 6�G�Q
(j �J �(i J
E -MAIL SC y] P
STREET ADDRESS
CITY, STATE, ZIP
FAX
13 OWNER ❑ OWNER - BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTORNAME LICENSE NUMBER LICENSETYPE
BUS. LIC0
COMPANY NAME
E -MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. L1C H
COMPANY NAME
E -MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK i W v D �D C_
EXISTING USE
PROPOSED USE
CONSTR. TYPE
B STORIES
USE
TYPE
OCC.
SQ.F'T.
VALUATION (S)
EXISTG NEW FLOOR
DEMO
TOTAL
AREA AREA
AREA
NET AREA
/ a e'/
lY �' �/
BATHROOM
KITCHEN - OTHER
REMODEL AREA
REMODEL AREA REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK /PORCH AREA
GARAGE AREA: DETACH
ATTACH
9 DWELLING UNITS:
IS A SECOND UNIT El YES
SECONDSTORY ❑YES
BEING ADDED? F]NO
ADDITION! ENO
PRE - APPLICATION ❑YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
ED wr
%' We
, ,
TOTAL VALUATION:
PLAN."GAPLK [:]NO PLANNING AROVAL LETTER
EICHLER HOME? ❑NO
�TI"Vr
1 ;n'& kM`T't��. wr 5Y'�+�..n
�.d`'_� i7•.d' �+z.. `�wak�_
By my signature below, I certify to eac of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I ha, rov' a is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to Idi c ns ction. I authorize representatives of Cupertino to enter the above - identified property for inspection purposes.
Signature of Applicant/Agent: Date: 2 ,
SUPPLEMEN (INFO ION REQUIRED
Q
RO61: SLIP . ..:., .;
New SFD or Multifamily ellings: Apply for demolition permit for
��OVER�TH><COUNTER
�aBTJ�TLbLr
o
existing building(s). Demolition permit is required prior to issuance of building
I rye
f - _
GP)ANRE \VIEW 5}
permit for new building.
'„� { 3'L i..
❑ EaPRESSy r �%
.
'`
J._..F'a it-
�1 PL.ANNINGPLAN RE NI
YIEIi'.
Commercial Bldgs: Provide Hazardous Materials Disclosure
'T r ���,�,
.xr��y,3��"."r°.'�'."
'8`4S'E'UR
� s� r�'
_ a completed
form if any Hazardous Materials are being used as art of this ro ect.
P
Ai{D �
j"t"
PUHI zc�� RKS r .
� i.
P
_Copy of Planning Approval Letter or Meeting with Planning prior to
'
submittal of Building Permit application.
?�JOJ, �' ' x
S� +SxA�`TAxYSEVtERnrSTJUCr £t?:
'IN, �`X*'��;$��'y' f��
BldgApp_201 1. doc revised 06121111
CC-
V-0 CffTY OF �CUPERTINO
IFEIE IES'I'MATOR — BUILDING DIVISION
. •
ADDRESS: 10558 sterling blvd
DA'R'E: 02118/2015
REVIEWED BY: Mendez
PC FEE ID
APN:
BP #:
'VALUATION: $100,000
*PERIY[i IT TYPE: Building Permit
PLAN CHECK TYPE: New Construction
PWMARY
USE: SFD or Duplex
2nd Unit? Yes (� No
PENTANIATION
PERMIT TYPE: 1R3SFD21VD
WORK
construct attached lower level in law unit 622 sq ft
SCOPE
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.t
PC FEES
PC FEE ID
BP FEES
BP FEE ID
R -3 (Custom)
II- B,111- B,IV,V -B
622
$2,654.00
IR3PLNCK
$1,666.00
/R31NSP
PME Plan Check:
$0.00
Permit Fee:
$1,666.00
Suppl. Insp. Fee:Q Reg. COT 0 0 hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax: IBCONSTAXR
1
TOTALS:
622
$2,654.00
$1,666.00
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District. eta). These fees are based on the Dreliminary information available and are only an estimate Contact the Dent for addn'l info.
FEE 11TEMS (Fee Resolution 11 -053 E . 711113)
1 fcclr, Phut Check
Planrh. Plon Check
Elec. Plan. Check
aleeh. Perwrit i"Ce:
P11m11. Permil Fee:
Mire. Permit Fee:
(7rlrcr' aUcch. trap.
Other Phrmh Insp.
Other Glec. lnsp.
1- leclr. /n.yr. Fee:
Plunth. Insp. Fee:
Llec. Insp. Fee:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District. eta). These fees are based on the Dreliminary information available and are only an estimate Contact the Dent for addn'l info.
FEE 11TEMS (Fee Resolution 11 -053 E . 711113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,654.00
= s.f.
$0.00
Remodel, Other
1REMRESOTH
Suppl. PC Fee: E) Reg. () OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$1,666.00
Suppl. Insp. Fee:Q Reg. COT 0 0 hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax: IBCONSTAXR
1
# new
units
$670.76
Achnuti�trative Fee:
Work Without Permit? O Yes E) No
$0.00
Advanced Planning Fee: 1PLLONGR
$87.08
Select a Non - Residential
Building or Structure
0
i
71 uvel Doc ulne Ovation Fees:
Strong Motion Fee: IBSEISMICR
$13.00
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$4.00
SUBTOTALS:
$5,094.84
$0.00
TOTAL. FEE:
1 $5,094.84
Revised: 02/14/2015
luNINE,
OO
CON7RA OR / SUBCON7TRACT®R US7
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014 -3255
Telephone: 408 - 777 -3228
Fax: 408-777-3333
JOB ADDRESS: \ L
e'( V n
PERMIT #
OWNER'S NAME: M0, SP
'�a„," t'
PHONE # Z4 04 — Iq q Q_,6 gg S
GENERAL CONTRACTOR: Q
Ca0 0v C't e ')
BUSINESS LICENSE #
ADDRESS: �e
k r A Cv P e �` �;m
CITY /ZIPCODE: q 5 04 94
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING (FINAL OR (FILIAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITE' OF CUPlERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signature Date
Fiease check applicable subcontractors and complete the following information:
d
ftG f.
Vner Wontractor Signature
Q 2,1 e- 1-E
(Date
57
SUBCONTRACTOR CONTRACTOR
]I USINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
s ; C��. S �v C t,
Cement Finishing
Electrical
$ S C' le C' 'Y' C
Excavation
"00c"T> e 1 Co °inS vCit, C r)
Fencing
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating
jVC CC. k \ e
Insulation
Landscaping
Lathing
-
Masonry
V` Ccv'st 0C�;c
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
/✓I
Sheet Metal
Sheet Rock
Tile
ftG f.
Vner Wontractor Signature
Q 2,1 e- 1-E
(Date
57