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B-2016-2369 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2369 10210 DANUBE DR CUPERTINO,CA 95014-2142(369 49 009) O RA CONST HOLLISTER,CA 95023 OWNER'S NAME: HAFEZI FARHAD AND JAHANSHAHI SHOLEH TRUSTEE DATE ISSUED:07/25/2016 OWNERIS PHONE:408-386-0498 PHONE NO:(408)592-1606 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class GENERAL BUILDING CONTRACTOR Lic.#785317 Contractor ORA CONST Date 10/31/2016 X BLDG —ELECT _PLUMB MECH XRESIDENTIAL COMMERCIAL 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. JOB DESCRIPTION: KITCHEN REMODEL(90 S.F.);BATHROOM REMODEL(115 S.F.) I hereby affirm under penalty of perjury one of the following two declarations: HALL BATH AND MASTER BEDROOM 1. 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 643.-performance of the work for which this permit is issued. 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. Sq.Ft Floor Area: Valuation:$30000.00 APPLICANT CERTIFICATION 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 APN Number: Occupancy Type: and state laws relating to building construction,and hereby authorize 369 49 009 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,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City inconsequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally,the applicant erstands and will comply with all non-point source regulatio r the eZrn Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. X K -Signature Date 7/25/2016 Issued by:AbbyAyende C Date:07/25/2016 OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for compensation,will do the work,and the structure is not intended or offered for inspection. sale(Sec.7044,Business&Professions Code) z. 1,as owner of the property,am exclusively contracting with licensed Signature ofApplicant: contractors to construct the project(Sec.7044,Business&Professions Code). Date:7/25/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER t. 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. HAZARDOUS MATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the s. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equipment or devices which emit hazardous air contaminants as define by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with t Cupertino Municipal Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety ode Sections 2NO5,25533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Ow r authorized 1k.t: APPLICANT CERTIFICATION ;Date:7/25/2016 1 certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct.I agree to comply with all city and county ordinances and state laws i hereby affirm that there is a construction lending agency for the performance relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.) to enter upon the above mentioned property for inspection purposes, (We)agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments,costs,and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATI40A Code,Section 9.18. I understand my plans shall be used as public records. Licensed Signature Date 7/25/2016 Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 � � (408)777-3228•FAX(408)777-3333•building ftupertino.ora & lC�.- 2j y ❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT PROJECT ADDRESS APN# �(`a `j/A Q 0 G OWNER NAME �1'"\ �•'�^L\ ��'`�Y`�U\ P� 't� LES-vIVIAIt L C"� �'Cy\S\ STREET ADDRESS @ A w CITY,STATE,ZIP FAX ` FA CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX ❑ OWNER-BUH,DER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT rCONTRACTORNAME,1�1 LICENSENUMBER LICENSETYPE BUS.LIC# NAME E-MAIL ®�� g Q _ STREET AD FESS CITY,STATE,ZIP ARCHITECTIENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK CL CNS bAo, VW45w 'leawmi CID 5A EXISTING USE - PROPOSED USE CONSTR.TYPE I #STORIES USE TYPE OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMO TOTAL •a® �� AREA AREA AREA NET AREA BATHROOM - KITCHEN OTHER - - - - REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: LIDETACH E]ATTACH #DWELLING UNITS: IS ASECOND UNIT ❑YES SECONDSTORY ❑YES BEINGADDED? ❑NO ADDITION? ❑NO PRE-APPLICATION ❑,YES IF YES,PROVIDE COPY OF IS THE BLDG AN E]YES RECD Eli 1'3Y; T TAL VALUATION: PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑.NO O i' `A By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the properly owner's behalf. I have read this application and the information I ha roved s 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 on tnrction.1l authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent:. Date: SUPPLEMENTAL INFORMATION REQUIRED ' LAiv,cxEcxTyP> .,. iEoi rii cgap _ C( New SFD or Multifamily dwellings: Apply for demolition permit for : czv R Ts olm xi i; © BUJLDHVG Pr.Art w existing building(s). Demolition permit is required prior to issuance of building X permit for new building. LI= Xrtzss, ❑x1etAIUNIIvpLaNzVrz vU r, _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure El PLIDIIC-WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE "FIRE DEPT Copy of Planning Approval Letter or Meeting with Planning prior to JVIAJOR � r� �',SANITARY SEYT�RDTSTRICT , submittal of Building Permit application. © .El1RFIRONMEN7 1 HEALT73 - BldgApp_201 Ldoe revised 06/21111