B-2016-1854 CITY OF C UPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1854
10885 MIRAMONTE RDI(356 01 036) NEWHOME
CONSTRUCTION
CORPORATION
FREMONT,CA 94539
OWNER'S NAME: DATE ISSUED:06/19/2017
OWNER'S PHONE: PHONE NO:(408)421-9808
-1
LICENSED CONTRACTORS DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#832709
Contractor NEWHOME CONSTRUCTION CORPORATION Date 11/30/2020 X BLDG —ELECT —PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH X RESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
CONSTRUCT 2 STORY SFD(5,799 S.F.)WITH ATTACHED GARAGE
I hereby affirm under penalty of perjury one of the following two declarations: (628 S.F.)
1. I have and will maintain a certificate of consent to self-insure for Worker's REV#1 -RELOCATING RETAINING WALL(25 FT).-ISSUE 6-20-2019
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
permit is issued. Sq.Ft Floor Area:6427 Valuation:$900000.00
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 R-3(Custom),R-3(Custom),U(Private Gar/Ag Bidg),U
representatives of this city to enter upon the above mentioned property for (Private Gar/Ag Bldg)
inspection purposes. (We)agree to save indemnify and keep harmless the
City of Cupertino against liabilities,judgments,costs,and expenses which
may accrue against said City in consequence of the granting of this permit. PERMIT EXPIRES IF WORK IS NOT STARTED
Additionally,the applicant understands and will comply with all non-point WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source regulations per Municipal Code,Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 6-20-2019
Issued by:Kim Dunbar
OWNER-BUILDER DECLARATION Date:06/19/2017
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons: RE-ROOFS:
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
compensation,will do the work,and the structure is not intended or offered for installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
sale(Sec.7044,Business&Professions Code)
2. I,as owner of the property,am exclusively contracting with licensed
contractors to construct the project(Sec.7044,Business&Professions Code). Signature of Applicant:
Date:6-20-2019
I hereby affirm under penalty of perjury one of the following three declarations:
1. I have and will maintain a Certificate of Consent to self-insure for Worker's ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
2. I have and will maintain Worker's Compensation Insurance,-as provided for by HAZARDOUS MATERIALS DISCLOSURE
Section 3700 of the Labor Code,for the performance of the work for which this I have read the hazardous materials requirements under Chapter 6.95 of the
permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will
3. I certify that in the performance of the work for which this permit is issued'I maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
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
Worker's Compensation laws of California. If,amaterial. Additionally,should I use equipment or devices which emit hazardous
after making this certificate of air contaminants as defined by the Bay
and 25534.
be deemed revoked.
APPLICANT CERTIFICATION Owner or authorized agent:
I certify that I have read this application and state that the above information is Date: 6-20-2019
correct. I agree to comply with all city and county ordinances and state laws CONSTRUCTION LENDING AGENCY
relating to building construction,and hereby authorize representatives of this city I hereby affirm that there is a construction lending agency for the performance
to enter upon the above mentioned property for inspection purposes. (We)agree of works for which this permit is issued(Sec.3097,Civ C.)
to save indemnify and keep harmless the City of Cupertino against liabilities, Lenders Name
judgments,costs,and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally,the applicant understands Lender's Address
and will comply with all non-point source regulations per the Cupertino Municipal
Code,Section 9.18. ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Signature Date 6-20-2019 Licensed
•
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1854
10885 MIRAMONTE RDI(356 01 036) NEWHOME
CONSTRUCTION
FREMONT,CA 94539
OWNER'S NAME: ZOMORRODI KAMBIZ AND KHORSHIDIAN SIMA DATE ISSUED:06/19/2017
OWNER'S PHONE: PHONE NO:(408)421-9808
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#832709
Contractor NEWHOME CONSTRUCTION Date 02/28/2018 X BLDG _ELECT _PLUMB
MECH X RESIDENTIAL_COMMERCIAL
I hereby affirm that lam 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: •
CONSTRUCT 2 STORY SFD(5,799 S.F.)WITH ATTACHED GARAGE
I hereby affirm under penalty of perjury one of the following two declarations: (628 S.F.)
a. 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.
2. 1 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:6427 Valuation:$900000.00
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 APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize
OP i 0 3� Deferred Submittal(R-3),R-3(Custom),R-3(Custom),U
representatives of this city to enter upon the above mentioned property for ✓s (Private Gar/Ag Bldg),U(Private Gar/Ag Bldg)
inspection purposes. (We).agree to save indemnify and keep harmless the
City of Cupertino against liabilities,judgments,costs,and expenses which
may accrue against said City.in consequence of the granting of this permit. PERMIT EXPIRES IF WORK IS NOT STARTED
Additionally,the applicant understands and will comply with all non-point WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source regulations per the Cupertino Municipal Code,Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION. .
Signals Date 10-23-2017
Issued by:Kim Dunbar •
OW R-BUILDER LARATION Date:06/19/2017
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons: ! • RE-ROOFS:
a. I,as owner of the property,or my employees with wages as their sole All roofs shall be inspected prior to any roofing material being installed.If a roof is
compensation,-willi do the work,and the structure is not intended or offered for installed without first obtaining an inspection,I agree to remove all new materials for
sale(Sec.7044,Business&Professions Code) inspection.
2. I,as owner of the property,am exclusively contracting with licensed
Signature of
contractors to construct the project(Sec.7044,Business&Professions Code). Si� Applicant:
Date: 10-23-2017
I hereby affirm under penalty of perjury one of the following three declarations:
1. I have and will maintain a Certificate of Consent to self-insure for Worker's ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
2. I have and will maintain Worker's Compensation Insurance,as provided for by HAZARDOUS MATERIALS DISCLOSURE
Section 3700 of the Labor Code,for the performance of the work for which this I have read the hazardous materials requirements under Chapter 6.95 of the
permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will
3. I certify that in the performance of the work for which this permit is issued,I maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
shall not employ any person in any manner so as to become subject to the Health&Safety Code,Section 25532(a)should I store or handle hazardous
material. Additionally,should I use equipment or devices which emit hazardous
Worker's Compensation laws of California. If,after making this certificate of air contaminants as defined by the Bay Area Air Quality Management District I
exemption,I become subject to the Worker's Compensation provisions of the will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
Labor Code,I must forthwith comply with such-provisions or this permit shall the Health&Safety Code,Sec7s025533,and 25534.
be deemed revoked.
APPLICANT CERTIFICATION Owner or authorized ages
I certify that I have read this application and state that the above information is Date: 10-23-2017
correct.I agree to comply with all city and county ordinances and state laws CONS UCTION LENDING AGENCY
relating to building construction,and hereby authorize representatives of this city I hereby affirm that there is a constructiori lending agency for the performance
to enter upon the above mentioned property for inspection purposes. (We)agree of work's for which this permit is issued(Sec.3097,Civ C.)
to save indemnify and keep,harmless the City of Cupertino against liabilities, Lender's Name
judgments,costs,and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally,the applicant understands Lender's Address
and will comply with all non-point source regulations per the Cupertino Municipal •
Code;Section 9.18. ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Signature Date 10-23-2017 Licensed
Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1854
10885 MIRAMONTE RD1(356 01 036) ATHK
CONSTRUCTION INC
MILPITAS,CA 95035
OWNER'S NAME: ZOMORRODI KAMBIZ AND KHORSHIDIAN SIMA DATE ISSUED:06/19/2017
OWNER'S PHONE: PHONE NO:(408)569-5890
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class a Lic.#941248
Contractor ATHK CONSTRUCTION INC Date 12/31/2017 X BLDG _ELECT _PLUMB
MECH X RESIDENTIAL 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:
CONSTRUCT 2 STORY SFD(5,799 S.F.)WITH ATTACHED GARAGE
I hereby affirm under penalty of perjury one of the following two declarations: (628 S.F.)
t., I have and will maintain a certificate of consent to self-insure for Worker's
I.j Compensation,as provided for by Section 3700 of the Labor Code,for the
X performance of the work for which this permit is issued.
z. 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. Sq.Ft Floor Area:6427 Valuation:$900000.00
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 APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize n Deferred Submittal(R-3),R-3(Custom),R-3(Custom),U
representatives of this city to enter upon the above mentioned property for i!p Q' QA (Private Gar/Ag Bldg),U(Private Gar/Ag Bldg)
inspection purposes. (We)agree to save indemnify and keep harmless the
City of Cupertino against liabilities,judgments,costs,and expenses which
may accrue against said City in consequence of the granting of this permit. PERMIT EXPIRES IF WORK IS NOT STARTED
Additionally,the a.•licant understands and will comply with all non-point WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source regulatio - .er the Cupertino Municip. 'ode,Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature ',
/ Issued by:Kim Dunbar
OWNER-BUR D
ILDEECLARATION Date:06/19/2017
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons: RE-ROOFS;
1. I,as owner of the property,or my employees with wages as their sole All roofs shall be inspected prior to any roofing material being installed.If a roof is
compensation,will do the work,and the structure is not intended or offered for installed without first obtaining an inspection,I agree to remove all new materials for
sale(Sec.7044,Business&Professions Code) inspection.
2. I,as owner of the property,am exclusively contracting with licensed
contractors to construct the project(Sec.7044,Business&Professions Code). Signature of Applicant:
Date:06-19-2017
I hereby affirm under penalty of perjury one of the following three declarations:
1. I have and will maintain a Certificate of Consent to self-insure for Worker's ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
2. I have and will maintain Worker's Compensation Insurance,as provided for by HAZARDOUS MATERIALS DISCLOSURE
Section 3700 of the Labor Code,for the performance of the work for which this I have read the hazardous materials requirements under Chapter 6.95 of the
permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will
3. I certify that in the performance of the work for which this permit is issued,I maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
shall not employ any person in any manner so as to become subject to the Health&Safety Code,Section 25532(a)should I store or handle hazardous
material. Additionally,should I use equipment or devices which emit hazardous
Worker's Compensation laws of California. If,after making this certificate of air contaminants as defined by the Bay Area Air Quality Management District I
exemption,I become subject to the Worker's Compensation provisions of the will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
Labor Code,I must forthwith comply with such provisions or this permit shall the Health&Safety Code,Sections 25505,25533,and 25534.
be deemed revoked.
APPLICANT CERTIFICATION Owner or authorized agent:
I certify that I have read this application and state that the above information is Date:06-19-2017
correct.I agree to comply with all city and county ordinances and state laws CONSTRUCTION LENDING AGENCY
relating to building construction,and hereby authorize representatives of this city I hereby affirm that there is a construction lending agency for the performance
to enter upon the above mentioned property for inspection purposes. (We)agree of work's for which this permit is issued(Sec.3097,Civ C.)
to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Name
judgments,costs,and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally,the applicant understands Lender's Address
and will comply with all non-point source regulations per the Cupertino Municipal
Code,Section 9.18. ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Signature Date 06-19-2017 Licensed
Professional