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11080070 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22510 STEVENS CREEK BLVD CONTRACTOR:FREY ENVIRONMENTAL PERMIT NO: 11080070 OWNER'S NAME: ABDOLLAHI MORTEZA AND FERESHTE 1336 BROMMER ST STE A6 DATE ISSUED: 12/10/2012 OWNER'S PHONE: 4085074467 SANTA CRUZ,CA 95062 PHONE NO:(831)464-1634 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# `'C 7 MECH r RESIDENTIAL r— COMMERCIAL Contractor lti's Date I hereby affirm that I I licensed under the provisions of Chapter 9 JOB DESCRIPTION:TEMP SOIL VAPOR EXTRACTION SYSTEM AND 499 (commencing with Section 7000)of Division 3 of the Business&Professions GALLON Code and that my license is in full force and effect. PROPANE TANK-RESTRIPE PARKING LOT,ADDING 8'SOLID PANEL FENCE ON SOUTHERN PROPERTY BOUNDARY. 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 performance of the work for which this permit is issued. 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: Valuation:$50000 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number:35701085.00 Occupancy Type: correct.1 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 indemnify and keep harmless the City of Cupertino against liabilities,judgments, PERMIT EXPIRES IF WORK IS NOT STARTED costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with a►1 non-point so stieps pe Cupertino Municipal Code,section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. Date Si nature l �i g ?110h2Issued by: Date: ❑ OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed.if a roof is 1,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,1 agree to remove all new materials for will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection. Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date: construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 1 have read the hazardous materials requirements under Chapter 6.95 of the 1 have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Safety Code,Section 25532(a)should I store or handle hazardous material. permit is issued. Additionally,should I use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534. become subject to the Worker's Compensation provisions of the Labor Code,I m ._ forthwith comply with such provisions or this permit shall be deemed revoked. r eft: j Date: �" W12— APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 1 certify that 1 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 I hereby affirm that there is a construction lending agency for the performance of work's to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.) upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the Lender's Address granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9.18. 1 understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 22510 Stevens Creek Blvd DATE: 08/16/2012 REVIEWED BY: Sean APN: BP#: 11080070 'VALUATION: Iso 'PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY SFD or Duplex PENTAMATION 1 RPGAS USE: PERMIT TYPE: WORK Add a 499 gallon propane tank. ' SCOPE 441� _ �Q APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Piping, Gas <=4 Outlets 1PGASRES 1 # $67 TOTALS: $67.00 Plumb.Plan Check 4.0 hrs $532.00 k IPLMBLNC I Plumb.Permit Fee: IPPERMIT Other Plumb Insp. p.p hrs $45.00Ll 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 prelimina information available and are only an estimate. Contact the Dept/or addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff' 7/1!11) FEE QTY/FEE MISC ITEMS PME Plan Check: $532.00 Y17- d PME Unit Fee: $67.00 PME Permit Fee: $45.00 Administrative Fee: 1,4DMIN $42.00 Work Without Permit? 0 Yes 0 No $0.00 Travel Documentation Fee: ITRAVDOC $45.00 Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS:. $731.00 $0.00 TOTAL FEE: 1 $731.00 Revised: 07/01/2012 GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 950143255 miscCUPERTINO 77 (408)7 -3228 • FAX (408)777-3333• building(a.cuoertinaorg LUMBING ❑MECHANICAL []ELECTRICAL ❑MISCELLANEOUS PRCIEC ADDRESS z-5 OWNER NAME ?HONE E-MAIL Aoa Zca• XA0 STREET'ADDRESS�br y t CIIY, STATE,ZIP FAX CONTACT NAME � �� PH � ` w �t0 T E �"1✓I I��•�2 STREET ADDRESS ��y CITY SLATE, Z1PTf � r =,. FAX ❑OWNER ❑ OWNER-BUILDER BUI j ER ❑ OWNER AGER r ❑NTRACTOR CONTRACTOR AGENT C3HIT ARCECT ❑ENGIN= ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC# COMPANY NAME G_ �"� E-MAIL FAX STREET ADDRESSSe � �y CITY,STATE ZIP /! 164 6 PHONE Z. ARC-IITECTIENGWEER NAMFw f p LICENSE NUMBER�y1 j5 2, �Z BUS.LIC# COMPANY NAME'l J y E MpJ7� 7\✓1G c�� M- FAX STREET ADDRESS n CTTY,STATE,ZIPA. USE OF ❑SFD.DUPLEX ❑ MUL -FANCLY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG LN BYES BUILDING: ❑COMMERCL4L URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EiCHLFR HOME? ❑NO DESCRIPTION OF WORK v ', A cc V. k� I TOTAL VALUATION: 000 RECEIVED BY: r 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 provided 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 r u1 di g construct rize representatives of Cupertit�:o e^ter'",h ab ve-id 6:Eed'prepe.:;for inspection purposes. Signature ofApplicant/Ageat Date: SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY w ❑ OVER-THE-COUNTER L F ❑ EXPRESS Y U _ w STANDARD U 3 ❑ LARGE C ❑ NWOR MEPMisc,4pp_2011.doc revised 06/21/11 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR SUBCONTRACTOR LIST ........................................ JOB ADDRESS: 22510 Steven's Creek Blvd PERMIT#11080070 OWNER'S NAME:Mortza Abdollahi PHONE#408-5074467 ..........................................I--,...........-.1..........---.................. GENERAL CONTRACTOR:FREY Environmental, Inc. BUSINESS LICENS F#32849 ADDRESS:1336 Brommer St,Ste.A-6 CITY/ZIPCODE:Santa Cruz 95062 *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 UNTII., THE GENERAL CONTRACTOR AND Al.A., SUBCONTRAC'T'ORS 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: V TSUBCONTRACTOR BUINESS NAME BUSINESS LICENSE# Cabinets & Millwork Cement Finishing x Electrical Alternative Power and Electric Excavation x Fencing Perham Construction Flooring/Carpeting Linoleum/Wood Glass/Glazing Heating Insulation Landscaping Lathing Masonry Painting/ Wallpaper Paving Plastering Plumbing Rooting ........... ......................... .............................................. Septic Tank ................................................................................ ........................................... Sheet Metal ............. .......... Sheet Rock .......... Digitallyi,,,l by Terrence Kinn Terrence Kinn DIN - :cTarrenca Kinn,o=FREY Environmental,Inc, ou=R'glonal Manager,email=terrykinn@fmyinc.com,c=US 12/20/13 Date:2013.12.20 12:29:26-08'00' Owner/Contractor Signature Date it v0-7 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 22510 stvns crk blvd DATE: 08/09/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: 1$50,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY Commercial Building PENTAMATION 1 U1 USE: PERMIT TYPE: WORK tem soil vapor extractions stem SCOPE OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. s.f. U (Private Gar/Ag Bldg) II-B,111-B,IV,V-B 0 $0.00 $0.00 TOTALS: 0 $0.00 $0.00 MECH,HOURLY 0 Yes 0 No PLUMB,HOURLY 0 Yes 0 No ELEC,HOURLY 0 Yes No NOTE: Theseees are based on the preliminary information available and are only an estimate. Contact t/te De t or addn'l info. FEE ITEMS (P'ee Resolution 11-05 li ff 7/111) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? G Yes 0 No $0.00 ® hours Plan Check,Hourly Suppl. PC Fee: Reg. OT 0.0 hrs $0.00 $520.00 ISTPLNCK PME Plan Check: $0.00 Permit Fee: Hourly Only? Q Yes 0 No $0.00 Suppl.Insp.Feer Reg. 0 OT0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Acoustical Fee: 0 Yes 0 No $0.00 0 Work Without Permit? 0 Yes 0 No $0.00 E) Planning Fee: $0.00 ® hours Inspections 0 $520.00 ISTINSP Inspection,Hourly Strong Motion Fee: IBSEISMICO $10.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $2.00 SUBTOTALS: 1 $12.501$1,040.00 TOTAL FEE:T $1,052.50 Revised: 07/04/2011 ` CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333•building(ci_)cupertino.org On NEW CONST�RUCTION ❑ ADDITION /❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT ti PROJ1TADDRESS`ib'TC�Ci^�j �.{�- 01 APN# �� D( V� OWNERN EE42,C � �C0.�•� PHONE, E-MAIL STREET ADDRESS 1, CITY, STATE,ZIP FAX 'LZ 1 O C{� V C.s Lr�.—t CONTACT NAME�^G C ^e) PHONE 1 I �• '6 14 E MA_UIl_ STREET ADDRESS CITY STATE,ZIP FAX t 3 , Cr..Z. Solo ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR N,��IIE LICENSE NUMBER LIC SE TYyPE BUS.LIC# 'FIL` 'bN.t/I�db�ldLfLG✓► �•'�C_ 1045 ? ft —tto�Z COMPANY AME E-MAIL FAX STREET ADDRESS / CITY,S TE,ZI ^ PHONE �'� (a owl•7/� (Tgilt ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK -•ice.. 8� O � •� 11�LY1• �c t►vA�j•�p, p d✓� 41k— +0 GD✓�t��L �j W EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA +.Z 4 �'f X10 /►[1/\ BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK'PORCH AREA GARAGE AREA: DETACH ❑ATTAC H #DWELLING UNITS: IS A SECOND UNIT 11YES SECOND STORY ❑YES BEING ADDED? ❑NO .ADDITION? ❑NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVED BY: TOTAL VALUATION: PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO 501-Ir— By 01-Ir— 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 provide is vni-rect I h ve read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state Iawswl ding cons orize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: 7 d/// SUPPLEMENTAL F&FORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC 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 ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH