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03010120-FPgoo a to a 0. Z 6 a kOyU m�c�F kOsy xm� W 0� [BUILDING DIVISION PERMH I' BUILDING ADDRESS: OWNER'S NAME: DELPARASTARAN MEHRAN AND ARCHITECTIENGINEER: LICENSED CONTRACTOR'S DECLARATION I hereby allirtn that I am licensed under provisions of Chapter 9 (commencing kith Section 7600) of Division 3 of the Businessand Professions Code, and my license is n full force and effect. License Class Lic. k Data Contractor ARCHITECTS DECLARATION I understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Can tractor's License Law for the following mason. (Section 7631.5, 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 Cor such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License law (Chapter9 (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 Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (SS6o). ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and thestructure is not intended proffered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds orimproves thereon, and who doessuch work himself or through his own employees, provided that such improvements are not intended or offered forsale. 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.). I, as owner of the property m exclusively contracting with licensed contractors to construct the project (Sec. 7 , Business and Professions Code:) The Contractors Li- cense Law does not appy an owner of roperty who builds or improves thereon, end Who contracts forsulh' rijectswilh c tractor(s)licensed pursuant to the Contractors License Law. or exam tfn r Sea B& P C f r this eason r owner t} r✓� D �LL 1 WORKER'S C PENSATION DECLAARON hereby affirm under penalty of perjury one of the fallowing declarations: ❑ IhaveandwillmaintainaCertificateofConsenttoself-insureforWorkersCompcn- 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 wit] 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: Carrier, Poticy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This scctionnecdnot be completed U the permit is forone hundreddollars(3100) nr less.) 1 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 Workers' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT. If. after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Lahor Code, you must forthwith comply with such provisions or this permit shall he deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a con8tntclion lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) ]enders Name Lender's Address 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 relating to building consuv ion,andhere yallthorize representatives of this city to enter upon the above- mentio d properly for nspcction purposes. (We get to save, i emnify and keep harmless the City of Cupertino against liabilitie dgmenlsc is ndexpenseswhichmay inany way accrue against said City in eo - C4CC of ling ar This permit. APP ANTU TANDS AND WILL COMPLY WITH ALL NOV-PONT of A %L Date HAZARDOUS MATERIALS DISCLOSU, RF.. Will the applicant or future building occupantslomorh ie hazardous material as defined by the Cupertino Municipal Code, Chapter 9.12, end the Health and Safety Code. Section 23532(a)? ❑ Yes No Will the applicant or future building occupant use equipment or devices which emit bazardous air contaminants as defined by the Bay Area Air Quality Management District? r ' ❑ Yes Ihavere thehazardo smaterials requkemenisunder Chapter 6.95oftheCalifor- niaHealth &�" elyCode, ons 25505,25533 and 25534. 1 understand that if the building docs c� fly ha a t ant, that it is my responsibility to notify the cup t f the req it en which met prior to issuance of a Certificate of Occup cy. 1 ){ero aulhorixed Rent Yam AJLIXsl:. Joh Description ADD 70 SQ,FT./KITCHEN REMODEL Sq. Ft. Floor Area 102 - PIERS RegwredInspections 2 5 906ation Occupancy Type 103 PERMIT NO. 104 - REBAR 105 - ANCHOR BOLTS 106 - SEWER & WATER APPLICATION SUB DATE - UNDERFLOOR PLUMBING 203 01/22/2003 204 - UNDERFLOOR FRAME 205 SANITARY NO. 301 CONTROL NO. 302 - TUB & OR SHOWER 303 - ROUGH MECHANICAL 304 BUILDING PERMIT INFO 305 BLDG ELECT PLUMB 307 - INSULATION 308 - SHEETROCK Joh Description ADD 70 SQ,FT./KITCHEN REMODEL Sq. Ft. Floor Area 102 - PIERS RegwredInspections 2 5 906ation Occupancy Type 103 - UFER 104 - REBAR 105 - ANCHOR BOLTS 106 - SEWER & WATER 202 - UNDERFLOOR PLUMBING 203 - UNDERFLOOR MECHANICAL 204 - UNDERFLOOR FRAME 205 - UNDERFLOOR INSULATION 301 - ROUGH PLUMBING 302 - TUB & OR SHOWER 303 - ROUGH MECHANICAL 304 - ROUGH ELECTRICAL 305 - FRAME 306 - HOLDOWNS 307 - INSULATION 308 - SHEETROCK 309 - EXTERIOR LATH 310 - INTERIOR LATH 311 - SCRATCH COAT 313 - ROOF NAIL 501 - FINAL ELECTRICAL ENERGY 502 - FINAL PLUMBING ENERGY 503 - FINAL MECHANICAL ENERGY 504 FINAL BUILDING ENERGY 505 - FINAL ELECTRICAL 506 - GAS TEST 507 - FINAL PLUMBING 5 L MECHANICAL 095 G QF Issued by? 1 WORKS Date Re -roofs Type of Roof 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 "B" or better CITY OF CUPEkTINO CITY OF CUPERTINO PERMIT APPLICATION FORM f 6.3d(0 (2'�:> In APN # / 3 C l — ' 4 — 0 22Cj Date: r Fee Group BAPPLOTHER $iuldirig Address p 3 S C AS o l Z4 MECHANICAL Owner's Name: /,me.�fgM Rsr�n Jel c,�as�a� Phone#: 4o%_ 9-1 Contractor, 1111�-- L-15 Licbnse #: Contact: N 1ty o�3t.� ]� G'f cox Phone grca+\ Con. Tau for B Q Zone Applicant/Contractor: Fax #: Hotel and Motel BUILDING Build g Permit Info: Bldg Elect Pl b h Job D cription' R ential: J Sq.Ft..Floor Area: $/S�q.pt.: �L Valuation Architect/Engineer: �1 � f Type of Construction: Occupancy rou0 l Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tau for B Q Zone BUMDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax — ResilMobile BUILDING BELEC1000 Elec 600V <-- IOOOA ELECTRICAL BELEC1001 Elec 600V > IOOOA ELECTRICAL BELE 200 Elec Svcs 600V <— 200A ELECTRICAL BENERGY Energy BUILDING.- BENERGYADD EnergyAddMulti BUILDING ' BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BMITIGATR Res, Housing Mit Fee BUILDING BAMWMULTI New Multi Family Re's MECHANICAL BNEV[WMULTI New Multi -family Res ELECTRICAL BNUCOM vM New Comm Electric ELECTRICAL BNUCOMIVIM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING 1 of Cl ��7 , 1 �f vL CUPERTINO CITY OF CUPERTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BNUMULTI New Multi -family Res PLUMBING BOVERTMffi Inspection Overtime BULDING BPBACKFLOW -Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BpERMT"EE Bldpermit Fees BUILDING BPFUCrLRE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING 13PLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e OfFixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trp PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER InsWYAlter Water Pie PLUMBING BPWHEATER Water HeaterNent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING 13REMACOVER A/C Unit > 10,000 din MECHANICAL BREMAIRHAN AIC Units <=10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL 13REM13USWAY Remodel Busways ELECTRICAL BREM[FIT Lighting Mures ELECTRICAL BREMFURN Relocation of -Furnace MECHANICAL BREMFURNOV Relo Fumace > 1 OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNR.APP Rem Non -Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rept], Switch & Outlets ELECTRICAL 13RENMLOCA Relocation of Hood MECHANICAL BREM[REpALT Re air/Alter Heating MECHANICAL 13REMRESAPP Remodel Res Appliance ELECTRICAL BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL 2 of 3 CITY OF CUPERTINNO PERMIT APPLICATION FORM \ i uanti Fee IID Fee Description Fee Grou BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD - Scb Specific -Plan BUILDING BSEISMICOM Seismic Commercial, BUILDING BSEISMI-CRE Seismic Fee Res BUILDING BSF&2FAM Single & 2 Family BUILDING SFNA Single Family New Add BUILDING BSPECIAL Special Insection BUILDING BSWW Swimming Pool BUILDING BTEMP Temporary Power- ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Tem Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING BBOILERI Boiler <=100,000 Btu MECHANICAL BBOILER2 Boiler > 100K to 500K Btu MECHANICAL. BBOILER3 Boiler > 500K to 1M Btu MECHANICAL BBOILER4 Boiler > 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler > 1.75 M Btu MECHANICAL JO J 3 of 3 1