Loading...
07120086CITY OF CUPERTINO .Ale '.,j �rgsa'm �gk�r�, T+��s �g4:.j�'�k?: " ONTRACTOW, 13�i�O1 MAT1 - BUILDING DIVISION PERMTT �' BDILD11bnYss&ASCO2GNE DR JAHAN FARIDNIA PERMIT NO. 07120086 10535 GASCOIGNE DR 01/07/2008 PHONE: SANITARY NO. CONTROL NO. ARCHITTEC (ENGINEER: BUILDING PERMIT INFO BLDG EIFLI PLUMB MECH LICENSED CONTRACTOR'S DECLARATION - Job DOSCIIpCIOn ' 1 humby affirm real 1 am limtucd under doriuons of Chaptrr 9 (communing with Smom70fU)of Diviaion3ofthe Budneas and Professions Crde.aMmyliuseis REV SHR WL & SHRL STRAP LOCTN, ADD 2 WINDWS IN in License rce 0. s d affeCddc.I MSTR BEDRM,ORIG 06020035 Dam contractor ARCHITECTS DECLARATION I understand my plans shall k used as public records Licensed Professional OWNER -BUILDER DECLARATION I herehy alTrm that I am exempt from me Contmcmr. License Law for de following ..an. (Second 7031.5, Business and Professions Cade: My city or Mary ' which mquirm a permit m am crmed, alter. pmpmw, demolish, or repair any stared.¢ -- prior m its issuance. also requires tk spplknt for each Permit to file .aigned assumed,thek is licensed to of me Contractor's law(CTuPta 9 Sq. Ft. Floor Area Valuation p.oumt the Pmvivous pp (commencing with Senian 700o1 of Divisionlnftkeusibauand Prof inns Cadr)ur $0 that he is exempt therefrom and the basis for cite alleged conception. Any vbWimt of Number 37528004 UV Occupancy Type Section 7031.5 by any applicant far a permit subjects the applicant to a civil penalty of not tame Nan rive hundred dollars(M). ❑ 1, asmwnerof the property, or my employees with wages as mev talc eampuuatim, ns Required Inspections will do den ..,Land the structure is not intended or@fernd fara.in(Sec. 7044, Business t apply m an w. of and Professions Code: The Contmcmrs License Law dart tao q P property who builds or improves dro mu.and whodoessuchworthimselfor0uough has Own employers, provided dimmed impmwments am net intended. nattered foredo. If. ' however. me building or improvement is mid within one year of campleoan, the awmr- builder will law the burden of proving mat Ire did tat build or improw fen purpose of asks.). ef I. as owner of she property, am eulusively contracting with licenud tmnrumn m - construct the project (Sec. 7044, Business and Profesdans Co it :) The CootrxtM Li - cause Law does not apply m in owner of progeny who Wilda or improves thew. and. Wine emm.cts for such pmjecm wpm aemmuclonts) licensed pursuant ad IW Ormusetora License law. I ore tamp, under See ,B under penalty of perjury me of tk folowing decl mot .. ❑ I h.w aM will mai in of milonmr eCud 3M the Laborthe fen b Second T/00 of me labor Coe. for tk perfmnartoe of tire r which this wort for which mix permit is iced. Permit ❑ I haw and will maintain Workers Compensation Insure¢, as required by session _ 3700 of tie labor Cost. far me pedormantt often wort fen which this permit is be a xt My Workers Cmnpeasation Inmr.xe artier and Policy number art: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE (Thiswzim need rot kcompkwd if th pemii is fmom hundred doom. CS100) or less) I comlh Out in the perfammce of the wort for or this permit Dull he rimmed revoked. ) CONSTRUCTION LENDING AGENCY 1 hcmby.firm mat teem I,. Construction lending agency, fen de perfarmmeo of ' the work for which this permit is issued (Sec. 3W7, Civ. CJ Lender's Name dander's Addreas 1 certify that 1 have read this application and sum that the no. information is CORect. I agree 10 Comply With all city and county ordinances and sole laws rem ag to building construction. and hereby aumorito representroves car this city m eneruprn me above mentioned pmpeny for inspection purgores. (We) agree to save, indemnify and keep harmless the City of Cuyetfm against j liabilities.jud,brmu, Casts and espcntem which may in my way scenic egainm said Gy in consequence of me granting of this permit. t APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date — w SO RCE REGULATIONS. Re -roofs Type of Roof Z- `lr A S Sig Applican✓Conmxt r Date the applicant or future Wilding arupantatore or hmWk havrtloas material as defsmd by the Cupertino Municipal Cade. Chapter 9.11, and tie Holm and Safety . Section 25533(a)7 All roofs shall be inspected prior to any roofing material being installed. ❑Ye If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupied use equipment or devices had emit hmardous it contaminants as dcrined by the Bay Area Air Quality Mao.gmncnt all new materials for inspection. District? ❑Yen (DO. I have mad the beard.s maerislsrequirerncros underchsPer6.95oftkCslifof- nuHcal"Safely Codc, Sections 25505.25533 mW25514. 1 mv1vvand thaifine bn0dmg does Out mrtemty haw a Imam, that it is my reasonability m badly the amganr a de requirements which mesa he men per m issamec of. Cemreae of Occupancy. o r Sig nature of Applicant COVER SHEET 07120086-D 10535 GASCO I G N E DR CONTROL # PERMIT # b `1 IA o D 8 (o DATE PROJECT SPw-, c, c vl G ctd *w o ADDRESS APPLICANT OWNER sue^^ aim, a JMA 9 APN# 3 '-?JL2,W — �� RES. (LUNG) (GARAGE) COMM. SQ. FT. (NEW) T.I. SQ.F E RES. REMODEL CONTACT PHONE#� S �G `T FAX VALUATION RECEIPT # PLN. CHECK ' ENERGY CONSTRUCTION TAX (Y) (I) GRADING SCHOOL FEES (Y) (N) SOILS HOUSING MITIGATION FEES (Y) (I) BLDG PMT HEART O CITY (I� SEISMIC NOTES: /% l I ELECT PLBG MECH ISSUED BY ��l��i DATE 3�� TOTALFEES y,. CITY OF CUPERTINO BUILDING DIVISION PE RAW M COIGNE DR OWNER'S NAME: JAHAN FARIDNIA PHONE: ARCHITEC IENGINEF:R: LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, aM my licenscis in full fora and effect License Class Lie. p Date Couraetor ARCHITECT'S DECLARATION I understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractors I icensc Law for the following mason- (Section 70315, Business and Professions Code: Any city oreounty which requires a permit to construct, alter, improve, demolish, at repair any struaum prior to its issuance, also requires the applicant for such parmil to file a signed statement that he is licensed pursuant to the provisions of the Contractor's ljecasc Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Prokssi0. Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 1031.5 by any applicant for a permit subjects the applicant to a civil penalty of .or more than five hundred dollars (S500)- I. as owner of the property, or my employees with wages as their solecompensadon. will do the wore, and the structure Is not intended or offered for ec sale (S7044, Business and Professions Code: The Contractors License Law don not apply to an owner of property who builds or improves thereon, and who does such work himself tr through his own employees, provided that such improvements are not intended or offered for sale IL 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 sak-)-), Er I. as owner of the property, am exclusively contracting with licensed contnaetom to construct the project (Sec. 7044. Business and Professions Code) The Contractor's Lj- cerse Law does not apply to an owner of property who builds or improves themon, And, who contracts for such projects with a contractor(s) licensed pursuant to the Contractors Lirraae Law. ❑ I am exempt under Sec , B & P C far this mason O 12 N WORKER' C ON 'DB�CLARA ON �� O I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a Certificate of Consent to self -insure, for Wori ces Compm- sadon, as provided for by Section 3700 of the labor Code, for the performance of the work for which this permit is isstaed- ❑ I have and will maintain Workers Compensation Insurance. as required by Section 3700 of the Labor Code, for the performance of the won for which this permit is issued My Worker's Compensation Insurance carrier had Policy number are: Carrier Policy No.: CEI=CATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE (This section need not be completed if the permit is fir one hundred dollars (Sloe) or less) I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in any manner so as tQbe�come sub�'ect to the Workers' Compertion Laws of Caliromia —_� lt+—e A � Applicant NOTICE TO APPLI CAkb If, a()cr making this Certificate of Exemption. you should become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that them is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. Q Lenders Name Lenders Address 1 certify that I have read this application and state that the above inforvhation is correct I agree to comply with all city and county ordinances and stale laws misting to building construction, and hereby author m representatives of this city to enter upon the ahovc-mcndoned property for inspccuon purposes - (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, toss and expenses which may in any way acme against said City in consequence of the granting of this permit APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT SOLIRCE REGULATIONS. I%--- X, 2 ""ice 6 $ Si tra ApplicandConc r r Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant sore or handle hazardous material as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety Code, Section 25532(a)? ❑ Yen F< Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Managmscrtt District] ❑ Yes ZXD I have mad the hazardous ma„-rials mquirements under Chapter6.95 of the Califor- nia Health & Safety Code, Sections 25505, 25533 and 25534.1 understand that tithe building does not eurmndy have a tenant, that it is my responsibility to notify the occupant of the requirements which must be met prior to issuance of a Certificate of Occupancy- .d ,�. �•-: f (tuner n­NAcd Eacnl Da JAHAN FARIDNIA 10535 GASCOIGNE DR FERMII NO, 07120086 PERMIT ISSUE DATE 01/07/2008. SANITARY NO. CONTROL NO. BUILDING PERMIT INFO BLDG ELECT PLUMB Job Description REV SHR WL & SHRL STRAP LOCTN, ADD 2 WINDWS IN MSTR BEDRM,ORIG 06020035 Sq. Ft. Floor Area $ 0 Valuation 3 752 80 04??bT Number Required Inspections Occupancy "Type 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 0-7/a ooR-� L CITY OF CUPERTINO REVISION/DEFERRED PERMIT APPLICATION FORM APN # 3 7 0 d Date: Z 2 v 7 Original Permit-- � Building Address: 5 3 -r--> f+5 (90 Al e; Ge . Mailing Address (if different from building address): Owner's Name: mhRy�m FAR00 4 Phone #: C�a �� 76 Z_ 31 o Z Contractor: Phone: p 3 7S - 56 i Fax: (1Fo 6) `7 8 2 - 31 o z Contractor License #: 6, 20 15 O Cupertino Business License #: Contact: J A 1A N 0 P, N !;q Phone: (4 3 7�_ `� 6 9� f Fax: (4-0g 7g2-- 31o2— Building Permit Info: Bldg ❑ 1 Eled_7 Plu❑b Qech Residential Commercial ❑ Job Description: s h ea,,j Q ncjIra Stiea, wQ/% SIra10 ° A wz� Uj i Masi e. bea rho rv` . Type of Construction (Usage Class): Occupancy Type: 1 FR, 11FR ❑ 11, 111, V-1HR ❑ 11, 111, 1V V-N T--3 Valuation (cost of project): Project Size: Standard [El Large ❑ Major Valuation: