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08090183PERMIT # AACTay�� PROJECT j&/ ♦ �i -�. 13D APPLICANT DATE �wi0=Ma ,IAId WAa=0 PUBLIC WORKS ASSESSOR APN# 0,75 RES. (LVNG) (GARAGE) COMM. SQ. FT. (NEW) I T.I. SQ.FT. RES. REMODEL CONTACT PHONE# VALUATION (Cost of Project) NOTES: FAX REQD. PAID CONSTRUCTION TAX (Y) (I) SCHOOL FEES (Y) (I) HOUSING MITIG (Y) (N) HEART OF THE CITY (Y) (N) TOTAL FEES -- CITY OF CUPERTINO r �1 BUILDING DIVISION PERMIT .'n4 BUILDING DRESS: PERMIT NO. 1 87 1HANNA DR FAISAL & FARAH MERCHANT 08090183 OWNER'S NAME: PERMIT ISSUE DATE FAISAL & FARAH MERCHANT 18721 HAMA DR 09/29/2008 PHONE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION - Job Description 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, and my license is REV F LR P LN FMV / C SMTC C HG S ( FMRM G S T C L S T , RMV FP) in full forts and effect. License class Lk. • REV RF FRMNG PLAN FAM RM BEAM— ORG # 0 8 0 4 0171 Date Contractor ARCHITECTS 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 License Law for the following reason. (Section 70313. Business and Professions Code: Any city or county which requires a permit to constrteL alter. improve. demolish, or repair any structure prior to is issuance. also requires the applicant for such permit to file a signed statement Contractors License Law (Chapter 9 Sq. Ft. Floor Area Valuation that he is licensed pursuant to the provisions of the 7000) Division 3 Business Profession& Code) or 0 (commencing with Section of of the and that he is exempt therefrom and the basis for the alleged exemption. Any violation of ,�,p Number 37529010 Occupancy Type - Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not mom than five hundred dollar (SSoo)• : U( ❑ L as owner of the property, or my vnployces with wages as their sole compensadon, Required Inspections will do the work, and the structure is not intended or offered for sale (Sec. 70". Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such wort himself or through his own employees, provided that such improvements ate not intended or offered for sale 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 sal.). ja I, as; owner of the property, am exclusively conuacting with licensed contactors to bonsuuct the project (Sec. 7044. Business and Professions Code:) The Conracme3 U. tense Law does not apply to an owner of property who builds or improves thereon, and. who contracts for such projects with a comractor(s) licensed pursuant to the Contractors License Law. ❑ 1 am pt under Sec . B R P C for this reason Dwner � M <<.L�-�— Dae WORKER'S COMPENSATION DECLARATION _ 1 hereby affirm under penalty of perjury one or the following declarations: ❑ 1 ham and will maintain a Certificate or Consent to self -Irene for Workces Cool sation, as provided for by Section 3700 of the labor Code, for the performance or the work for which this permit is Issued_ ❑ I have and will maintain Workers Compensation Insurance, m 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. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' . COMPENSATION INSURANCE (This section need not be completed if the permit is forone hunMed dollars ($I00) or lest) I certify that in the performance of the work for which this permit is issued. I shall not employ any person In any mannetsgat t q�rome subject m the Workers' Compensation Laws of Cali,.. Date Yr+y 1 f A Applicant NOTICE TO APPLICANT: IL alter making tins CeNificate of"Exciription, you should become subject to the Workers Compensation provisions or the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked, CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a conawction lending agency for the performance or the work for which this permit is issued (Sec. 3097, Civ. C.) " Lender's Name Lender's Address I ratify that I have read this application and state that the above infomution is correct. 1 agree to comply with all city and county ordinances and sate laws relating to building construction• and hereby authorize representaidws or this city to enter upon the above -mentioned property for inspection purposes (We) agree to save. Indemnity and keep harmless the City or Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the granting or this permit APPLIC UNDERSTANDS AND WILL COMPLY WITH ALI, NON -POINT Issued by: Date SOURCE L.ATT S. rn'kr � dam' Re -roofs Type of Roof Signawm of Applicant/Conuactor Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant sort or handle hazardous material m defined by the Cupertino Municipal Code. Chapter 9.12. and the Health and Safety Code, Section 25532(a)? ❑ Yes )6 No 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 Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes �No 1 have read the hazardous materials requirements under Chapter 6.95 or the Califor- maHealth do Safety Code, Sections 25505.25533 and 25534" 1 understand that If the bolding does not curmady have a tenant. that it is my responsibility to notify the occupant of the require ta which t� be �etp�mra cer;feate or�17 ` - Signature of Applicant Date N"o _ All roof coverings to be Class'%" or better Owner or thorizcd agent ,0?090/�3 ow CUPEIk1'IN0 CITY OF CUPERTINO REVISION/DEFERRED PERMIT APPLICATION FORM APN # 3 7S-— b 1 v v v Date: q ZGL/D� Original Permit #: 04? O `, / �' Building Address: Mailing Address (if different from building address): Owner's Name: Phone #: Contractor: Ou-vl�- Phone: Fax: Contractor License #: Cupertino Business License #: Contact: Phone: 1r1t f - &97-0 Fax: Building Permit Info: Bldg P"" Elect ❑ Plumb ❑ Mech ❑ Residential Commercial Job Description: 4t4S1r)izso -/2e Floor- — i o /Cfasm�-Fie, C hSe p/ �D �Y4i�� -�i`r+� roaa7�l�f G fad , YPrr ��P "1' ��2n - mw lc/ Is the project in the Wildland- Urban Interface Fire ea? Yes No 0� Type of Construction (Usage Class): * Occupancy Type: 1-A2 1-B ❑ II/III/V-A ❑ II/III B, IV -HT, V-B ❑ Valuation (cost of project): Project Size: Express Standard Large E Major Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it to the application or if applicable, include in plan set & the sheet index. Points Achieved: For help, contact Build it Green at www.buildit2reen.org Revised 9/15/08 CITY OF CUPERTINO ,7 CUPE� INO REVISION/DEFERRED PERMIT APPLICATION FORM FEE SCHEDULE Quantity Sq Ft Fee ID Fee Description Fee Group Permit Type 1REVCOMNEW Revision Commercial New B 1* 1REVCOMTI Revision Tenant Improvement B 1* TI 1REVSFDWL Revision SFDWL B 1R3SFDW 1REVRESADD Revision Addition B 1R3SFDADD 1REVRESREM Revision Remodel B 1R3SFDREM 1DEFINSP Deferred Submittal not R-3 Inspection B 1* 1 DEFPLNCK Deferred Submittal not R-3 Plan Check B 1 * OR 1* TI 1DEFR31NSP Deferred Submittal Inspection B 1R3SFDW 1R3SFDADD 1R3SFDREM 1DEFR3PLNCK Deferred Submittal R-3 Plan Chk B 1R3SFDW 1R3SFDADD 1R3SFDREM