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07080089 CITY OF CUPERTINO BUILDING DIVISION PERMITI�1�£���A�I�l�1 PERMIT NO. BUILDING ADDRESS: 1330 FLOWER CT TBD — TO BE DETERMINED 07080089DA PERMIT ISSUE DATE OWNER'S NAME: SANJIDEH KOOROS AND PARVIN K S AR CONTROL NO. 4E: BUILDING PERMIT INFO rRCH IENGiNEER: BLDG ELECT PLUMB MECH nLICENSED CONTRACTOR'S DECLARATIONJob Description reby affirm that I am licensed under provisions of Chapter 9(commencing 70(1())of Division 3 of the Business and f iu s Code,and my license is PANEL UPGRADE TO 2 0 0 AMPS BAY AREA ELECTRIC PAID o- in full force and of License Class Lic.ii FOR BL 08/09/07 Date Contractor ARCHITECTS DECLARATION I understand my plans shall be used as public records V ,Licensed Professional OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the Ofollowing mason.(Section 7031.5,Business and Professions Code:Any city or county ❑-1 which requires a permit to construct,alter,improve,demolish,or repair any structure 'w prior it)its issuance,also requires the applicant for such permit to rile a signed statement Ft.Floor Area Valuation that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q $1800 m (commencing with Section 7000)of Division 3 of the Busincssand Professions Code)or that tie is exempt therefrom and the basis for the alleged exemption.Any violation of pN Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 36618038 Number P Y yP not more than five hundred dollars($500). 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 sale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are 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 sale.). L as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044.Business and Professions Code:)The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon,and. who contracts for such projects with a contractors)licensed pursuant to the Contractors License law. 0 1 am exempt under Sec. B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: J I have and will maintain a Certiricate of Conscnt to self-insure for Workers Compen- 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 will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Workers 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 for one hundred dollars(S 100) or less.) I certify_that 1n t performancc of the work for which this permit issued,I shall not employ any per in any manors so as to become subject to the W kers'Compensation Laws of Califo Date Applicant NOTICE TO AP M:If,after makin is C it ca emption,you should become subject to the Worker's Compensation provisions o the Labor Code,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY .�-. I hereby affirm that there is a construction lending agency for the performance of > the work for which this permit is issued(Sec.3097,Civ.C.) a Q Lender's Name 4z Lender's Address C) I certify that I have read this application and state that the above information is r correct.I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorise representatives of[his city to enter upon the y (� above-mentioned property for inspection purposes. (We)agree to save,indcmmify and keep harmless the City of Cupertino against hithilities,judgments,costs and expenses which may in any way accrue against said City q J Z inconsequence of the granting of this permit. Date �+ API ANT UNDERSTANDS AND LL C M Y WITH ALL NON,-POINT Issued b,,: SO R REGULATIONS. f Re-roofs �v Signa App ntract Date T of:Zoof HAZARDOU MATERIALS DISCLOSURE Type Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Munici 1 Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roof:.shall be inspected prior to any roofing material being installed. Yes o 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 rncd by the Bay Area Air Quality Management all new i naterials for inspection. District? .Dyes o I h ad the hasardt s materials requirements under hap[er 6.95 of the Califor- nia Hcal &S ety Codc,Section 25505,2553 d255 I ders[and that if the building _ does not a tly have a tenant,that it is s ity oufy the a:cup�jF of Date requircm which must be met prior to issu �e oC cru c of Occup / ignatur�of Applicant v All roof coverings to be Class"Br' or better Owner or authorized agent ate Community Development 9.k�104 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 '"UPEKTINO Building Department JOB ADDRESS: ' 7 I �c C����� PERMIT # 011 tF OWNER'S NAME: PHONE GENERAL CONTRACTOR r' FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and com Clete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical — ��{ _C q Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile ` 10 l© Owner/ ontractor Signature Date CITY OF CUPERTINO city OF PERMIT APPLICATION FORML CUPEkTINOoe CPN# Date: .1� /0 Building Address: �' �-�' Mailing Addre s (if different from building address): Owner s Name: � one Contractor: oZa (�31 T . _1 ContaPhone: Cupertino Business License#: h Fax: Building Permit Info: Bldg ❑ Elect Plumb ❑ Mech ❑ Job Descriptio D Residential 1 ommercial El Sq.Ft. Floor Area: S60 I Sq.Ft.: Cost of Project: Occupancy Group:q r up:n Type of Construction: r Please check this box if the project is a second-story addition: El Project Size: Standard Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Dther Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boilcr> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 B.oilcr> 1M to 1.75 M Btu MECHANICAL BBOILER5 Eoiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Cc n. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax -Resi/Mobile BUILDING BELEC 1000 El ec 600V <= l OOOA ELECTRICAL BELEC1001 F lec 600V> 1000A ELECTRICAL BELEC200 Elea Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD ='nergy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING l of 3 CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: CathyS COPY # 1 Sec: Twp: Rng: Sub: Blk-: Lot: APN 36E18038 .00 DATE ISSUED. . . . . . . : 08/ 09/2007 RECEIPT #. . . . . . . . . . BS(100002324 REFERENCE ID # 07080089 SITE ADDRESS 13:,0 FLOWER CT SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : SANJIDEH KOOROS AND PARVIN K ADDRESS . . . . . . . . . . : 13.30 FLOWER CT CITY/STATE/ZIP . . . : CU'.?ERTINO, CA 95014-5302 RECEIVED FROM . . . . : RIMO Y JIZEH CONTRACTOR . . . . . . . : TBI - TO BE DETERMINED LIC # 00096 COMPANY TB:) - TO BE DETERMINED ADDRESS CITY/STATE/ZIP TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY kMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- BELEC200 METERS 1. 00 29 .43 0. 00 29 .43 0. 00 BSEISMICRE VALUATION 1, 800. 00 0.50 0. 00 0.50 0. 00 EPERMITFEE FLAT RATE 1. 00 38 .37 0. 00 38.37 ----- -0. 00 ---------- ---------- ---------- - TOTAL PERMIT 68.30 0. 00 68.30 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- ---------- CREDIT CARD 68.30 MC --------------- TOTAL' RECEIPT 68. 30 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- 103 UFER 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL