01100028 OF
CI BUILDING DIIVISSIIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10403 NOEL AVE. CLASSIC KITCHENS 01100028
OWNER'S NAME: APPLICATION SUB DATE
AM KATHY & PARVIZ KOHDI 4335 EL CAMINO REAL 10/04/2001
PHONE: (650) 949-1280 SANITARY NO. CONTROL NO.
'
0 OZ
ARCHITEC71.#Nb1MR: BUILDING PERMIT INFO
w `� BLDG ELECT PLUMB MECH
was s'a -
5 y z LICENSP ' NTR " A ON lob Description
5z=C To y affirm rh ''cons ovi he Chapte be mincing
whit Semi 77 0 of yllon nh :mess and fe license REMODEL & ADD 189 S . FT.
[y in in full force
o U License Class !� /-f Lic.p SZ!
3 3 a in Dare Con recto
C CT'S DECLA
nd my p>�s shall bed as public records ,(
3 5 p p�, Lice /rofess�ona R y7g14
'tu,)y o OWNER BUILDER DECLARATION
w 1 hereby afilrm rhm 1 1. exempt son the Contractor's License Law county
C?O fallow Im reason.(section 703L5 Business end Professions Code.Any city structure
Q 12 Q Q Q Q
which r quirts a pemut to construct,alter,improve,demolish o pav any srmmure Y '
�,3� .,pnm10 licensed
partottgnlRe Neapplis of the Cmarmmll fl amgn, suteme9 - - - -- —
mal,lid31cenzd partner,to thed fBovissof o t Brant LicenseW (Chapter) �,,y ,tgct q x^. ., Valuation
or he, a is with Section mu'onof Div ' n 3 of the le,ml x a d Professions Code) ,'�Z i 13 Y}"7';{l,}—.Ok/�7eat i
or,hat io rs exempt any a oro and the basis forme alleged eiempaod Any l violation
of Section 70315 iv any applicant fora permit subjects th<epplicem to a civil pcnalry' p y V p
of nor mor.than eve hundred dollars($soo). 101APN�"bATION Occu ant e
0I.as owner of the property,or my employees with wages.their sole morpeasatime,
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business and Professions Cade:The Contractor's License Law does not apply to an 103 - UFER Required Inspections
owner of property Who builds or improves themon,and who does such work himself _ 10 4 - REBAR , _ _ _ _
_ ere or through his own employees.provided that such improvements not intended or
.&led for sale.If,however,the building or improvement is sold within one year of 1 0 5 — ANCHOR BOLTS t "
completion,the owner-builder will have the Wmen of proving that he did not build or
improve for purpose of sale.). 106 - SEWER & WATER
❑f;as owner arine propeny:a,n excltlaivei;commuting with licensed cantiactars to _ _ ...202-' - UNDERFLOOR PLUMBING .. '
construct the project(Sec.7044,Business and Professions Code:)The Cormanor'a 203 — UNDERFLOOR MECHANICAL
License Law does not apply to an owner of property who Wilds or improves thereon,
and who comrecu for such projects with a contractors)licensed pursuant to the .. 204 UNDERFLOOR FRAME
Contractors License Law.
❑Taro exempwndcr Sec, ,B&PCfor this reason 205 - UNDERFLOORINSULATION
Owner - ' " - Date' 301 - ROUGH PLUMBING
c _ WORKER-SCOMPENSATIONDECLARATION 302 - TUB & OR SHOWER
I hereby affront under Penalty of Mary oat of the following daelamdon,: 303 - ROUGH MECHANICAL
❑ 1 nave'ane wise maintain'.Certificate of Coastal,to self-insure for Worker, 304 - ROUGH ELECTRICAL
Compensation, as provided for by Section 3700 of the Labor Code, for the
perfortaanee of the work for which this permit is issued;
305 — FRAME
01 have end will ammuia Worker',Compensation Insurance,u requirtd by section 306 - HOLDOWNS
37M a !!"CERT C ON OF once of be work for nuwhichnumber
so perm t s
F. 4... x1 :307 a INSULATION
_
m Labor Cod far the parr
ras d M W ke fualnsur tamer end Pat n°mber art
ca policy No mo`( 2 308 $H, ETROCK'I
EMPIONMOMWORKERS',t 3'09 EXTERIOR-'4LATH''
c ION INSURANCE '
...._......._... ..,-,." ._. . . ..... . . ... .._.
COMPENSAT
310.,-' INTERIOR LATH'
oo lcseciion need not bebompleteJ iFnW pcnnir is for one hundred dollen 311 - SCRATCH COAT z. ..ay 1 ',�"•
(5100) 1 )
shallnot emptor any the Tic io any manner,o os to became sobject,.thewsuad 31'3 - ROOF NAIL
1tenfiythan� theNrson*ifarmanga'nnr 5wo�k for which ontissued, 501 - FINAL ELECTRICAL''ENERGY
Compensation ewsarca ramra.Da-1 rs . .502 - FINAL PLUMBING ENERGY
NOTICE TO APPLICANT.If,after making thisCenificate of Exemption,you should 503 - FINAL MECHANICAL ENERGY
Q 0 Wamme subject to the Workers Comns
pemion provisions of rhe Lsbor Code,you most
forthwicom
th comply with such provisions or this permit shell be aeemm revoked. . 504 —...FINAL BUILDING ENERGY_
CONSTRUCTION LENDING AGENCY 505 FINAL ELECTRICAL
a 1 hereby whiich than the 's named
war lendingag ), f m performance —
Lof emewmkrnewnrnmspe l, tl(s 3097 c c) 506 GAS TEST
W q Lender's
onde shame 507 - FINAL PLUMBING
Le tle sAddres
0 1 emify Net I have reed rtes epplr mime end state that above mfo rnation is 508 - FINAL MECHANI CAL
W �." correct.I agree to comply with all city and county ordinances and sum laws relating 509 - FINAL GRADE
V m Wilding construction,and hereby authorize representatives of this city to enter upon
'W theaWve-me_mipnedp,operryfarmspemianpurpasts. 510 - FINAL PLANNING
Y (We)agree to save,indemnify and keep harmless the City of Cupertino against
CA liabilities,judgments,costs and expenses which may in any way accmt against said 514 - FINAL PUB C WORKS
C) City in con quanta of ib gmnting of this permit.'
PPLIC T UNDERSTANDS AND WILL COMPLY W ITH ALL NONPoINT"
REGULA s,' •, .•i. Issued by: Date
Re-roofs _ ® Q
es defnetl by,the Cun 6 nfir cr I Code,Chstore
o and�iodous Type of Roof -..-
PP � ef E
HAZARDOUS MATERIAIS pISCLOSUR '
ua II tine a licat or future Wilding occupant tort a handle heuNaus material
Pe
Otho' '• ( ' „r.': All roofs shall be inspected prior.to any,roofing.material being..installed..... _..
cod Section2 . �y
Will the applicant or far..building mwpium a.equipment or device,which If a roof is installed without first obtaining an inspection, Ill gfe'.to remove
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
DistricA . all new materials for,inspection. Applicant understands and will comply with
°via _ °"° all non-point source'regulatlons.
1 hive read be hazmdous mammals requiremenu under Chapter 6.95 of the
California Health k Safety Code,SecGans 25505;25533 and 25534.1 understand that
if the building does not currently have a tenant,that it is my responsibility to notify the "
at.Pa.'
of the virem pia which,must he met prior to issuance of a Cenificete of
-' °cc a Signature of Applicant Date
Gw r mmmead agent r Sr2�E H r p Data All roof coverings to be Class"B" or better .
OFFICE
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CITY OF CUPER VINO `
BUILDING DIVISION PERMIT CONTTRACTOR INF,OORMAI;IOW;1
BUILDING ADDRESS: CLASSIC KITCHENS PE
10403 NOEL AVE . 101100028
NBR'S NAME: 4 3 3 5 EL CAMINO REAL APPLICATION SUB DATE
W
KATHY & PARVIZ KOHDI 10/04/2001
ZONE: (650) 949-1280 SANITARY NO. CONTROL NO,
ARCHITEC IENGINIi IiR: BUILDING PERMIT INFO
BLDG ELECT PLUMB MP-CH
°foo
LICENSED CONTRdunderSDECLARATION JobDescri tion
1 hereby aflifm that 1 nm licensed under provisions of Chapter Y(commencing p
gowith Section 71M0)of Division J of the Business unJ Podeasions Codc,and my licenm is
„ m
In11fur.a,, Moo, REMODEL & ADD 189 SQ,. FT.
=a>aF4 License Class Lic.. -IIVALE®
oz— Datn Contractor
P� � ARCI II'n:C'S DECLARATION
� < l u alcmumd my plans shall be used as public records MAR
X0 2 8 2003
=LLO Licensed Poifcesional
OWNER-BUILDER DECLARATION
hereby affirm that 1 am exempt from the Contractor's License law fur the BUILDING
a 5:p0 following reason.(Section 7031.5.Business and Professions Cotte:Any city or County
a $E which requires a permit to construct,shot,improve,demolish,or repair any muewm
prior it)its issuance,also requires nmkppficent forsuch permiuo file a signedsuturmnt a�.mn
xx< that he is licensed purmatntn the provisionsofthe Contractor's License law(Chapler4 Sq. Ft. Floor Area $12 OV&Qtion
Ce fwmmeBeing wish Section7(XXB of Division 3 of the Business and Professions Code)or
W�S Nat he is exempt therefrom and the bash for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of Occupancy Type
not more than fns hundred dollars(S500). P Y YP
0 I,as owner of the pmperty.or my employees with wages ss their tole compensation,
will do the work,and she grucmm is not intended or offered for sale(Sce.70W,Business
and Ponfeaai,a Code:The Contactors License law does net apply to an owner of 10 2 - PIERS
equired Inspections
poi who builds or improves thcmon,and whodoes such work himselfor through his
own employees.provided that well improvements an not intended ornRend for aide.If. 103 — UFER
however,the building or improvement is sold within one year ofcnmpletion.she nwnef- lO4 — REBAR
budder will have the burden of pvi
rong that he did out mild or improve for purpose or
'am')' 105 - ANCHOR BOLTS
01,as owner of Bee property.am exclusively contacting with licensed controctorsm 106 - SEWER & WATER
Conswct the project(Sec.7144,Business and Professions Code:)The Contractor's I.I.
see law does not apply to an owner of property who wilds or improves shemon,and, 202 — UNDERFLOOR PLUMBING
who contacts for such projects with a connonam(s)licensed pursuant to the Comracmts
License Law. 203 - UNDERFLOOR MECHANICAL
❑I am eacmptunder5cc. .B&PCfonhisreasan 204 - UNDERFLOOR FRAME
r Data 205 - UNDERFLOOR INSULATION
WOR K ER'S COMPENSATIONDECLARATION 301 - ROUGH PLUMBING
1 hereby alfrrm under penalty of perjury one of the following declaationa:
❑I have and will maintain a Certificate ofComnnt to self-insure for WohcYs Compere 302 — TUB & OR SHOWER
Wim.u provided for by Section 3710 of the labor Code,for the perfonnattce of tltc 3 03 - ROUGH MECHANICAL
work for which Nis Permit is issued. 304 — ROUGH ELECTRICAL
❑1 have and will maintain Worker's Compensation Insurance,as required by Section 305 - FRAME
3700 of the IawrCntle,for the performance of the work for which chis Permit is issued.
My Worker's Compensation Insurance carrier mad Policy number me: 306 — HOLDOWNS
Carrier: Policy No.; 307 - INSULATION
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPFNSA'r10N INSURANCE 308 — SHEETROCK
(This section need me wcompletediftw p mitisforonehundmddnllam(SBxq 309 - EXTERIOR LATH
crag.) 310 - INTERIOR LATH
I cenify that in the performance of the work for which Nis permit is iaucd.1 shall not 311 - SCRATCH COAT
employ any pemnn in any manner sn tic m become subjects,the Workers'Com ncr atinn
Lawsufcarmmin.Date 313 - ROOF NAIL
Applicant
NOTICE TO APPLICAW:11,ofmr making this Certificate of Exemption,you should 316 - INT SHEAR
become subject to the Worker's Compensation provisions of the Labor Code,you must 501 - FINAL ELECTRICAL ENERGY
OZ forthwith comply with such provisions or Nis permit shall w deemed revoked.
zCONSTRUCTION LENDING AGENCY 502 - FINAL PLUMBING ENERGY
I hereby affirm dust urcin is a Construction lending agency(or the Performance of 503 - FINAL MECHANICAL ENERGY
X � tin the
Land'
ra k Nafor
W 504 - FINAL BUILDING ENERGY
Iw mc
III z LahZsAddmm 505 - FINAL ELECTRICAL
U O 1 certify Nat 1 have read this application and start Nat the above information is 506 - GAS TEST
W t.. Correct.l agree to Comply with all city and county ordinances and sure laws relatingm
pU building construction,and hereby authorimmpreentativesofBox city toenter uptmthe 5 FINAL PLUMBING
r W about-mentimcdorpeny for impaction purposes. �5�F"L
N L
(We)agree m save,indemnify end keep harmless the City of Cupertino against
tiIqliabilities.judgments,1.costs iand lcurily ad kee mayiaanyway ty rm of
in
U APPLICANT UNDERSTANDSof the granting(if IAND WILL COMPLY WITH ALL NON POINT Issued byhis Permit. NG Date
SOURCE REGULATIONS.
Re-roofs 516 - NAL BUILDING
Signature of ApplicuI IAZARDOUOContractor Date
IIALARDOf15 MATERIALS DISCLOSURE Type Of ROOF
Will Bre applicant ,futurebuildingoccupantstowor handle hmvafth ad Safety as defined by the Cupeninn Municipal Cost.Chapmr 9.12,and the Ilcalsh anti Safety
ode,Section zs53xa17 All roofs shall be inspected prior to an roofing material beim Installed.
El YC. El No P P � Y S g
Will the applicant or future wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
Mail hazaNnus air comeminenu as defined by be Bay Arca Air Quality Management all new materials for inspection.
District%
O Yes 0N
I have mad she humblo s mamriafsrequiremene,underCwpmr695ofthe CalRnr.
ria l lcafth&Safety Code.Sections 25505,35533amf25534.1 understand thatifthe wilding
docs not currently have a secant,that it is my responsibility to easily the cavansnt of the
requirements which mug be met prior to issuance ora Certificate ofocupart Signature of Applicant Date
Owner of aothoro,cd agent Date All roof coverings to be Class rB" or better