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07050185 CITY OF CUPERTINO �. BUILDING DIVISION' PERMITPERMIT No. 1k�17 t�iR IYEQIEM�TIONt BUIL¢(i�G�IZES ORTE MADERA LA LION ELECTRIC CO 07050185 OWNER'S NA,jME: PERMIT ISSUE DATE M. ALAMDAR 1211 PARK AVE STE 104 05/18/2007 NE: SANITARY NO. CONTROL NO. (408) 297-7009 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH i p o LICENSED CONTRACTOR'S DECLARATION V F. 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description z with Section 7000)of Division 3 of the Business and Professions Cade,and my license is TEMP POWER TO PERM POWER METER a o in full force and effecL .ern License Class Lic.M F Date Contractor ,a ARCHITECTS DECLARATION i a< 1 understand my plans shall be used as public records )yU 'v y Licensed Professional OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractors License Law for the p O following mason.(Section 7031.5,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 for such permit to rile a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.ft.Floor Area $10 0 Valuation aE (commencing with Section 7000)of Division 3 of the Business and Professions Code)or L 3 9 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 ofNumber Occupancy Type not more than five hundred dollars(5500). 3 2 6 4 5 0 3 0 '�J 0 1,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 docs not apply to an owner of q 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 w'1 have the burden oC proving that he did nor build or improve for purpose of sale) 1,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 docs not apply to an owner of property who builds or improves thereon,and. who contracts for such projects with a tractor(s)licensed pursuant to the Contractor's License Law. 0 1 am exem t U. B&P C for this reason Owner �UateT D WORXM'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 0 I have and will maintain a Certificate of Consent to self-insure for Worker's Compen. sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 0 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 Worker's Compensation Insurance carrier and Policy number are: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not he completed if the permit is for one hundred dollars($100) or less.) I certify that in the performance of the worl for rc t rmit is issued,1 shall not employ any person in any mana as to omc ubjcc Workers'Compensation Laws of California Date Applicant NOTICE TO APPLICA r making this Cc fhcatc of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must .J Z forthwith comply with such provisions or this permit shall be deemed revoked. Z CONSTRUCTION LENDING AGENCY E-+ 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.) Q Lender's Name a z Lender's Address U Q 1 certify that 1 have read this application and state that the above information is Ly correct.I agree to comply with all city and county ordinances andstate laws relating to 0 U building construction.and hereby authorize representatives of this city to enter upon the �\ U ahove-mcntioncd property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against \\\. C-1) liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of th' pe ?}�y �. APPLICANT UNDERSTA S D W COMPLY WITH ALL NON-POINT Issued by: SOURCE REGULATION 07 Re-roofs Signature of rector Date HAZARDOUS 4ATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. 0 Yes o Will the applicant or future building occupant use equipment or devices which If a roof is instz.11ed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? 0 Yes 42 o I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code.Sections 25505,25533 and 25534.1 understand that if the building does not currently have a tenant,that it is responsihility to notify the occupant of the requirements which Abe mel prior hss a of a Ccrufhcate of Occupancy. Signature of Applicant Date a Owner or aum Date All roof coverings to be Class"B"or better CITY OF CUFERTINO 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: bethe COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32645030. 00 DATE ISSUED. . . . . . . : 05/18/2007 RECEIPT #. . . • • . • • • : BS000001385 REFERENCE ID # . . . : 07050185 SITE ADDRESS . . . . . : 21835 CORTE MADERA LA SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : M. ALAMDAR ADDRESS CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1128 RECEIVED FROM . . . . : M ESHRAGHI CONTRACTOR . . . . . . . : HAMID R HOZHABRY LIC # 26941 COMPANY . . . . . . . . . . : LION ELECTRIC CO ADDRESS . . . . . . . . . . : 1211 FARK AVE STE 104 CITY/STATE/ZIP . . . : SAN JCSE, CA 95126 TELEPHONE . . . . . . . . : (408) 297-7009 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BTEMP FLAT RATE 1 .00 62 .10 0. 00 62 .10 0 . 00 EPERMITFEE FLAT RATE 1 .00 38.37 0. 00 38 .37 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 100.47 0 . 00 100 .47 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 100 .47 1023 --------------- TOTAL RECEIPT 100.47 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 103 UFER 304 ROUGH ELECTRICAL CITY OF CUPERTINO c zvaF' PERMIT APPLICATION FORM CUPEkTINO ON# `75 -C3& Date: Building Address: 1 ! Mailing Address (if different from building address): Owner's Name: / Phone#: clmk Contractor: License Contact: �` ESL �,�2 Phone: Z�2 67 6 S Cupertino Business License#: R,Ay�tE? ( Fax: I Building Permit Info: �-�� w (w`a YU r,.p LU C Bldg ❑ Elect ❑ Plumy ❑ Mech ❑ Job Description: Residential 0 � �`�-�1c P`�'`1� Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: l a Occupancy Group: Type of Construction: Please check this box if the project is a second-story addition: ❑ lroject Size: Standard ® Large ❑ Major [] Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other-Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 1 SOK to 500K Btu MECHANICAL BBOILER3 Boiler> 300K to 1M Btu MECHANICAL BBOILER4 Boiler> 1 M to 1:75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Cons auction Tax BUILDING BCONSTAX Ind/Ofi7Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax —Resi/Mobile BUILDING BELEC 1000 Elec 6C OV <= l OOOA ELECTRICAL BELEC1001 Elec 00V> 1000A ELECTRICAL BELEC200 Elec Svcs; 600V<=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING I of 3 CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. lJousing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Cc mm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmos3heric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE PLIg Fixture PLUMBING BPGAS Gas Pir ing System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Cf eck Repeat Fee BUILDING BPREPIPE Rei a Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S )rinkler/Backflo PLUMBING BPSTORM Storni/Rain Water PLUMBING BPTRAP Ki•:chen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main'Water Service PLUMBING BREINSPECT Rein ection Fee BUILDING BREMACOVER A/C Unit> 10,000 cf n MECHANICAL BREMAIRHAN A/C Units<= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remc del Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Fuinace> l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc:Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power D(vice/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Reloc�.tion of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 Community Development 10300 Torre Avenue }{. Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 '-UPERTINO Buildin r Department JOB ADDRESS: PERMIT # OWNER'S NAME: tat PHONE # u O O �Z 3 Z 3 GENERAL CONTRACTOR: L.:,' gEU i-c- FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and com lete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical L t V�,\ r r� 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 Owner/Contractor Signature Date