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11090107 CITY OF CUPERTI.NO BUILDING PERMIT BUILDING ADDRESS: 10485 STERLING BLVD CONTRACTOR:ALI'S CONSTRUCTION& PERMIT NO: 11090107 REMODELING ,)WNER'S NAME: SHADI ZOMORRODI 681 E BROKAW RD DATE ISSUED:09/16/2011 i NER'S PHONE: 4088393914 SAN JOSE,CA 95112 PHONE NO:(408)898-6474 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIALE] License Class /� Lic.# Qo qLk S INSTALL TEMP POWER POLE S Contractor (.(7 r 2 ( NC, f�i I rJlh Date ? —7--r� C.��c I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$800 1 have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this APN Number:37526032.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply Issued b Date: with all non-point source reg I ns per the Cupertino Municipal Code,Section 9.18. ry RE-ROOFS: Signature_/O Date v' 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. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(x)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Muni ipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sectiolm 25505,2 53 a d 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Dater permit is issued. I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter --n the above mentioned property for inspection purposes.(We)agree to save nnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION ,.,,cs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 37526032 . 00 DATE ISSUED. . . . . . . : 09/16/2011 RECEIPT #. . . . . . . . . : BS000014779 REFERENCE ID # . . . : 11090107 SITE ADDRESS . . . . . : 10485 STERLING BLVD SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : SHADI ZOMORRODI ADDRESS . 1540 SOUTHWEST EXPY UNIT 306 CITY/STATE/ZIP . . . : SAN JOSE, CA 95126 RECEIVED FROM . . . . : OMID MIRI CONTRACTOR . . . . . . . : ALI ZAMANI LIC # 28677 COMPANY . . . . . . . . . . : ALI' S CONSTRUCTION & REMODELIN ADDRESS . . . . . . . . . . : 681 E BROKAW RD CITY/STATE/ZIP . . . : SAN JOSE, CA 95112 TELEPHONE . . . . . . . . : (408) 898-6474 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- -ADMIN HOURS 1 . 00 41 . 00 0 . 00 41 . 00 0 . 00 1BCBSC VALUATION 800 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 800 . 00 0 . 50 0 . 00 0 . 50 0. 00 1EPERMITFE FLAT RATE 1 . 00 44 . 00 0 . 00 44 . 00 0. 00 1ERT<200 UNITS 1 . 00 44 . 00 0 . 00 44 . 00 0. 00 1TRAVDOC FLAT RATE 1 . 00 44 . 00 0 . 00 44 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 174 .50 0 .00 174 . 50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 174 . 50 035918 --------------- TOTAL RECEIPT 174 .50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 402 TEMPORARY POWER Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: \O48S div PERMIT# OWNER'S NAME: i\C v PHONE # GENERAL CONTRACTOR: Pti S cin -trc�c= �Gn BUSINESS LICENSE # "NC�Zk'y33 ADDRESS: 631 �'.. i rc)K,rkL' 2r( Scw cSC CITY/ZIPCODE: cry *Our municipal code requires all businesses working in the city to have a City of Cupertino Vusiness license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. 1 am not using any subcontractors: ` ' CO~ a t I Signature Date Please check applicable subcontractors and complete the following information: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/Carpeting Linoleum /Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature I D to CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10485 sterling blvd. DATE: 09/16/2011 REVIEWED BY: APN: -7sU BP#: 'VALUATION: $800 IWOr PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY SFD or Duplex PENTAMATION 1 REAP14 USE: PERMIT TYPE: WORK install temp power pole SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Temporary Power 1 ERT<200 100 Amps $44 TOTALS: $44.00 Elec.Plan Check I 0.0 hrs $0.00 77 - Elec.Permit Fee: IEPERMIT Other Elec.Insp. 0.0 hrs $44.00 NOTE: This estimate does not include fees due to other Depts(i.e.Public Works,Sanitary Sewer District,School District,etc.). Thesefees are based on the preliminary in ormadon available and are only an estimate. Contact the De t or addn'1 info, FEE ITEMS (Fee Resolution 11-053 Lf f/1/1 1) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $44.00 PME Permit Fee: $44.00 Administrative Fee: IADMIN $41.00 Work Without Permit? Q Yes (D No $0.00 Travel Documentation Fee: ITRA VDOC $44.00 Strong,Motion Fee: IBSEISMICR $0.50 Select an Administrative Item 131du Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $174.50 $0.00 TOTAL FEE $174.50 Revised: 09/02/2011 `J GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 X CUPERTINO (408)777-3228• FAX(408)777-3333• building(aDcupertino.org \ MISC []PLUMBING Ol MECHANICAL OTELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS g APN# b-757Po� OWNERNAN$ PHONE 1 37'l E-MAILE �' C�� w�-��C CcV'.�S�C�c STREET ADDRESS CITY, STATE,ZIP C FAX CONTACT NAME PHONE E-MAIL`��.,`(�{ice,�r--� ��'`-=``r'�::��(`t✓r�A �-k c,L--�` �`�3 4�(.F. S ik 0,H IkZ Al-'1 -Z o F lC`i.',QL STREET ADDRESS \ CITY,STATE, ZIP FAX 1 OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME �\` , LICENSE NUMBER qQ�j�� LICENSE TYPE BUS.LIC# COMPANY NAME E-MAIL 7 FAX STREET ADDRESS CITY,STATE,ZIPPHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME' E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF Fd m DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN El YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE CYNO EICHLER HOME? ❑NO DESCRIPTION OF WORK TOTAL VALUATION: S(.1Q RECEIVED BY: By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is c n ect.,�have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relatir. -•^ l 1, -I'--ecT »* �*+�P*rnresentatives of Cupertino to enter the above-identified property for inspection pu(poses. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY OVER-THE-COUNTER Y ❑ EXPRESS U w ❑ STANDARD U ❑ LARGE c, rEl MAJOR MEPMscApp_2011.doc revised 06/21/11