The URL can be used to link to this page

10020029CITY OF CUPERTI BUILDING ADDRESS: 22401 SALEM AVE UNIT 3 ""NER'S NAME: IRAN HATAMI t..VNER'S PHONE: 4087258311 1 LICENSED CONTRACTOR'S DECLARATION License Class ��'83 L° Lic. # 3y3 / Contractor K!-yG'4vCAOD P� m >�i G Date �o 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. I 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 permit is issued. APPLICANT CERTIFICATION 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 upon the above mentioned property for inspection purposes. (We) agree to save 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 with all non -point source regulations per the Cupertino Municipal Code, Section S;^^ature ivy. y�JC�^---- Date �%�L/ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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. I 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 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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 U. 'he above mentioned property for inspection purposes. (We) agree to save I iify and keep harmless the City of Cupertino against liabilities, judgments, co:..., and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all on -point source regulations per the Cupertino Municipal Code, Section 9.18. CJ .9—V —� l7 /U Signature Date r10 BUILDING PERMIT CONTRACTOR: REDWOOD PLUMBING CO PERMIT NO: 10020029 INC 1590 TACOMA WAY DATE ISSUED: 02/04/2010 REDWOOD CITY, CA 94063 PHONE NO: (650)369-1793 BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r MECH r RESIDENTIAL r COMMERCIAL r JOB DESCRIPTION: REPLACEMENT OF 45,000 BTU FURNACE IN SAME LOCATION Sq. Ft Floor Area: I Valuation: $2200 APN Number: 32615044.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issue y: Date: 2—t-,/- /d RE -ROOFS: 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. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. er ori rd agent: ( � Date: — —41-_;201V CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CITY OF CUPERTINO 7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: B1{: Lot: APN ........: 32515044.00 DATE ISSUED.......: 02/04/2010 RECEIPT #......... BS000009689 REFERENCE ID # ...: 10020029 SITE ADDRESS 22401 SALEM AVE UNIT 3 SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OWNER IRAN HATAMI ADDRESS 22401 SALEM AVE UNIT #3 CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-0951 RECEIVED FROM ....: REDWOOD MECHANICAL CONTRACTOR PPRCELL, ALICE V LIC # 640 COMPANY REDWOOD PLUMBING CO INC ADDRESS 1E90 TACOMA WAY CITY/STATE/ZIP REDWOOD CITY, CA 94063 TELEPHONE (E50)369-1793 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC ---- NEW BAL ---------- 1BCBSC ------------- VALUATION ---------- 2,200.00 ---------- 1.00 ---------- 0.00 1.00 0.00 1BSEISMICR VALUATION 2,200.00 0.50 0.00 0.50 0.00 1EPERMITFE FLAT RATE 1.00 42.00 0.00 42.00 0.00 1MPERMITFE FLAT RATE 1.00 42.00 0.00 42.00 0.00 1MRRAA UNITS 1.00 63.00 0.00 63.00 0.00 1PPERMITFE FLAT RATE 1.00 42.00 0.00 42..00 0.00 1TRAVDOC FLAT RATE 1.00 42.00 0.00 42.00 ---------- 0.00 ---------- TOTAL PERMIT --------- 232.50 ---------- 0.00 232.50 0.00 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT : AMOUNT --------------- 232.50 --------------- 232.50 VOICE ID DESCRIPTION -------- ---------------------------- 505 FINAL ELECTRICAL 508 FINAL MECHANICAL REFERENCE NUMBER -------------------- #8938 VOICE ID DESCRIPTION -------- ---------------------------- 507 FINAL PLUMBING t, CITY Of CUPEkTINO CITY OFCUPERTINO FURNACE/AC PERMIT APPLICATION FORM APN # Date: Building Address: �` ?u�LlGl ,Sf44 -= r Ave (J,�rc r 3 Owner's Name... Phone #: YO 5 7,2 �5 Contractor: Phone �C v?�L,.0d;Ae-N-N T �� M A.1 e,— �'– Fax #: 65c, - _3G 7-V 0, Contractor License #: Cupertino Business License #: 53�43f 4 - Contact: Phone #: -- Fax #: —. Building Permit Info: Elect Plumb �� Mech Residential Commercial ❑ Job Description: ,! 4 f��r^� ►ac�im .r OY-- Y15 OC -0 1 For Residential Installations: Attic ❑ I" floor 2°d floor ❑ Adhere to minimum setback requirement ❑ For Commercial Installations: Replacement same weight ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: Type of Construction (Usage Class): Strapped ❑ On Platform Bonded New Location ❑ Replacement Project Size: Express [+]----Standard ❑ Large Major ❑ Valuation: Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, include in plan set & the sheet index. A 01 /07/04 Revise 51-ffl- CITY Of CUPERTINO CITY OF CUPERTINO FUR1vACE/AC FEE S CHEDULE Quantity Fee ID Fee Descriplion Fee Permit Type Group 1MRAPPVNT Residential fu- the install/relocate/ or M replacement of ea appliance vent install & not incl in an appl permit. FURNACE FURN/AC 1 PGASRES Residential fo - ea gas piping system of P 1-4 Outlets 1 BPGAS For each gas piping system of 5 or P more per outlet. 1 BCBSC Cal Bldg Stan lards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Residential Seismic B } 1 MECPLNCK Mechanical Plan Check M 1MFR=<100 Furnace Syst --=100k BTU install or M relocate ea fot ced-air/gravity type furnace/burne -, incl ducts/vents attached to su-;h appliance up to and include 100,000 Btu/h_ 1MFRN>100 Furnace Syst => 100k BTU install or M relocate ea foi ced-air/gravity type furnace/burne -, incl ducts/vents attached to su,;h appliance over 100,000 Btuft 1 EPERMITFEE Electric Perm- t Fee E / 1 MPERMITFEE Mechanical P ;rmit Fee M r 1PPERMITFEE Plumbing Per nit P I 1TRAVDOC Travel Documentation B 1BUSLIC Business License B CITY OF TPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: 117zz o/ '5�ze m fa 0,-, r 4r PERMIT # 06)Z—azo Z OWNER'S NAME: rRAN dAcIrAlm PHONE # yC - 7.;2. - �;3 / / GENERAL CONTRACTOR: P�op-vcmD FAX # 6'50 - 3�,7 19i S— I am not using any subcontractors: Si ;nature Date Please check applicable subcontractors and complete the following information: Owner/ Contractor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical 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