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10100060 - PUB 1�i lel I ►k;l 1;-,i1 I`'��I 1=�1 I��I I ��.I I``�I I`�I ISI 1;-�H1 I�� l 1=�' l�t�l IdI a H D 1- a Z w -�-- � ca u ro M C:) v o pC a a a 0 LO H d O W Q 07 W P4 H QJ N H U1 H L U If 94 P4 W U 'i V N 4 "F LO � i.!" H pp�� H O Odd F F p p OOC U 0 paa u H tz w x w a rw H o Q A o a s cr Q waaxa -Hi } o D Z A = Q CO io H H �i H LOC) N �i CxJ' 121 Z O o = - a a H a ama H A C3 - C W 00 i17 H Wq O E a. v M - ll� _ u D HMHaH x CL - m a xZ Z y 0 N y �p N y 0 Za. '- `. CD Idl +.` o m o ti.. CIL a X1 _� xo U cr w:ll. y o z u Idl Icll el D a a a a a w m O c v 2 U1 I ! O O O O Q Ir y tz LU CD 1�I J M ~ u Z O m CC: +p -1 i; Z O UJ CD CD o oN w U) U o 0 o U oCc v U - o kA M y n a x x43 fo a ti .n A x y 3 d a iv fo u- � ~ a N O E E �, 3 F Z a> > > w (D � o 's in QI 3 Z y m O u ` Z x o o /o m u m Q 3 U m m - 3 a� c� x m a O 9 E c .� 0 E y E a� ro y a O' fo w 6 a wi `m :a o o a - .� `m .- E IL IL O Q cn U IL O d a. Lo I Q IL U U U a izi a CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10006 SPANISH OAK CT CONTRACTOR:KHORSHIDIAN PERMIT NO: 10100060 KAYKHOSROW AND ROO OWNER'S NAME: KHORSHIDIAN KAYKHOSROW AND ROO 10006 SPANISH OAK CT DATE ISSUED: 10/07/2010 OWNER'S PHONE: 4082213667 CUPERTINO,CA 95014-5624 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION I F BUILDING PERMIT INFO: BLDG "" ELECT PLUMB " License Class Lic.# ri MECH RESIDENTIAL COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: INSTALL KITCHEN RECESSED LIGHTS MASTER BATH& (commencing with Section 7000)of Division 3 of the Business&Professions HALLWAY BATH LIGHT&VALVE REPLACEMENT.FURNACE Code and that my license is in full force and effect. REPLACEMENT INSTALLED NEW LAUNDRY BOX& 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 Sq.Ft Floor Area: Valuation:515000 permit is issued. APPLICANT CERTIFICATION APN Number:342,32074.00 . Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Issued by: Date: Signature Date OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for 1,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: I,as owner of the property,am exclusively contracting with licensed cont dors to construct the project(Sec.7044,Business&Professions Code). v ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. 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 Owne=da r. f l�j O forthwith comply with such provisions or this permit shall be deemed revoked. Date: 6 V APPLICANT CERTIFICATION f — CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct.1 agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address costs,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. , 1 understand my plans shall be used as public records. Signature Date L)9 Licensed Professional CITY OF CUPERTINO ADDITION/REMODEL CUPERTINO FEE SCHEDULE APN# 32 _ 0-7L J Date: Is a 2"d unit being added? Yes ❑ No [K If yes, please fill out the permit application for 2"d unit. Building Address: Mailing Address (if different from building address): /Daa Q ` G 1/l0 Owner's Name: - Phone# Contractor: IPhone #: 0/10 Fax #: Cupertino Business License: State Contractor License #: Contact: Phone#: -36,(0-7 41" Fax #: Landscape Or inance Compliance: Landscape area in sq. ft. (includes all irrigated areas): If 2,500 sq. ft. or less, compliance with the Landscape Water-Efficiency Checklist is required. If more than 2,500 sq. ft., a complete Landscape Project Submittal is required. Compliance Method: ❑ Plant Type ❑ Water Budget Building Permit Info: Bldg. ®' Elect. Plumb. [ Mech. Hillside ❑ Job Description: Addition-What is being added?(Be Specific): What is being remodeled (not including addition)?J/k.Sr Remodel Includes Re-Roof Yes ❑ No f yes list number of quares Remodel Includes Structural: Yes ❑ No Do you have the pre-application planning approval? Yes ❑ No ❑ If yes, please provide a copy of your planning approval letter. Planners name: Square Footage: Addition: Porch: Deck: Garage: Detached Attached Remodel: Kitchen �� Bath �7.1�' Other ,5)401 Type of Construction(Usage Class): Occupancy Type: (1 1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B � Valuation: $1SJZ ' Please check this box if the project is a Project Size: Express Standard. ❑ Large ❑ Major ❑ second-story addition ❑ Please complete relevant portion of the Green Building Checklist& attach it to the application or if applicable, Green Building Points Achieved: include in plan set& the sheet index. �-- Revised 05/18/10 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 I SUBCONTRACTOR LIST JOB ADDRESS: �E� PERMIT# 00 6 669 OWNER'S NAME: PHONE# D GENERAL CONTRACTOFt BUSINESS LICENSE# ADDRESS: CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL .BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: 70 Signature Date Please check applicable subcontractors and complete the following information: 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 7/d Owner/ ontractor Signature Date