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13070070CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10653 MINETTE DR CONTRACTOR: FAZILAT HAIDER PERMIT NO: 13070070 OWNER'S NAME: FAZILAT HAIDER 10653 MINETTE DR DATE ISSUED: 11/12/2013 OWNER'S PHONE: 4089961915 1 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ff CONSTRUCT A 372 SQ FT REAR ADDITION; CONSTRUCT License Class Lic. # A Contractor Date 476 SQ FT FRONT ADDITION; REBUILD AND EXPAND I hereby affirm that I am licensed under the provisions of Chapter 9 ATTACHED GARAGE (420 SQ FT). (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: $200000 1 have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 37532034.00 Occupancy Type: 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 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 CALLED INSPECTION. upon the above mentioned property for inspection purposes. (We) agree to saveki; indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the Date: 1///T)1-3 granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Secti 9.18. RE -ROOFS: Signature Date 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 y 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, f ' Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). 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 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(a) 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 Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date: 11-12-4 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 CONSTRUCTION LENDING AGENCY 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 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 upon the above mentioned property for inspection purposes. (We) agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, 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. Date Signature Ir CITY OF CUPERTINO BUILDING PERMIT DR CONTRACTOR: -67'1&0/" PERMIT NO: 13070070 BUILDING ADDRESS: 10653 MINETTE Cv/YST�� cno DATE ISSUED: 11/12/2013 OWNER'S NAME: FAZILAT HAIDER PHONE NO: OWNER'S PHONE: 4089961915 JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ (� LICENSED CONTRACTOR'S DECLARATION CONSTRUCT A 372 SQ FT REAR ADDITION; CONSTRUCT License Class_ Lic. # /! LL 476 SQ FT FRONT ADDITION; REBUILD AND EXPAND Contractor (,Zf���T '� Date ATTACHED GARAGE (420 SQ FT). 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 Valuation: $200000 performance of the work for which this permit is issued. Sq. Ft Floor Area: L 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 APN Number: 37532034.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES ORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WIT AYS PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter AYS F ALLED INSPECTION. upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, in the Z� costs, and expenses which may accrue against said City consequence of Issue Date: granting of this permit. Additionally, the applicant understands and will comply with all non -point source rggulations per the Cupertino Municipal Code, Section 9.18. wRE-ROOFS: (/ Date 7 �Z"f _� All roofs shall be inspected prior to any roofing material being installed. If a roof is Signature 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 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER the following two reasons: 1, as owner of the property, or my employees with wages as their sole compensation. do the work, and the structure is not intended or offered for sale (Sec.7044, will Business & Professions Code) HAZARDOUS MATERIALS DISCLOSURE I, as owner of the property, am exclusively contracting with licensed contractors to 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(a) 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 as defined by the Bay Area Air Quality Management District 1 Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and performance of the work for which this permit is issued. I have maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sectio 25505, 25533, and 25534. ff / and will Section 3700 of the Labor Code, for the performance of the work for which this �, ) /, Owner or authorized agent: Z h , �"✓ Date: '7 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 CONSTRUCTION LENDING AGENCY Compensation laws of California. If, after making this certificate of exemption, I I I hereby affirm that there is a construction lending agency for the performance of become subject to the Worker's Compensation provisions of the Labor Code, must work's for which this permit is issued (Sec. 3097, Civ C.) forthwith comply with such provisions or this permit shall be deemed revoked. 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 upon the above mentioned property for inspection purposes. (We) agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, which may accrue against said City in consequence of the I understand my plans shall be used as public records. costs, and expenses 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 l /o CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10653 MINETTE DR CONTRACTOR: GROUP CONSTRUCTION PERMIT NO: 13070070 OWNER'S NAME: FAZILAT HAIDER 686 STOCKTON AVE DATE ISSUED: 11/12/2013 OWNER'S PHONE: 4089961915 SAN JOSE, CA 95126 PHONE NO: (408) 482-6322 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL ❑ CONSTRUCT A 372 SQ FT REAR ADDITION; CONSTRUCT License Class_ Lie. # �i+ % ^T A 476 SQ FT FRONT ADDITION; REBUILD AND EXPAND T— Contractor '411, C (C Date to7- Z ATTACHED GARAGE (420 SQ FT). DEF # 1 - TRUSSES - ISSUED 10/22/14 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: N'aluation: $200000 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 MIN Number: 37532034.00 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 P RMIT 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 FRO 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 p Z 2 granting of this permit. Additionally, the applicant understands and will comply u�e_ with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. � , / �/ Vim' Date RE -ROOFS: be inspected to material being installed. If a roof is Signature //J/�� All roofs shall prior any roofing installed without first obtaining an inspection, I agree to remove all new materials for inspection. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: 1 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 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 & 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(a) 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 Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: 4,L-4 Z7 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 CONSTRUCTION LENDING AGENCY 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 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 upon the above mentioned property for inspection purposes. (We) agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, 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 BUILDING PERMIT BUILDING ADDRESS: 10653 MINETTE DR CONTRACTOR: GROUP CONSTRUCTION PERMIT NO: 13070070 OWNER'S NAME: FAZILAT HAIDER 686 STOCKTON AVE DATE ISSUED: 11/12/2013 OWNER'S PHONE: 4089961915 SAN JOSE, CA 95126 PHONE NO: (408) 482-6322 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ CONSTRUCT A 372 SQ FT REAR ADDITION; CONSTRUCT 2 � License Class `Lic. # ] '1 A 476 SQ FT FRONT ADDITION; REBUILD AND EXPAND ' Contractor 'Date ATTACHED GARAGE (420 SQ FT). I hereby affirm that I In licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions 6/23/2014- REVISION #2 ADD 92 SQ FT TO FRONT OF SFDWL, Code and that my license is in full force and effect. RECONFIGURE LAYOUT OF EXISTING PLANS- ISSD 7/23/2014 1 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 I work for which this permit is issued. pe rmance of the Sq. Ft Floor Area: Valuation: $200000 ave 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: 37532034.00 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 Issued by: Date: granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. RE -ROOFS: Signature_,, / / Date 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) 1, 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(a) 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 Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505 2553 , and 2553 00, Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date: ?tk.A/ 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 CONSTRUCTION LENDING AGENCY 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 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 upon the above mentioned property for inspection purposes. (We) agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, 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 BUILDING PERMIT BUILDING ADDRESS: 10653 MINETTE DR CONTRACTOR:-TB9- +&ff __ PERMIT NO: 13070070 OWNER'S NAME: FAZILAT HAIDER DATE ISSUED: 11/12/2013 OWNER'S PHONE: 4089961915 PHONE NO: JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL LICENSED CONTRACTOR'S DECLARATION CONSTRUCT A 372 SQ FT REAR ADDITION; CONSTRUCT �� 3 C f 7 A 476 SQ FT FRONT ADDITION; REBUILD AND EXPAND License Class_ Lic. # /J DD ^ Z I _ / ATTACHED GARAGE (420 SQ FT). Contractor�fot�� (C.Yi S�luc��'vrlDate I hereby affirm that I am licensed under the provisions of Chapter 9 REV # 1 - RECONFIGURE INTERIOR WALLS AT LAUNDRY AREA, WINDOW & DOOR IN SAME LOCATION - ISSUED 4/21/14 (commencing with Section 7000) of Division 3 of the Business & Professions REMOVE 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 Valuation: $200000 performance of the work for which this permit is issued. Sq. Ft Floor Area: JJW I have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 37532034.00 Occupancy 'Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 + RMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter 180 D ROM ICALLED INSPECTION. 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 Is Date: granting of this permit. Additionally, the applicant understands and will comply y: i with all non -point source regulations Per the Cupertinoertino Municipalal Code, Section 9.18. - DRE Signature Date 71 1 —I y -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. ❑ 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 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 & Professions Code) 1, 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(a) 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 as defined by the Bay Area Air Quality Management District 1 Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Secti s 2555055 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: �! `"" J"aJ Date: 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 CONSTRUCTION LENDING AGENCY 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 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 upon the above mentioned property for inspection purposes. (We) agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, 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 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-32"Ir lmnpm j� I (408) 777-3228 • FAX (408) 777-3333 • buildinq�cupertino.orq 1���// f F-1 DcvleTnT.iInT: FT RF) nRTGINAL PERMIT 4 134�( "NEW CONSTRUCTION M ADDITION " ALE -+Ilei, 1 11 +,�/. �1 ' APN9 / �-- 3 Z �" J r_1 PROJECT ADDRESS 1s/ 1 �^ (� OWNER NAME PHONE E-MAIL a b STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAME PHONE ®� 2 r� E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX fiocf kADY1 A (/, —, , a f, Of ,e 512 8 ❑ CONTRACTOR ElCONTRACTOR AGENT ElARCHITECT ElENGINEER 13DEVELOPER ❑ TENANT OWNER ❑ OWNER -BUILDER OWNER AGENT CONTRACTOR NAME LICENSE NUMBER A LICENSE TYPE BUS. LIC R' (/ 3 / COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECTIENGINEER NAM � � // LICENSE NUMBER BUS, LIC 4 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK LTA✓'\ i �.7 C EXISTING USE PROPOSED USE CONSTR. TYPE I u STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR AREA DEMO AREA TOTAL NET AREA AREA BATHROOM REMODEL AREA KITCHEN REMODEL AREA OTHER REMODEL AREA PORCH AREA DECK AREA TOTAL DECKTORCH AREA GARAGE AREA: EIDETACH []ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑YES ADDITION? ❑NO BEING ADDED? ❑NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES • RECEIV Y: TOTAL V ON: PLANNING APPL # ❑ NO PLANNING APPROVAL LEITER EICHLER HONIE? ❑ NO i 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. 1 have read this local and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable application ordinances and state laws relating to building co ruction. I authorize representatives of Cupertino to enter the above- r1entifiied gropj]e for inspection purposes. I y/ Date: (01,2A Signature of Applicant/Agent: / '�7 ""� SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP OVER-THE-COUNTER�`PLANNINGPLAN UILDING PLAN REVIEW New SFD or Multifamily dwellings: Apply for demolition permitfor is required to issuance of building existing building(s). Demolition permit prior for new building. :.EXPRESS REVIEW permit Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIcwoRxs _ form if any Hazardous Materials are being used as part of this project. LARGE ❑ FIRE DEPT , Copy of Planning Approval Letter or Meeting with Planning prior to El I+IAaoR ❑ SANITARY SEWER DISTRICT _ submittal of Building Permit application. El ENVIRONMENTAL HEALTH B1dgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Lvtrirt oto ) Thoco foot oro hated nn the nreliminary information available and are only an estimate. Contact the Dept for addh7 info. FEE ITEMS 6Fee Resolution 11-053 Eff. 711113) ADDRESS: 10653 MINETTE DR DATE: 10/22/2014 REVIEWED BY: MELISSA APN: 375 32 034 BP#: 13070070 `VALUATION: Iso *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Du lex USE: P Suppl. PC Fee: (j) Reg. 0 OT PENTAMATION PERMIT TYPE: 1 GENRE WORK DEF # 1 - TRUSSES - ISSUED 10/22/14 SCOPE NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Lvtrirt oto ) Thoco foot oro hated nn the nreliminary information available and are only an estimate. Contact the Dept for addh7 info. FEE ITEMS 6Fee Resolution 11-053 Eff. 711113) FEE QTY/FEE ec. Plan ChGfck 0/hur r Ele(. Insp. Pee: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Lvtrirt oto ) Thoco foot oro hated nn the nreliminary information available and are only an estimate. Contact the Dept for addh7 info. FEE ITEMS 6Fee Resolution 11-053 Eff. 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 F -T-1 # $286.00 Deferred Submittal IDEFSUBM Suppl. PC Fee: (j) Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT O.p hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 i Mzll Irlwtion fax: 1 0 Work Without Permit? 0 Yes Q No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure E) i 1 pr e; J". Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS: $0.00 $286.00 TOTAL FEE: $286.00 Revised: 07/10/2014 CUPERTINO n. CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • I—I building C(2)cupertino.org nTT rT�l T n A r TCA A TrnN / Tr g<rlFVrhJ / 1lFFFRRF.D C)RICUNAi.PFRMIT# '30% 00 I_ I1VC,W lUna .-I lJ . -- - - PROJECT ADDRESS 16&1; 3 M ( 4�,_ # ^ ,cl ccO/ -3 2- 3 L J OWNERNAME ( VI.EQ j3 P HONE 5 E-MAIL / A DF VU STREET ADDRESS'D/3 NfL rLy" �A.PN .— CITY, STATE, ZIP L,CA 15C)/ FAX CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LTC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE j` DESCRIPTI F W� ©/� ��— I% / r i �� " I /Y EXISTING USE PROPOSED USE CONSTR. TYPE I # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO -, TOTAL AREA - AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREATOTAL DECKTORCH ARE I GARAGE AREA: 0 DETACH ❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑YES BEING ADDED? ❑ NO ADDITION? []NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES R E TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO By my signature below, I certify to each of the following: I am the property owner or authorized agent to t the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and veri is accurate. I agree to comply with all applicable local ordinances and state laws relating to uilding onstructioon. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Date: Signature of Applicant/Agent: � SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP OVER-THE-COUNTERuILDINc PLAN REVIEW _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. EXPRESS. 'ANNING PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure El`STANDARD PUBi [c woexs form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALT'II BldgApp_2011.doe revised 06/21/11 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 WWI (408) 777-3228 • FAX (408) 777-3333 • buildingQcupertino.org CUPERTINO ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS 1C)&53 In I . �� �W D APN 9 OWNERNAME PHONE - J E-MAIL STREET ADDRESS 1 06 5 3 CITY, STATE, ZI(�_c,� I FAX 1 - � ��a > 5b� CONTACT NAME PHONE _ / 45- E-MAIL STREET ADDRESS CITY, STATE, ZIP b FAX ky OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRA OR NAME LICENSE NUMBER 0,4 n LICENSE TYPE BUS. LIC N Wei E-MAIL l FAX -� Q COMPANY NAME �O, ` Cr �y -1� v STREET ADDRESS S 3i CITY, STATE, ZIP S Q IVIA P D ARCHITECT/ENGINEER NAN4Br' LICENSE NUMBER ` BUS. LIC P COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE � DESCRIPTION OF WORK w �►�( e EXISTING USE PROPOSED USE CONST . TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: C3 DETACH []ATTACH 9 DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑YES BEING ADDED? NO ADDITION? []NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEIVED BY TOTAL PLANNING APPL K ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property ow-ner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating -Jo buildm2 construction. I autho ize representatives of Cupertino to enter the above -identified property for inspection purposes. Date: Signature of Applicant/Agent: SUPPLEMENTA ORMATIONREQUIREDPS AN CHECK TITERotrr%nGSLTP New SFD or Multifamily dvvellings: Apply for demolition permit for ❑ o� * �i)<COLiRTER _° BUIIDIAGPLAIsRE�SEW existing building(s). Demolition permit is required prior to issuance of building permit for neer building. RxPxEss rLAnT> `c PLAn REv1En _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ sTATDARD C1 PUBLICWORIs form if any Hazardous Materials are being used as part of this project. ❑ L�TcE ❑ piRF.IE>?T _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ SAAITARS sLRnISTRrcr ❑a�L�yOR submittal of Building Permit application. BldgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION WtADDRESS: 10653 MINETTE DR DATE: 04/21/2014 REVIEWED BY: MELISSA N: 375 32 034 BP#: 13070070 'VALUATION: Iso VPERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY PENTAMATION 1GENRES USE: SFD or Duplex PERMIT TYPE: WORK REV # 1 - RECONFIGURE INTERIOR WALLS AT LAUNDRY AREA REMOVE WINDOW & DOOR IN SCOPE SAME LOCATION -ISSUED 4/21/14 c,,..:t- Qou /)htrirt .Vritnnl TE: ]his estimate Uoes not mcmae jeer true to utuer �epu„n,c,,,� I..�. < <�•••��•�b. • --�.-- ..--...-, - - - -- __,� Dont Mr addn'l info. District, etc.. These fees are oasea on me reurrunur FEE ITEMS (Fee Resolution 11-053 E(f 7,1-131 Ertl” . ....... 1. u.n.. FEE « .•. ••• QTY/FEE �••- -•- --------- -- MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes Q No $0.00 1 hours Plan Check, Hourly $139.00 ISTPLNCK Suppl. PC Fee: Q Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Work Without Permit? 0 Yes (j) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 0 i Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS: $0.00 $139.00 TOTAL FEE: $139.00 muvIJCU. U4,v ucU i -r j'�y' CITY OF CUPERTINO I lV fi,,1 MVP 1 CTTM A TnR — RT TII ,DTN(: MVISION 1' ii •-•n.r i .r......»..... » »--»�-- FEE •__ �. _ QTY, ADDRESS: 10653 minefte dr DATE: 06/23/2014 REVIEWED BY: Mendez $0.00 BP#: 'VALUATION: $1,000 APN: Supp/. PC Fee: Reg. Q OT 0.0 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY $0.00 PENTAMATION SFD or Du lex P PERMIT TYPE: i USE: Suppl. Insp. Fee-.(F)Reg. OT 0.0 woRK revision #2 add 92 sq ft to front of sfdwl reconfigure layout of existing plans.... SCOPE PME Unit Fee: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Fro s, Fire, Sunuury .3cwcr ---.----I.. :.Jn6te -i nra nnty nn ovtimatP_ Cnntact the Debt for addn 7 info. Disrricr, ere . mese fees ure bused w, ine rail -Mur FEE ITEMS (Lee Resolution 11-053 E . 7ff !1/13) .r......»..... » »--»�-- FEE •__ �. _ QTY, ____ ___ _____ __ MISC ITEMS Plan Check Fee: $0.00 Select a Misc Bldg/Structure or Element of a Building Supp/. PC Fee: Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee-.(F)Reg. OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 T_=-.ria, ift'vi '/antr t "_ O 0 Work Without Permit? C) Yes (F) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential or Structure 0 0 � /Building aft"tlt'YI r.)(1('jj7tP£'t/tdl7t�7't 1r`t'C'.�`. Strong Motion Fee: IBSEISMICR $0.50 # $695.00 Revisions IREVRESADD Addition B1d�Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.50 $695.00 TOTAL FEE: 1 $696.50 Revised: 04/01/2014 CUPERTINO CONSTRUCTION PERMIT APPLICATION �� COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION �v la. 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 ��amp (408) 777-3228 • FAX (408) 777-3333 • buildinc(d�cupertino.org ❑ NEW CONSTRUCTION �9 ADDITION ❑ ALTERATION / TI ❑ REVISION/ DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS (b V C � A A/1 (� `} (. � %! ] v 1 �. " � 3?__ ^� /t APN #�!7 A�f ,I / _ OWNER NAME �/ 1 (q ( E -MA/ ( 1 AT 6 J1 I PCV— PHONE 4 Ila ( ��ZI��P VJ 1 l q Ll 1 �C� `� ' tier "AIM � t (L CITY, STATE, STREET ADDRESS 1 N 6S 3 M I sua" �.) - PPc , CON TACT NAME 5u r �'vlri/ �T V 4 _ PHONE 6J O SM � � S E l"�' 4r `' STREET ADDRESS 2S V IEN V A CITY, STATE, ZIP S o A Jm /9 F ❑ OWNER OPNER-BUB DER❑OWNTERAGENT11 CONTRACTOR 1:1 CONTRACTOR AGENT ❑ARCHITECTEl EENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME LICENSENUMBER LICENSE TYPE BUS, LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT ENGLNEER NAME v�� LICENSE NUMiBER I� /� 6 l C�7U2 BUS. LIC # COMPANY NAME 'Al" fir„� C7 A / E-MAIL 4eUe �+` � n � 'Al”`C (�q [ FAX STREET ADDRESS 'rx`I4//]� �/1 J[ j� / 9�j'( 6 CITY, STATE, ZIP ,I `SOMA SOMA PHONE DESCRIPTION OF WORK pv1�1(/7.711T-74 j 1' /�� 1 p b h 'st 1✓1'- `i a -1 f.-/ ✓�/� 0 F- ahlwp Ww" II V7, 11 V I N6 Ml 701 _, _tf-p"0M Ap I riet_— EXISTING u 'r PROPOWE CONSTR TYPE I # ST USE rs TYPE OCC. SQ.FT. VALUATION ($) EXISTG� ` AREA /i• NEW FLO AREA 0 DEMO AREA TOTAL NET ARE .1 BATHROOM REMODEL AREA REMODEL AREA _� REM OTHER n REMODEL AREA P03tCYH ggEA N Xd\ D€�K AREA '�A_\TV7M�` TOTAL DECK/P H AREA N GF.R2, AREA:'XDETACH 42 E ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY E] YES BELNGADDED? 11 NO ADDITION? []NO PRE -APPLICATION ❑ YES IFYES, PROVIDE COPY OF IS THE BLDG ANYES I TO AL VALUATION: PLAN`NING.APPL # ❑ NO PLANNING APPROVAL LETTER _- EICHLER HOME? ❑ . 0 ,�, G, QU By my signature below, I certiry to each o following: I am the property own ora orize e property owner's behalf. I have read this application and the information I have Ovid is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to buil nstruc a orize representatives of Cupertino to enter the above -identified properjy for inspection purposes. , Signature of ApplicantlAgent: � Date: SUPPLEMENTALPS1,1A RE ON UIRED Q 'A P%ANCHECKTIPE F ROUTINGSLIP ovEx Ta>:eou.TER ❑ Buu DIAL PLaN REVIEW New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. © EXPRESS flfPiANI.1,ICYLaNREv[Ew- _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure i rA.�DARD E ❑ PUBLIe�tioRss�q form if any Hazardous Materials are being used as part of this project. © LARGE ❑ FLRE _ Copy of Planning Approval Letter or Meeting With Planning prior to V '�I] 5 ❑ submittal of Building Permit application. ItLAJOR SANITARYSE�i'ERDISTRICE _ - D ENI7RON'hfE\T.ALHEALTA BldgaApp_201 1. doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION La ADDRESS: 10653 MINETTE DR DATE: 07/10/2013 REVIEWED BY: MELISSA PC FEE ID APN: 375 32 034 BP#:� JO 71V *VALUATION -$200,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY USE: SFD or Duplex 2nd Unit? Yes F No OTC? 0 Yes I)No PENTAMATION 1 R3SFDADD I PERMIT TYPE: i WORK ADDITION OF 848 S.F. OF LIVING SPACE & 420 S.F. OF ATTACHED GARAGE SCOPE Suppl. Insp. FeeQ Reg. Q OT OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) II-B,III-B,IV,V-B 1,268 $2,637.09 IR3PLNCK $1,832.25 1R31NSP Permit Fee: $1,832.25 Suppl. Insp. FeeQ Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 C'onsfruction Tax: 0 Work Without Permit? © Yes (F) No $0.00 TOTALS: 1,268 $2,637.09 Travel Documentation Fees: $1,832.25 Strom; Motion Fee: IBSEISMICR MECH, HOURLY 0 Yes G No PLUMB, HOURLY Q Yes Q No ELEC, HOURLY 0 Yes Q No MISC ITEMS Plan Check Fee: Elec. Plan Check f ' f tHit F'Pi': Plumb, 0.0 1 Cubit Mech. Insp.ET-t- Other Plumb Insp. t')tker Eke. Insp. Ll ,IM'h. Insp. 1,c, v;? ,. 'cue: Permit Fee: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public works, fire, Sanitary Sewer enstncy acrium n.*- _:. TG r .. ti,a.,,a on a,onreliun;nan, infnrmatinn availahle and are only an estimate. Contact the Dept for addn'l info. uLc ✓uu..0 v .. ..... V............». "LJ LL LI.L, CLI,. Z. ILL- all FEE ITEMS (Fee Resolution 11-053 Eff.' 7%7/12) -_1__..____ -_ _.. FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,637.09 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: Q Reg. 0 OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $1,832.25 Suppl. Insp. FeeQ Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 C'onsfruction Tax: 0 Work Without Permit? © Yes (F) No $0.00 Advanced Planning Fee: IPLLONGR $177.52 Select a Non -Residential E) Building or Structure Travel Documentation Fees: Strom; Motion Fee: IBSEISMICR $20.00 Select an Administrative Item . BldgStds Commission Fee: IBCBSC $8.00 SUBTOTALS: $4,674.861 $0.00 TOTAL FEE: $4,674.86 Revised: 07/01/2013 To Whom It May Concern, I Fazilat Haider Owner of property located at 10653 Minette Dr. Cupertino Ca give permission to change the permit name to Nabeel Awad (Group Construction) as of 4/21/2014. r!1 Fazilat Haider �E 2-1 - 1,V - Date Nabeel Awad (Group construction) Date 1O(5L;b o�- 16- 1-c IV 1� -S u�70 - A 6 kt k J � W� Ca -,AJ Y CW��' �a53 (�`'' CUPERTINO OWNER -BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildino(alcupertino.org Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE ADDRESSr a C 5o 7PN BP# 1301 o o OWNER NAME 21 D F OWNER ADDRESS DESCRIPTION OF WORK: We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS: Please read and initial each statement below to signify you understand or verify this information.) f ` 1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner - Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. �11&_2. 1 understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. 3. I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. �4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. )& , 5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. � 6. 1 understand if I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. A-,7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. 8. 1 understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for 9ny financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. OwnerBuilderFonrtt 2010. doe revised 04114/10 9. 1 understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. VA 10. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the parry legally and financially responsible for proposed construction activity at the site address listed above. Fo 11.1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner -Builders as well as employers. fo 12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS: Please complete the following construction lending agency information.) 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.) Lender Name: Lender Address: Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the oroperty owner's signature. _ Property Owner's Signature: (la ff, :jI , !W 0 4 AAI Date: --------------------------------------------------------------------------------------------------------------------------------------------- (NOTE. The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner -Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: Address of Authorized Agent: Tel No I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: 014�i7erBuilde7Fon77 2010.doc remised 04114/10 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 / SUBCONTRACTOR LIST JOB ADDRESS: tb(55 i n e e,'Pr . PERMIT # �✓- O�� OWNER'S NAME: 1FPtZ LIA T Gt . — )2 PHONE # '5 ,G / /S GENERAL CONTRACTOR: -r)3jD 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: Signature Please check applicable subcontractors and complete the following information: Date 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 2 -) ?> Date CUPERTINO OWNER -BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildin-gacupertino.org Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE ADDRESSAPN l0 3 T Gf Y1�1•.0,q 5or 3 7 5- 3 9- o 5+- BP# 1307op`7a OWNER NAME �Z OWNER ADDRESS 53 Ck Y /It DESCRIPTION OF WORK: .Q, aAck 1 I 1614 We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS: Please read and initial each statement below to signify you understand or verify this information.) 'Fkt 1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner - Builder' building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. 2. 1 understand building permits are not required to be signed by property owners unless they are responsible for pp the construction and are not hiring a licensed Contractor to assume this responsibility. t 3. 1 understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. R 4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. VkA 5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer' under state and federal law. H 6. 1 understand if I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. VVA 7. 1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. FO -8. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. OwnerBuilderForm 2010.doc revised 04/14110 F4 9. 1 understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.csib.ca.gov for more information about licensed contractors. PkA 10. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the site address listed above. VV,_11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner -Builders as well as employers. � 12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS: Please complete the following construction lending agency information.) 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.) Lender Name: Lender Address: Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable�to the cit ma be required to be presented when the permit is issued to verify the property owner's si nature. Property Owner's Signature: Date: --------------------------------------------------------------------------------------------------------------------------------------------- (NOTE: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner -Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: Address of Authorized Agent: Tel No I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: OwneYBuilderForm 2010.doc revised 04/14110