13080111CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7456 ROLLINGDELL DR
CONTRACTOR: ESFANDIYAR ALAEE
PERMIT NO: 13090111
OWNER'S NAME: ESFANDIYAR ALAEE
7456 ROLLINGDELL DR
DATE ISSUED: 08/15/2013
OWNER'S PHONE: 4089814242
CUPERTINO, CA 95014-5813
PHONE NO:
❑
JOB DESCRIPTION: RESIDENTIAL El COMMERCIALE]
LICENSED CONTRACTOR'S DECLARATION
License Class Lic. #
KITCHEN REMODEL 205 SQ FT TO INCLUDE NEW
SKYLIGHT,
Contractor Date
WINDOW, RELOCATE WINDOW IN FAMILY ROOM AND
I hereby affirm that I am licensed under the provisions of Chapter 9
SLIDING
(commencing with Section 7000) of Division 3 of the Business & Professions
DOOR
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
Sq. Ft Floor Area:
Valuation: $350000
performance of the work for which this permit is issued.
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: 35931063.00
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 INSP C ION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
L
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 obtainin an inspection, I agree to remove all new materials for
inspection.
OWNER -BUILDER DECLARATION
Signature of Applic 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
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. 1 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
1 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 Cu er 'no Municipal Code, Chapter 9.12 and
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
the Health & Safety Code, Sections 25533, a 5534.
L 5'
Owner or authorized agent: 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
Compensation laws of Califomia. 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
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
ARCHITECT'S DECLARATION
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 Qurce egulations per the Cupertino Municipal Code, Section
Licensed Professional
9.18. / z
Date `'
Signature
CUPERTINO
CONSTRUCTION PERMIT APPLICATION S11
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION (� `
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 O�
(408) 777-3228 • FAX (408) 777-3333 • building(a)cuper ino.org
❑ NEW CONSTRUCTION ❑ ADDITION O ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT d
PROJECT ADDRESS —+4�/ 11oL014,biLC bILIV
APNH /� C5 (0 .
OWNER NAME (.F'A(,� A IA ALAE £
G J
PHONE. 4 03 9 Q I
,�o C 1j 7MAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
CONTACT NAME C' (AN AdCLA
1� U l/
PHONE 4LA lu 0[ �
u
E-NIAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OWNER ❑ OWNER-BUB.DER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE NUMBER TCENSETYPE
BUS. LIC k
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
ARCMTECT/ENGINEERNAME
LICENSE NUMBER
BUS. LIC k
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK M�DfL R110IA"I )JLAND
N[w/ WIN9bw i/V kjiC41fAl N V IN I -AlD—Ill t1n/D Al" JlooplG 00tz
lAl fAM114- J
EXISTING USE
PROPOSED USE CONSTR-
TYPE
N STORIES
n t J(b6o L
0EXISTG C U
11 � f� *1 t4
I lL L
V_
I I
USE
TYPE
OCC.
SQ.FT.
VALUATION (S)
AREA �0 53
NEW FLOOR
AREA
DEMO
AREA O
TOTAL
NET AREA
5
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA Z O ('
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECKIPORCH AREA
GARAGE AREA: LJDETACH
❑ ATTACH
I
k DWELLING UNITS
IS A SECOND UNIT ❑ YES
SECOND STORY ❑YES
BEING ADDED? ❑NO
ADDITION? []NO
PREAPPLICATION❑ YES IF YES. PROVIDE COPY OF
IS THE BLOC AN ❑YES
17
TOTAL VALUATION:
PLANMNGAPPLN []NO PLANNING APPROVAL LEITER
EICHLER HOME? []NO
By my signature below, 1 certify to each of the following 1 am the property owner or authoriz d a t to act on the property owner's behalf. I have read this
have prov s correct. 1 have read the Description of Work a erify it is accurate. 1 agree to comply with all applicable local
application and the information 1 ed i
ordinances and state laws relating to it g c struction. I authoriz epresentatIves of Cupertino to enter the above-identifi d prop rty for inspection purposes.
1 Dater
Signature ofApplicanUAgenL
SUPPLEMENT INFORMATION REQUIRED
,,kLAiY` ''
SX,�t'
,>' TEcXcTia? ,
y
_ New SFD or Multifamily dwellings: Apply for demolition permit for
❑ OVF,RTii.E40UJVT1"R r
❑ '
existing building(s). Demolition permit is required prior to issuance of building
�Ul[,DtNC��IANSIt�'S'I�W`/
permit for new building.
❑ I XPRSS ; �,
❑ PTfA NJNC� P At�1tYTW ;"
Commercial Bldgs: Provide Hazardous Materials Disclosure'
❑
W(5l�11cS
a completed
�'["ANAARA
,P ttLJ�C j �
form If any Hazardous Materials are being used as part of this project.
D ° i:A
C
_ Copy of Planning Approval Letter or Meeting with Planning prior to
RGE
❑'�-�
FIRE DEPT
❑
submittal of Building Permit application.
SA(11fiA6Y SEwLJtDI$TRiCT
❑ ENVIROPiMENTAL HEALTH"" ,
BldgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
�FEE ESTIMATOR - BUILDING DIVISION
10ADDRESS:
7456 rollingdell dr
DATE: 08/15/2013
REVIEWED BY: Mendez
� APN:
BP#:
*VALUATION: 1$35,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
��I/wr Pohl" /Yl5'f`!.ET-L-
PENTAMATION 1R3SFDREM
PERMIT TYPE:
WORK
kitchen remodel 205 sq ft to include new skylight, window, relocate window in family room and sliding
SCOPE
door
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc). These Pees are based on the preliminary information available and are only an estimate Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff 711/12)
FEE
Wc'h, No, t'ho,k
C"(lwd'. i'l(xu
Pi(m l'J/we
h t't°e
-L-
l' /ooh P( 1'3211
s.f.
$626.00
aril Pc''.
(i�Lh l'f ;�/Pt Yi f7 -ET
��I/wr Pohl" /Yl5'f`!.ET-L-
.
C 4w) /Str,, )n9p
t. hrv
W("'c "' kcl'c
j1j,,/) tiiv/� J,,r
Al'-, ns�r, (��c".
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc). These Pees are based on the preliminary information available and are only an estimate Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff 711/12)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00F-2057
s.f.
$626.00
Remodel, Kitchen (<=300 sf)
1REMRESKIT
Suppl. PC Fee: Q Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
=#
$976.00
Window / Sliding Glass Door
1WINNEWNST New (Non -Structural)
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg. Q
OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Crsrr.arm tion To.':
F
�lrlrrrlrcl.tit�-ratea c' C">�.�:
Work Without Permit? 0 Yes (E) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
0
i
7 -o vel l )ocirFrwnto1ion Fccs:
Strong -Motion Fee:
IBSEISMICR
$3.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$2.00
f>�f►l['�
$5.50
$1,602.00
TOTAL FE:<
$1,607.50
Revised: 07/01/2013