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06010013 (2) CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRAGTORINFORMATIQN BUILDING ADDRESS: PERM'NO.0 6 010 013 OWNER'S NAME: PERMIT ISSUE DATE KALAI MEHDI AND LINDA S 01/04/2006 ONE: SANITARY NO. CONTROL NO. 7ARC,,HITEC`VEPIGlNEER: - BUILDING PERM'INFO BLDG ELECT PLUMLICENSED CONTRACTOR'S DECLARATIONJob Descri tion 1 hereby affirm Nat I am licensed under provisions of CMp er 9(commencing pSwlle.7M).&Divirim.3.d Ne Business and Prollum.Codgand my license is 1form,ed, a '7 —?2 —9� CHANGE OUT FURNACE Lace Laceseelm— v Lo.ver r4.AND I CENTRAL HEATING AND AIR PAID FOR THE B/ TSDElCr As shall x use DECLARATION A 2 � larrdenundmyplanahmbeaacumpublic reenNs IN THE FINANCE DEPT ON 1/4/06 R# 9511 ;LL LICCCRd PN(CWnna h� OWNER.BUILDER DECLARATION I Mrehy affirm that I am exempt from the Conuenos's License law for the E O o following reason.(Section 7131.5.BNiaess and PR@ssiuN Cole:My city M county S$ which rtqul.•Permit m cmrurteL slur,improve,tha oluh.ver open,any mucmR prior M its issuau'e.also requires the Applicant(orsuch permit to file a signed statement FF< that hculicensed punuanttotion provisioNMthe Comectur'sUccome aw(Chapicr9 Sq. Ft. Floor Area Valuation SS (commencing with Section 70DO)of Division 3ofthe BusineuandProfession,Crude)or $2648 that be is exempt therefrom and the huts for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the Applicant M a civil penalty of APN Number jjf�� Occupancy T1 not mom than five Washout dollars(SS00} ^ p y Ty(e y ❑1,As owner of the propery,a my employees u with wages their sole compensation, will do the work,and the sume ure is not intended or onertd fa Ne(Sm.7044,Business n�•.t a and Professions Cade:The Contractor's License Law does not apply m an owner of Required Ins f ecttpns(("a property who bulldsorimpmwa human.andwW dreuah weak himself orthrough his own employes,provided that such improvements Art act lnundW eao@red fosala it, •/iQN �S/ however,the building or improvement is sold Within ane yech ar of mptco ti ,the owner- ////ryry��33/a q {� 7 "to.) WE have the Nw ndof ProWng Nat he m build nlld ver improve fa purpose of sale.). ❑I.a,owner of the property,am exclusively contracting with licensed commum ,M mom Law the project(Sec.704,4,owner Business and Profession Cade:)IIIAves the em.Lid cone law docs not apply M ts owner of propeny.wN Nd p m improves Nemo,and whocontractsLace fa such projenA with a eonuacurtU licensed purtwm M JM ConvacmM1 0 l err ase. ❑lam eaemPt under See ,Bk PCfar Nis,esson Owner Dau Adlik WORKER'S COMPENSATION DECLARATION I hereby affnm under penalty of perjury are o(Ne following declenuoN: I haw and will munuin ACeNfiwM orConem an self-inure far WorkerACooper- Asian,As Provided far by Seamon 3700 of Oe labor Code.fa the performance of the wart for which this Permit is issa. ❑i have and will maintain Worker,Compensation Inunance,u required by Section 3700or the Ia1Wr Code,for the performance of the work forwhich his permit is issued. My Workers Compensation Inmrance eauier and Policy number are: Canis. XC 4WPolicy No.: CAICATE FEXEMPTION FROM WORKERS COMPENSATION INSURANCE Gbls section need rest be completed If the permit is forom hundred dollars($100) or ICm) I certify that in the performance of tie work far which this permit is issued,I shall not employ any person inmy manneru N an as an become subject e Workers'ComN peation Laws or Calitmela.D.12) Applicant —�6e..e — NOTICE TO APPLICANT:If.aMr making this Ceti of Exemption.you should become subject an the Worker's Compensation previsions or Ne labor Coda you most roMwiN comply with such provision or this permit shall be dcemcd revoked. ,Z.r�••' CONSTRUCTION LENDING AGENCY [••�� Ibarely annm that Jure is a commuction lending agency Rome perforamom of lYi ti uM work for which 444 permit Is issued(Sex.3097,Co.C.) Wh Q Lender's Name 0.z Lcadees Address , U O I modify that l haw mad this application and suss NH We,bow Inform W un u IT.F torten.l qnw to comply with all city and county ordinances and suss laws relating in - OO Wilding construction.and hereby motorize repreamatiu of this city an enm upon due alpw-menllancd Property for inspection PurpaYi. L-,a (W b ayntt to save,indemnify and keep harmless the City of Cupertino against GG list liabilities,judgments,costs and expenses which may in any way accrue.;.last mid City U In consequence of the granting of this permlt. A 41CANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 322 REGU TIO 6/-6L-1-66 Re-roofs Signuune of ApplifthunConuacto DAM HAZARDOUS MATERIALS DISCLOSURE Type of Roof WIII the applicant or future building occupant store orhandlc haNadon material u defend by Ne Cupertino Municipal Code,Chapmr 9.13,and the Health and Safety sue,Seeman sss3z(.)7 d No All roofs shall be inspected prior to any roofing material being installed. ❑Yes Yj Will the Applicant or future Wilding occupant use equipmentor devices which If a roof is installed without first obtaining an inspection,I agree to remove It hamydous at contaminants u defined by Ne Bay Area Air Quality Management all new materials for inspection. Atrict7 ❑Yea RJ No I have real JM harardoN meurials requirements under Chapter 6.95 or the Califon -is Hart"SLrctyC.&,Section 25505.75533 And 25534.1 undcmaeA that truss Noting dove not currently have a Ment that it is my responinlity M notify the moment or the npgJ�Cmenu conic mu metp artimamce nreceninwMar 06""67 cwpaney. Signature of Applicant Date 1 a 2/ —D 67-04 All roof coverings to be Class"B" or better Owner at auNodycJ a;ca Dau Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CI m Fax(408)777-3333 �UPEkTINO Building Department JOB ADDRESS:. PERMIT # Z ( Olodl3 OWNER'S NAME: L PHONE #5'/G-3 7 -2-1-1 3S GENERAL CONTRACTOR: ^ _n FAX # I am not using any subcontractors: `�ICR�Q__ �-✓` �— —�6 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 Ornamental Sheet Metal Painting,/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date ' O�o.1o013 a� CITY OF CUPERTINO FURNACE/AC CITY PERMIT APPLICATION FORM APN # 3- t 1- 3a, 003 Date: _ Building Address: Owner's Name: / Phone#: L 1A Contractor: Phone: License #: Ceptact: Phone: Cuperti o Business License#: —LSZ '� gi51 \ IN1010 Building Permit Info: Bldg ❑ Elect B� , Plumb Er Mech S Job Description: Y,. Residential Commercial ❑ For Residential Installations: Attic ❑ I" floor W 2"d floor❑ Adhere to min set back requirement E] For Commercial Installations: Replacement same weight ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Prot: Type of Construction: Occupancy group: jec Strapped ❑ On Platform ❑ Bonded ❑ Sq.Ft. Floor Area: New Location ❑ Replacement Qty. if Applicable Fee ID Fee Description Fee Group BENERGY Energy BUILDING BREMFURN Furnace MECHANICAL BREMACOVER A/C Unit> 10,000 clin MECHANICAL BREMAIRHAN A/C Units<= 10, 000 cfm MECHANICAL BREMRECEPT Rec tl, Switch & Outlets ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILIDNG EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BPGAS Gas Piping System Fee PLUMBING BUSLIC Business License BUILDING