14080245-DI
I
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19950 BAYWOOD DR
CONTRACTOR: A- MINZADEH PAYMAN
PERMIT NO: 14080245
AND LINGG KARIE
OWNER'S NAME: AMINZADEH PAYMAN AND LINGG KARIE
19950 BAYWOOD DR
DATE ISSUED: 11/06/2014
OWNER'S PHONE: 4088328869
CUPERTINO, CA 95014
PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
CONSTRUCT A ONE STORY ADDITION (703 SQ FT);
License Class Lic. #
F'RON'T
PORCH (56 SQ FT); INTERIOR REMODEL, (1577 SQ FT);
Contractor Date
200 AMP PANEL. UPGRADE.
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
Sq. Ft Floor Area:
Valuation: $90000
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
APN Number: 31630006.00
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 ®F PERMIT ISSUANCE OR
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 Fli 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
hy
granting of this permit, Additionally, the applicant understands and will comply
Y: Date:
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)
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. 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
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
1 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
0,
Owner or authorized agent: Date:
permit is issued.
l 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
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. 1 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.
p
Signature Date_ I L__�L+
lA
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT o BUILDING DIVISIO 01
10300 TORRE AVENUE ^ CUPERTINO, CA 95014 -3255
V
C '408,777 -3228 FAX (408) 777 -3333 bu�lding�a�cupertino.org
1[Bl�t1 i (Ll�i��
❑ NEW CONSTRUCTION E4 ADDITION ❑ ALTERATION ( TI ❑ REVISION /'DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS
O
I ' r ®
APN #
OWNER NAME
IH�ONE�„yt���� �/
lZ/IP�
E -MAIL
STREET ADDRESS �� �� u
CITY, STATE, � �n
FAX
CONTACT NAME 3
PHONE �01 b°
STREET ADDRESS* A2(�
CITY,,STATE, Zl%, ,
FAX
❑ OWNER 11 OOWNER-- B6UILDER 11 OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
.CONTRACTOR NAME
LICENSE NUMBER LICENSE TYPE
BUS. LIC #
COMPANY NAME
E -MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
AR� CT/ENGINEER NAME
I
LICENSE NUMBER
BUS. LIC #
COMPANY NAME %a i� `
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E -MAIL F per,, &„ p.�j0V JT* II f
I `p� rYrl 0�!%U UU�°� °
FAX
STREET ADDRESS
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CITY, STATE Cd
PHONE/
"� �J
DESCRIPTION OF WORK w p p�„ ` y� tj, A
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1 mneL +o = - N tomp Fecf
EXISTING USE
T
PROPOSF,p USE
CONSTR. TYPE
H STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION ($)
EXISTG tt.
AREA y r�• y
a
NEW FLOOR
AREA —7b -L
DEMO
AREA /�, �D
TOTAL
NET AREA
( /�r1�
V 1
03
BATHROOM
REMODEL AREA �LIo
KITCHEN
REMODEL AREA
OTHER
REMODELARR z
PORCH AREA DECK AREA TOTAL DECKRORCH AREA GARAGE AREA: DETACH
TTACHliJS
•
# DWELLING UNITS: IS A SECOND UNIT �ES SECOND STORY OYES
BEING ADDED? O ADDITION?
PO
PRE - APPLICATION ❑ YES IF YES, PROVIDE COPY OF
PLANNING APPL # 9NO PLANNING APPROVAL LETTER
IS THE BLDG AN ❑ YES
EICHLERHOME° 0
RECEIVED BY:
OT&L VALUATION:
By my signature below, I certify to each of the following: I am the property owner or authorized agent to 161.wKhe property owner's behalf. II 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 to building constructiorL I auth nze representatives of Cupertino to enter the above d ope for inspection purposes.
pV
Signature of Applicant/Agent: Date: !S
SUPPLEMENTAL INFORM ION SQUIRED
PLAN CHECK TYPE
ROUTING SLIP
❑ OVER -TH &COUNTER
5U1L1ING PLAN REVIEW
New SFD or Multifamily dwellings: Apply or demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
❑ EXPRESS
Iff PLANNING PLAN REVIEW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
STANDARD
PUBL C WORKS
_
form if any Hazardous Materials are being used as part of this project,
❑
LARGE
FIRE EPT
Copy of Planning Approval Letter or Meeting with Planning prior to
❑ v1AaoR'
SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL REALM___
BldgApp_2011.doc revised 06121111
Wf TrrTR7 d`hl 1 Wf Tr TIMT . 1Mn711TATAl.
MECH, HOURLY O Yes E) No
%L.1L R u lkyJC V. 1U 1C 1L01*i 1L lll N ILd
FEE ESTIMATOR - BITI LOENG ID>IVESEON
ADDRESS: 19950 baywood dr DATE: REVIEWED BY: Mendez
EILEC, HOURLY ® Yes Q No
APN:
BP #:
*VALUATION: 1$90,000
PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY
USE: SFD or Duplex
2nd Unit? Yes No
OTC? O Yes °
�IVo
PENTAMATION
1 R3SFDREM
PERMIT TYPE: d
W703
s ft addition to front of sfdwl orch 56 s ft remodel throe h out 812 s ft; 200 am anel u rade
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$0.00
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE IID
BP (FEES
BP FEE ID
R -3 (Custom)
II- B,111- B,IV,V -B
759
$2,654.00
IR3PLNCK
$1,666.00
1R31NSP
PME Permit Fee:
$48.00
Construcil'on lax.
A, li✓rr('liktralivc FcL('.'
O
Work Without Permit? O Yes Q No
$0.00
Advanced Planning Fee.
1PLLONGR
$106.26
Select a Non - Residential
Building or Structure
TOTALS:
759
$2,654.00
Stron_ Motion Fee:
$1,666.00
$11.70
MECH, HOURLY O Yes E) No
PLUMB, HOURLY Q Yes Q No
EILEC, HOURLY ® Yes Q No
11e, +t. (7a ck
i'lrurrh. Plea [ :b(c;
Elec. Plan Check 0.0 hrs $0.00
b1ecH. Permit Fees
phll -nh. Permil Pee:
Elea Permit Fee: /EPERMIT
Orlf( r tlechr irrsp�
Oflh r NUMb I»SP
Other Elec. Insp. 0.0 hrs $48.00
Al"th- %nsp. he':'
P171111h, lnsr ). Fee
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NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc.). These fees are based on the Preliminary information available and are only tin estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11 -053 Eff: 7/1,/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,654.00
812 s.f.
$575.00
Remodel, Other
IREMRESOTK
Suppl. PC Fee: ) Reg. Q OT 0.0 hrs
$0.00
PME Plan Check:
$0.00
200 amps
$48.00
Electrical
IBELEC200 Services
Permit Fee:
$1,666.00
Suppl. Insp. Fee:0 Reg. O
OT
0.0 Lhrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$48.00
Construcil'on lax.
A, li✓rr('liktralivc FcL('.'
O
Work Without Permit? O Yes Q No
$0.00
Advanced Planning Fee.
1PLLONGR
$106.26
Select a Non - Residential
Building or Structure
Q
di
Travel Documentation Fee: ITRAVDOC
$48.00
Stron_ Motion Fee:
1BSE1SMICR
$11.70
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$4.00
SUBTOTALS:
$4,537.96
$623.00
TOTAL FEE;
1 $5,160.96
Revised: 07/10/2014
cuf•�E r�T ir�c•�
CONTRACTOR / SUBCONTRACTOR LEST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014 -3255
Telephone: 408 - 777 -3228
Fax: 408-777-3333
JOB ADDRESS: 19C Dp
PERMIT
OWNER'S NAME:
PHONE #
GENERAL CONTRACTOR:
BUSINESS LICENSE #
ADDRESS: gotjMa c6l,5f
CITY /ZIPCODE:SAA 1=6au IS—L3
*Our municipal code requires aill businesses working i One city to have a City of Cupertino (business license.
NO BUILDING ]FINAL OR FINAL OCCUPANCY INS CTtO S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRA T OjE OBTAINED A CITY OF CUIPIE INO
BUSINESS LICENSE.
I am not using any subcontractors: �
U L to
]Please check applicable subcontractors and coi u tMe following information:
r9
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
/LW
Owner / o ntractor Signature
91te