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B-2018-0521 (2) CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR; PERMIT NO:B-2018-0521 10265 E ESTATES DR CUPERTINO,CA 95014-3312(369 08 011) SCHICKER INC CONCORD,CA 94518 OWNER'S NAME:TABATABAI ALI AND ZOHREH DATE ISSUED:03/29/2018 OWNER'S PHONE:408-343-0968 PRONE NO:(925)6764422 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B.C-61/012 Lid.#915382 X BLDG—ELECT_PLUMB Contractor SCHICKER INC Date 05/3112018 I hereby affirm that I am licensed under the provisions of Chapter 9(commencing —MECH$RESIDENTIAL_COMMERCIAL with Section 7000)of Division 3 of the Business&Professions Code and that my license Is in fall force and effect. JOB DESCRIPTION: BATHROOM REMODEL-(62 SF) I hereby affirm under penalty of perjury one of the following two declarations: r. I have and will maintain a certificate of emrscat to self-insure for Worker's Compensation,as provided for by Section 3700 o£the Labor Code,for the performance of the work for which this permit is issued. i. 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 permit is issued. Sq.Ft Floor Area: Valuation:$11000.00 APPLICANT CERTIFICATION 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 APN Number: Occupancy Type: and state laws relating to building construction,and hereby authorize 36908 011 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,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City In consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally,the applicant understands and will comply with all non-point source regul Ins per the C ipertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. ' f Signature Date 03/2912018 Issued by:Jasmine Archbold Date:03/29/2018 O W NER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of theRE-ROOFS• following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is t. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for compensation,will do the work,and the structure is not intended or offered for mspectien. sale(Sec.7044,Business&Professions Cade) z. 1,as owner of the property,am exclusively contracting with licensed Signature ofAppli.,,t: contractors to construct the project(Sec.7044,Business&Professions Code). Date:03/29/2018 1 hereby affirm under penalty ol'perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER r. 1 have and will maintain a Certificate of Consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Cade,for the performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE z. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materialsrequieants ander Chapter 6.95 of III Section 3700 of the Labor Code,for the performance of the work for which this Callfm nin Health&Safety Code,Sections25505,25533,and 25534.1 will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the a. I certify that in the performance of the work for which this permit is issued,I Health&Safety Corte,Section 25532(a)should I store or handle hazardous shall not employ n in an manner so as to become subject to the material.Additionally,should 1 use equipment or devices which emit hazardous p y any person y 1 contaminants as dented by the B Ana Air Quality Management District l Worker's Compensation laws of California.If,after making this certificate of will maintain complionce with the p,rNno Municipal Coda,Clmpter 9.12 and exemption,1 become subject to the Worker's Compensation provisions of the the IIealth&Safety Co e,S eHuns 2550,25533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Data:03/29/2018 I certify that I have read this application and state that the above information Is CONSTRUCTION LENDINC AGENCY correct.I agree to comply with all city and county ordinances and state laws I hereby affrm that there is a construction lending agency for the performance relating to building construction,and hereby authorize representatives of this city of work's for which this permit Is Issued(Sec.3097,Civ C.) to enter upon the above mentioned property for Inspection purposes. (We)agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments,costs,and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code,Section 9.18. 1 understand my plans shall be used as public records. SignatureDate 03!29/2018 Licensed Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 ts CUPERT[NO (408)777-3228•FAX(408)777-3333•buildin cupertino.org ❑NEW CONSTRUCTION ❑�A-+DDITION ALTERATION/TI ElREVISION/DEFERRED ORIGINAL PERMIT'S _'7 7-1 PROIECI ADDRESS /�ZO` /..,Ir+ )/� /��Iy,,./)� APN)k) Q�/)�)�(� OWNER NAME'?-14,r�},u J94�t.}nI UPI�-I"1)"J�/ tV - PHONE�lvb�7�-D/Od -E`.S ILl/(� (J ( a _bak ?s�oo Jao. STREET ADDRESS/o / J'�J��^ �DY CITY,STATE,ZIP ) CONTACT NAME 1!C.'Oh 'K'0.iJ�'1 PHONE �`L-676�f J4'Zz _I M (miCi9 JGh1e Lei'.G STREET ADDRESS II D t�/IY j/� J1'L CITY,STATE,ZIP✓/^a ONNER ❑OWNEER._B/uitnEER ❑ONNERAGENT JO CONTRACTOR ❑CCI'RACTOOk AGENT ❑ ARCHITECT`J❑dENGINFER ❑GDEEVELOPPER ❑TENANT CONTRACTOR NAME LICENSE NUTABER �!;7 /-7 LICENSE TYPE (jJ � 027Z COMPANY NAME r V j +CEMAIL FAX 7 STREET ADDRESS - CITY,STATE,ZIP , PHONE ARCHII'ECT/ENGINEER NAME ISENUMBER BUS.LIC k COMPANY NAME E-MAIL FAX STREET ADDRESS _^------— CITY,STATE,ZIP DESCRIPTION OF WORK. W4] ..��,ryO1sN 2 f F��i Y�,z) T�l,��)r clec,\tYGR �clrowd d(�FG1 (au ctnJ V9GRht� S-eh-fde2 EXISTING USE PROPOSED us. CONSTR TYPE ii STO i S x _ USE TYPE OCC. SQ.FT. VALUATION(S) EXIS'fG NEW FLOOR DEMO 7 TOTAL AREA AREA AREA - NETAREA BATHROOM /'7(�J��( KrTCHEN OTHER REMOOELAREA OREMODELAREA REMODELAREA PORCHAREA DECK AREA TOTALDECK/PORCHAREA GARAGE AREA: LJDHACH ❑Ai TACH *DWELLINGUMrS: IS A SECOND MIT ❑YES SECONDSTORY ❑YES BEING"'D? ❑NO ADDITION? ❑NO PRE-APPLICATION ❑YES IFYES,PRO—E COPY OF IS THE BLDG AN ❑YES PLANND� C-EIYFt1 BY =ck - TOTIAL VALnUATION; PLAXMGAPPL: ❑NO GAFPROVALLETTER EICIIIRHOIIIE? ❑NO P--. - { VL By my signature below,I certify to each of the following: 1. the property or�ner or authorized agent to act on the property oeroer's behalf.I have read this application and the information I at e provided is correct I have read[he Description of Work and verify i[is accurate.I agree to comply with all applicable local ordinances and state laws relati to eiyingco t coon,I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature ofApplicanUAgenC _ Date: SUPPLEMENTAL INFORMATION REQUIRED New SFD or Multifamily dwellings: Apply for demolition permit for OS'ERZ'HECOUL TEA BT]IL➢LNG PL .REyIEN,? existing building(s).Demolition permit is required prior to issuance of building - permitfarnewbuilding. ExPz .:a ®pzaN GPL R> _Commercial Bldgs: Provide acompleted Hazardous Materials Disclosure {--��,fR➢�� cF o-uuc��- form if any Hazardous Materials are being used as part of this project. _Copy of Planning Approval Letter or Meeting with Planning prior to a r y �'3JYiiS9R SP�TY§ARYSEF`ER�ISTHTC submittal ofBuilding Permit application. BldApp_2011.doc revised 06/21/77