01110112 CITY OF CUPERTINO -
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
•BUILDING ADDRESS: PERMfr N0.
10704 GARDENA CT 01110112
OWNER'S NAME: APPLICATION SUB DATE
SAAH ABDULLAH D AND HALA 11/27/2001
F HONE: SANITARY NO. CONTROL N0.
O ARCHITEC IE-NGINEER: BUILDING PERMIT INFO
w-r ... .. pG., E CT UMB F -
Z 6 I - - —_
an co LICENSED CONTRACTOR'S DECLARATION Job e$Q
as
i Z,_ I hereby affrm that I am licensed under provisions of Chapter (commencing •
=C5 with5ectioa7B10)o`Dim„ma3ofthe Business and professions Code,and mylioase FIRE DAMAGE REPAIR �A
ix is full force and effect.
s ce
g a ,License Class' Lir.p
i3.9u'-Data Contractor
u.G : _ ARCHITECT'S DECLARATION ZOO
-E O 5 1 ndcrsmnd my plan hall be used a public rad.
5 'CD'
'rc.0 d L abnaed Prdfa conal '.- - . - - .1 •
OR RER eUB:DER DECLARATION /y _
m ,r}sl htt by eff nthtlam ex ptf mthC t t License La for the u• 90000
F,Z f Ila ng ma nn (Semi 7051 5 Bus nes, d P f Code Any c ry c unry �i9
which requital a Permit to consumer after.imprewc,demolish, repair any sumature
3
prior to av issuance.al a requires the applicant for such IvemaiL to file asigned m:eme t - - - - - -- -. -------
that he 1i licens
r_... _ __ __. . .. - _ __ __dhathe[sheens ith Saennothep sosof the Contractors License Law(Chapter 96.C.f8F]�Arp® j� ,I Valuation
(cora n ¢ng with Sect 0 7IXq)of Division 3 of the Bnsin<ss and P nfezmons Cod) (, O n” � �c _V Y) V. - 4, t 9 p
or:hut he is exempt thcafmin and the basis bathe alleged]6empuon,Any violation l
of Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty'
.d not more in..five hundred dollars(550M4 1 OAPN Nlt�DATI ON "^ Occupancy Type
'❑1,as owner of the property,or my employees with wages as their sale compensation, 102 - PIERS
will do the work:and the xtmnure-is-not intended or offered for sale(Sec.7[114,
iBminuas and'Pm`essinns Cade:The Counsel.,'.License Law docs not apply to an 103 - UFER Required Inspections:,"
owner of property Who builds w improves themon,and who mars such amok himself
' or thmu h his own employees.Provided that such improvements arc not intended or _ _ 104 - REBAR _
ar int orienuou is acyld within aneyearof '- -
_ e..
comp) orsmear,noweeerwill avec p 105 - ANCHOR BOLTS d
' completion,the ownerbuildm will have the burden of proving that he did not build or
improve fm paq,ouuof s]a.). 106 - SEWER & WATER
,41ow -r--- xcu, .- nt ng
pl,m owner of the prnpeny,am exclusively contracting with licensed mntiactorsm 202 - UNDERFLOOR' PLUMBING'- ;,l:;-:: ,. -" "-
eomwa the project(Sec.lou,Business aad Professions Code:)The Conva<mn
203 3 - UNDERFLOOR MECHANICAL`' ` , ..
License Lew does no[apply to an owner of Portray who builds or improves memon, .
:.land who contracts for such pmjws with a cottontails)licensed pursuant to the 204 - UNDERFLOOR 'FRAME
'---- •--- --"--'
Contiactora License Law. . �------ -
❑l am exempt under Sec: ,B-&P C sur this amino 205 - UNDERFLOOR ''INSULATION
owre: Dade" 301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER
...��r•• --I hereby arena under penalty of perjury one of,the following demaations: 303 - ROUGH MECHANICAL
I�heve'unp wiil huintiin'a'Canificae of consent m self-insure sur Worker's 304 - ROUGH ELECTRICAL
pepipensappn,:aa.,provided [,Jnr far by.Sertmn.37M of the Labor-Cadthe
aform nee o`the worCfh which mea pe:mn i$issued: - 305 — FRAME``' 4'-
'❑-he1eu1'tdwill miA.i'n Workor'i CompmWion hwsmna..mclairedby Sachsen 306 - HOLDOWNS - -'—' - -
3700 of the Labor Code,for the performance of the workfor which this Permit is 3 0 7 - INSULATION
" ' issued.My Workers Compensation Imorro ae cancer and Policy number ere -
. , . . .. 8 K —
: • 1 ).;3.y, -3.0 -::SHEETROC ,
carrim:• Policy No.:' ...
" ;cERTIFlCATIO, OFE%EMPI'ION FROM.WORKERg'�- \ 7:'. I -�3O9 ` EXTBRIORa'LATH
_COMPENSATION INSURANCE"' "
' .'3'1'0.';=�7 INTERIOR-liATH-;,—;•;--. -�:::_.._.___.-sees----------
._.. __..
t' '(This'secvian need not he completed if the permit is for one hundred dollars l-s ..!It•L^ ,
.. 311 - SCRATCH COAT
,3.1.3.._ „ROOF NAILS,..
." I t fY tlmt in dM1 Pert mtunce of the wo k'f h ch tht per n I ssuW I t r
shall t employ any person nay manner
as m become a hjem t mFworkeri 501 - FINAL ELECTRI CAL ENERGY
Applicant o�,�w.w`q eYf m Date
Appl am C/i�/[nfaf,n _ sees ..502- FINAL. PLUMBING ...ENERGY-, .._.__... ..
OTIC,TO PS�PUCAFT:IL after making Nis Cmiecem of Exemption,you should G'
z becamesubjectT dieWorkeriCompensate.PrnvisionsoftheLuharCode,youmust 503 - FINAL MECHANICAL 'ENERGY
O'O rorhwim[omplywithauchprovision:orthiapermnanmlhdamedrevokcJ. ., 50.4 . FINAL .BUILDING ENERGY-._-
- _w its..-hpor"I_sor
,rA�, "a '• '�.' "" CONSTRUCTION LENDING AGENCY- 505 - FINAL ELECTRICAL 11t ••'
thereby-uRrin thatthere ise construction lending agency fw the,Perfonnence' ... f.L'.::: •'t: ..
Snnq pork rot wmrn mit p[rm�t�:y.o asyea ls[c.Jo97,cies c.) t _ _ __ 5 0 6 — GAS TES T Lender•$Name- -: _ -.._-sees_ . . ._._ ,.__. -
p Z Lenae .nddrcaa 507 - FINAL PLUMBING .
I certify that 1 have mad this application and state that the nbave information is 508 — FINAL ME CHAN I CAL I -
gT+ F., ammo.1 agree do an
with all city and county ordinances and state laws relating 509 - FINAL GRADE
O.sr, to building emauia,,on;and hemby a:ahorize'mpresentatives of this city to enter upon
the above-mentioned p,.pany far inspection purposes.. 510 - FINAL PLANNING
9 Wc)agree to save,indemnify and keep hannloss the Ci[y of Copetino against
F'V]
liabilities,judgments,coolsand astramse,wh eh may in any w y arae ngainet said 514 - F INA PU IC
U'7� City n on equence of the granting this Permit. -
T APP CANT UNDER NqS AND WILL COMPLY WITH ALL NON-POINT,: / 1 l[ •/
so'xe i' s ;, a Issued by: Date a -V
gnat re a pplic nt Contractor'.,+'V:..'... )t seata•.. . Re-COOTS �—
'" ' HAZARDOUSMATERIALS DISCLOSURE {
:,Wil the applicant 6ef6 m building ocmpadt$tort di handle heuidous m tenial Type of Roof-
defned by the Captaincy Municipal Code,LTapmz9.13,and the Health and Safety
Code
Section (a), '.y. . . i`t 1 s __ - .._... .';',an i...-�•t-sees.
11 YI
=_ i All roofs shall.be inspected pnor.to,any.roofng material,being,installed. .......
. -.
.WillthcapplicentarfuwrcWildingoccupemuueyuipmcmordcvittawhich ]f a roof is installed without first obtaining an inspection,"Pagree:to remove
ii huzank us air contaminants as defined by me Bay Area Air Quality Management
Californiaain? , '
(� all w materials for inspection. t comply ,- -sees_
Di a new pe Applicant understands and will with
0Ys, ❑N
c' non-point source regulations.
1 h <mad the hazard s mat Is 505 rem t ntl r Chapter 6,9i of Ne
Health ravan Safety Code Sections 25505 25533 and 25574 I understand that
hF Idol or sod rte dlyh am atthttany po.,hllyt notify the
< d f th quirem'. h h m-'t be t p or m[sauce e f a Ceaifi6im of 1_JQ 7i 7
:.. tOc franc ., D .-
�.� Signature of Applicant Dat
27 a
m.,author. agent' Date. All roof coverings to be Class "B"or betier
OFFICE