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07120087CITY OF CUPERTINO l TT BUILDING DIVISION PERMIT RM BUIL I G D FSS: PERMIT NO. ���� BYRNE AVE REZA RAFII 07120087 OWNER'S NAME: PERMIT ISSUE DATE REZA RAFII 10484 BYRNE AVE 06/11/2008 PHONE: SANITARY NO. CONTROL NO. ARCHITECr/ENGTNEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION I hereby licensed Chapter 9 Job Description affirm that I am under provisions of (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is S FDWL —1 , 3 9 4 ' DETACHED GARAGE 4 0 0 ' in full lora and effect License las Lia N 5/20/08 XTRA 11.5 HRS SUPPL PLAN CK FEES ADDED TO Date Contractor v ) ARCHn=sDECLARA N FEES. I understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractors License Law for the following reason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed to the of the Contractor's License Law (Chapter 9 Sq. Ft. Floor Area Valuation pursuant provisions (commencing with Section 7000) of Division 3 of the Business and Professions Code) or $600000 that he is exempt therefrom and the basis for the alleged exemption. Any violation of .. Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of 35714013 Number OCGll Occupancy Type not more than five hundred dollars ($500). ' ❑ 1, 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 and Professions Code: The Contractor's License Law does not apply to an owner of e Q ns p Required Inspections propeny who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year o! completion, the owner - builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑ I. as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li- cense law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law. ❑ I am exempt under Sea , B & P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 4 iha+c and will maintain a Certificate of Consent to self -insure for Workers Compen- sation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued ' My Worker's Compensation insurance carrier and Policy number are: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) or less.) I certify that in the performance of the work for w ' h is p emit is issued, 1 shall not employ any person in any o cl to m j e Workers' Co ensadon Laws of California. D c 1 Applicant NOTICE TO APPLICANT: If, after making Ifiis Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you in= forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (See. 3097, Civ. C.) Lender's Name ' Lender's Address I certify that I have read this application and state that the above information is correct 1 agme 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, indemnity and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in anyway accrue against said City in consequence o e gtanung of this permit STANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date S. / , !f�RIKLA�MN Re -roofs Type of Roof © Si o ApplicaDate HAZARDOUS US MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safely Code, Section 25532(a)? ❑Yrs �No 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 Wil] the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes No 1 have read the hazardous materials requirements undcrChapter 6.95 of the Califor- nia Health & SafciyCoda tions 25505, 25533 and 25534.1 understand that if the building docs not cu tl a pant, that it is my responsibility to notify the occupant of the requiremen chInube mel prior to issuance of a Certificate of cu an Signature of Applicant Date ® All roof coverings to be Class '',x{`' or better Owner uthorizcd agent Date