03090059 CITY OF CUPERTINO -"' a"z' -
BUILDING DIVISION PERMIT WCON�'RACT.OR INFOkvi TION.
DAM ASKART /21
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BUILDING ADDRESS: ADAM ASKARI PERMIT N0.03090059
1. 363 CAM11sTO VISTA IDR
R'S NAME: PERMIT ISSUE DATE
NE: SANITARY 8 CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
CJ O D l�
30o LICENSED CONTRACTOR'SDECLARATION Job Description
VF 1 hereby air,,.Net 1 em licmnseun
d der provisions of Chapter 9(commencing
EY`uj with ScetianTIXM)of Division 3 of NC Been msand Pmlexabok Codc.end mylimnse ie
s in full force and affect.
License Class Lic.0 DEMO
3t„ Dam Contncmr
¢ ARCHITECTS DECLARATION
f$U 1 understand my plana shall k used as public records
a
'0� Licensed Pmfcuionel
'y5 OWNER-BUILDER DECLARATION
a X I hereby affirm that I am exempt from the Contractor's License law for the
OO following mason.(Section 7031.5,Business and Profession Code:Any City Or county
$ which mpims a Permit to ecoutmcl,alter,improve,dcmnlixb,m repel,any structure
poor to its issuance.also requires the applicant forsuch permit to file asigned anammenl
that he is licensed pursuant to the provisions film Controcmh License Law(Chapter 9 Sq.Ft. Floor Area valuation
� $ (commencing with Section 70M)n(Divisma 3 of the Busineuond Putescinns Code).1
Nin he ts exempt thomfnm and On,basis for the alleged exemption.Any violation of -;4214ngg In In
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of APN Number Occupancy Type
not ream than five hundred dollars(SSW),
0 T.as owner of the property,or my employea with wages at their ole nom cmation,
will do Ne wank,and Ne swcwrt is not intended oroncrtd fovale(So,7(1 Bear. 704 - DEMO Required Inspections
and Professions Code:The Conoxecum,Life.Law cima not apply m an owner of q P
property who builds orimprovia thereon,and who dmsmch work himself or through his
own cmploy cs,provided that such improvements are not intended oroffered for sale.if.
however,the building or improvement is sold within one year of completion,the owner.
builder will bare the burden of proving Net he did not Wild or improve for purpose of
ask.).
0 1,as owner of the property,am exclusively contracting with Ikened eontranon to
construct the project(Sec.7044,Business and Professions Codec)The Contractor's Li. _
.am law dura not apply b an owner of property who Wilds or improves thereon,and
who contracts for such projects with o conuacmr(s)licensed pursuant to the Contractor's
Liken.Law.
0l an eacmp senders .B At P C for this mason
A l Cp c Daa
WORKER'S COMPENSATION❑ ATION
I hereby eMtrm under penally o!perjury ore of following declarations:
I haw and will mainoin a Cenificaleof Censer to self-idum(W Walker's Cumpem
coon,as provided for by Section 37M of the labor Code.for the performance Of the
work for which ON permit is issued.
0 1 have and will maintain Workers Conformation Insurance,as expired by Section
3700 urthe labor Code.for the Performance of the work for which this permit is hound.
My Wori Compensation loan. a caniorand Policy numbs,art:
Carrier: Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
mus section reed not hecompleted lithe(omit is for one hundred dollars(SI00)
or leu)
I certify that in the performance of the work(or which this retrofit issued.l shall nut
employ ann-Meym om/ �� ken'compensation
Laws of CyHporit CAEr
ApPlicagl Ait - A ,I r-I
NOTIC�'f�APPLICANCCYK IIIcr talking I ase of emrtion,you should
k.m ject to the Workeri Campcmation provision of the faWr Code.you muse
.Jz fortwith comply with such prnvisiom or this Permit shall k dammed reveled.
Z O CONSTRUCTION LENDING AGENCY
[-� I hereby affirm that Ness its constructinn lending agency for the Performance of
a> the.,it(or which this permit is issued(Sec,3097,Civ.C.)
[p7 QLanders Name
6r Lmnders Address
U Q 1 certify Nat 1 have read this application and sone No the aww information it
IL H correct.1 agree to comply with all city and county ordinances and sum laws mlating in
O V Wilding construction.and hereby authorim repremnWivcs of this city to Cato upon the
W
above-mentioned property for impaction purposes
y (We)agme to saw,indemnify and keep hantless tk City of Cupertino again)
0 HabRides,judgmcnts,coatsand expenses which may pct any way mCmmagainsi mid City
Z in consequence of the flooding of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH AL ONPOINf Issued by: Date
SOURC GULATIONS.
CA-0'
Re-roofs
Si inurco A plicae an for Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant some or londlc haasrdum material
as defined by the Cupertino Municipal Coda.Chapter 9.17.and the Health and Safety
Section 25532(a)?
❑Yea All roofs shall be inspected prior to any roofing material being installed.
�Nu
Will the applicant nr/f/uw\\m wining«mupant use equipment or devimm whish If a roof is installed without first obtaining an inspection,I agree to remove
It bavardm nair cmmarru ucts as dcOncd by the Bay Area Air Quality Management all new materials for inspection.
airier
Ores No
Ihawrealdteharud smamoalsmquimmenuunder Chapmr6.95ofthe Califon
Iiia Heat"Safety Code,Sectors 25N)5,25733 and 25530.1 undcmand that if the Wilding
does ten crosendy haw a¢sant that in is my respomihility m netily the mcufent of the
mqui mmnu hichmm melp'ormissuanccofaconife.tompmney. Signature of Applicant Date
OA,orau@onizcdapcnl Dam All roof coverings to be Class"B" or better