01110113 CITY DM8[ON O PERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10880 SANTA TERESA DR CRAFTSMENS GUILD INC 01110113
OWNER'S NANIE: APPLICATION SUB DATE
GHADERI MIR B AND SOHEILA S 10566 S DE ANZA BLV 11/27/2001
SANITARY NO. CONTROL NO.
`HONE: (408) 366-1000
p
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
z S y= LICENSED CONTRACTOR'S DECLARATION .., - "" °",I' Job Description
O z-o I hereby affirm that 1.m licensed under provisions of esChapter Code.(commencing
„Ca, wan s«amn]o..)mroiviamn3orme Business and Parrs:ion eoar,.der httnx ��� Q• FT.
iannfnnforce andrffrra. Gjp7i59• -
m ¢
Liters Class 'Q Lis.R
3>Q Date �— Commit, 0 4 2002
F u O g ARCHITECT'S DECLARATION JUN
1 understand my plans shall be used as public accosts
ad ca
a� Licensed Professional BUILDING
OWNERBUILDER DECLARATION
the Commcmr
v1 w 1 peso .(firm that 1 1. exempt from the Coamn Co License Law for the,
CY?a whichinganon.(station]071.5,Businessand mprve.demolish,
Code:Any city or county $60000
C xH o which rcquircx a permit m constmm,alter.improve,demolish,or apart any ztmnum
a3-e -Pnormits issuaocc..lm equiiu me applicant fw such perriduo filea signed San men,
mathp is littnsee"hon"Face"mvisiomofihe Convac 'm License Law(CM1apter9 %q F� orNea,�- Valuation
(doihmeaang,wini seangn loan or Dmi,mn3n,nne ee<ineF..an�l,Pmlex.ion.cnae) _ )R; f'35b 1' �O.U§.:,PJTJ + },a.i ..
or that be is
exempt bece". .std Ne basis or she alleged eseinption.Any violation.
..(Section].31.5 by any applicant for a permit eubjecm the appbcant to anvil pebaby' p7S
of not mom than five hundred dollars(5500). 101APN;tidffhATION Occupancy Type
O 1,as owner of the property,lir my employees with wages as their sole compensation.
willdo'the work:'and the snrctme'1,nw intended m offered tar sale(See.]oqq, - - Required Inspections
Business and Professions Code:The Commemr's License Law does not apply to an 103 - UFER 9 p
owner of pmpeny Who builds or improves mrmon,and who Jon such work himself
or through his own employees.provided that such improvements am not intended or104_--. REBAR-
offered for sale.If,however:the building -onmproif
rcmrat is sold within Fide e=do r 105 - 'ANCHOR BOLTS '
completion.the owner-builder will have the harden of pnwing the hadid nm build or
improve for purpaseofsali 106 - _SEWER & WATER
_- 1 m ownr of the Property.am exclusively usively consmm.ing.wi.l.c.ense._d-'c-om-racons to -- ---202 UNDERFLOORS PLUMBING
construct .-.. __-•.__
-_. -- _-
_. _.._. . ._. .
the does
(Sec,Oto a Busies and Professions Code:)The improves
tmreon, ,
. License Law dors not apply to an owner of n �
and who.cmnrana rod such pmirrn with property cense.para a�thti`the 2 03 - UNDERFLOOR MECHANICAL"
ConaacsTer License Law.,
204 = UNDERFLOOR FRAME__... . ._____. ...... .. ..... . . ..-
❑lam rxemvt ended s5c. :B�Pefor rola aaxn 205 - UNDERFLOOR' INSULATION
Owner Data 301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER
Ihereby armmunder Penalty ofPerjury one gthe mnowingdeclamations: 303 - ROUGH MECHANICAL
}•° 1 have and will maintain A Ciatirdotr of Consent to self-mxrc for worker'. 3 04 - ROUGH ELECTRICAL
,Compensation, as-provideai for by Section 3700 of the Labor Code, for the
'performance of the work for,which this permit is issues, 305 - FRAME
°1 have and will maintain Worker's Compensation Insurance.as require)by Section 306 - HOLDOWNS
3700 of the Wbor Corli far the performance of the work for which this permit is
iout,J My kw'sc- pe tionln rancecaeierand Policy be am: 307 _INSULATION .,,. „ _,_,r_,.,__.•• ,.,_
c ^5'rd � urylvai 30$; :- :SHEETROCK_.. . _
• ;CERTIFICATIONOFEXEMPTIONFROMWORKERS'( f 'a' k 309 EXTERIOR LATH'
s COMPENSATION INSURANCE` ' , _v _..__.
... .._n. -. __ _- ..... .. .. ..
1:07-;' INTERIOR LATH -
i (This scuion heed not Inc cmmplctcJ if the permit is(nr our hundred dollars '
aloowrlesx.) 311 - SCRATCH COAT
rttj matmm,Performance mita work for svhchm pammn'ui.`tn' '- —313 -"ROOF NAIL,-` . ,L:.„tip . : - .r_-. -... .
,hall not yPerronn any manner x rob�come 1tbl«tmmeworkers 501 - FINAL ELECTRICAL ENERGY
C P< (tion Ln a9fC=are am /�7�6ET`I
Applicant�Z -- - 502 -- 'FINAL PLUMBING ENERGY,
NOTICE TO APPLICA 1 m nal trstx tticare of Exemption you should ”
z hicome.ubjewathe WolkersCompensation provisions oftheLaborCorle,you must 503 - FINAL MECHANICAL ENERGY
Z forthwith comply with such provisions.,mit permn shall he d«meJ evoked. 5 04 FINAL--BUILDING ENERGY
.F � • " ' CONSTRUCTION'LENDING AGENCY.' 505 - FINAL ELECTRICAL .. •
I h . r the performance
� ? of the work forwni nN`Imrmtis ssued(seo.Jo9Znciv.C.t Vim' 506 - GAS TEST
y n 6 8 Y
Ck. Leader's Nium, I-
R .
z 'Lena Ada, s 507 - FINAL PLUMBING[,.
U 0508I terrify that I Overeat]this appl aoTn;.nd sae the me above nlbnna roq s - FINAL MECHANICAL
fi E. o-mced.1 agree to comply with all city and county ordinances and state laws adds ng 509 - FINAL GRADE
"0 V m building ronan .
raion.and hereby mulariepresentative.of this city to enter upon
y :the above mentioned property.srinspenlonpurpoxx. 510 - FINAL PLANNING
pa
We)agree to save,indemnify and keep harmless the City of Cupertino against
rn liabilities,judgments,costs and expenses which:may hi tiny way, ccmc tg -
FINAL WORKS
apst said 514 U
V Z City in consequence of the granting of tis pernsit. r,
r
SOURCE
'APPLICANT
ERSS`SNDSAND WILLCOMPLY WITH ALL NON-POINT ' Issued by: 'J Date
REGUS8 t Will Ap�licam/C t mr - Did Re-roofs •/ n / Z5 —1'- / '
HAZARDOUS MATERIALS DISCLOSURE / L /
c the applicant or fame holder;oca'am same or handle huardous mmnial' ,�.Ty pe.of.Root. .. , (.. ..__ .. . .-.. _.... .........
as defined by the Cupertino Municipal Code.Chapter 9,13,and the Health and Safety 1 o sty, ., i c,-
• 'Code,Section 2553_(a)^. °No fI',t,I, s s t _ .
Cyc' All roofs.shall be.inspected.prior to any-roofing material being installed._
Will tl .ppl t Lone e b la g p t y , t devices which If a roof is'instal led without first obtaining an inspection;-1 agree to remove
emit hast air contaminants.defined by the Bay Area Air Quality Mg t
District' all new materials for inspection. Applicant understands and will comply with
ON. all non-point source regulations..
1have read m Itr d . mom r I r I t. aider Chapin 695 of the
Califomi Health&Safety CodSerious 35505 25533 and2553) 1understand that
if the building de not cunendy have o le...i that is ns my responsibility,.notify he
occupant of the requirements which must be met prior to issuance of o Certificate of
i
'Occaparcy.
_. Signature of Applicant Date
Owner or amhnrixed.gem Dam All roof coverings to be Class`B"or'better ,
-. .. ,... .. .. -...._�... ... .. . ,. _ .. ._ .OFFICE. _- . ..