05060169 CITY OF CUPERTINO
BUILDING DIVISION PERMIT Rr.4UGT0RjINF0_RMATI®N
x9A�8ryr• t•>r l:aR, t•. x, .
BUILDING ADDRESS: ABCO CONST PERMIT NO.05060169
OWNER'S NAME: PERMIT ISSUE DATE
BEHROOZ ARAM 14880 LLAGAS5
IS: SANITARY NO. CONTROL NO.
(408) 779-7577
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECTPLUMB MECH
0 0 0 0
:oo LICENSEDCONTRACIOR'SDECLARATION
rO� affirm N1 xmby at 1 am licensed under providons of Chapter 9(commencing, JobDescription
a� with Seemem 70OB of Division Sof the Bad. it Proftogons Code,and my Become is
mFull force Adcrret DEMO (E) HOUSE
j 3 LkenA ClLk.N
Dale Contractor
ARCHITECTS DECLARATION
1 undersand my plans mall be used As public records
3 a Licensed Profcsd0nd
gO OWNER-BUILDER m me CommION �'
.40 i I hereby.(five that 1exempt(sure the Convector's :Any c Law for the \1'^
O 0 fallowing requires
a(Section 7031.5.Business andw,de Profession Cade;Any city or county
$8i which requires a pewit re cnnswc4 ailed Improve,h permit s or repair any atmmum $7000
r� poor Asthomsncursunt1Alm .ms the vision,o Tac suchpermitA0ense Late a (Chapter
p Q (that comment
incing cdpuntion7 0epmvisision3 fineBncafeLlanmlaw(ChoPar9 Sq. F[.Floor Area Valuation
of $ (cams A aggwidt Section and of Division of the BaimuandR Any vi Cook)or
3— Nal he B esemPt Umfrom and the EsW far Ux alleged acmPUon.Any violation of
Section 7031.5 by Ay applicant for a pewit subjects the applicant to a civil penalty of
net moa Nan five hundred doltars({.500), r Occupancy Type
❑I,As owner ofthe property,or my employe"with wages as their Ale compewtim.
will do the work.and me amrcmm is not Intended"Offered for We(Sec.7044,Business Required Inspections
and Professions Codc:The Conuaar'r uveae Law doe•not apply m an owner of 9 P
property who builds or improves Nueon,and who does such work himsel f or through his
own employees,provided that such improvements art ret intended ooBued f"ale.IL
however,the building or Improvement is Aid within cm year of oomplction,the owner.
builder will haw da burden of Proving that he did nm Wild"improve(ea purpm of
ale.).
❑1,as owner of W property,am aclualwly eonusuting with licensed contractors A
ceawet the Project(Sec.7044,Business and Profession Code:)The Consomme,Lt.
team Law does not apply in an owner of property who builds or improv"Neeson,and
who contracts for such poi)ems wide a eontracter(s)licensed pursuant in the Conusuar's
License Law.
❑1 am exxeemjpt i ncder See. .B,!P C fm this maw.
Owner Yl.c.h�(� �f41'/s Data
WORKER'S OC MANSATIONDECLARATION
1 hemby game under penally of perjury one of the following declarations:
A..am will om1mg.•Certificate
of Consent m self-i"wn for Worlmes Cori
"tion,As provided for by Scene.3700 of dee Labor Code,Tea dee pedormence of the
weak for which this pewit is iamd.
0 1 haw and will maintain Worker's Compensation Insurance,u required by Section
3700 of the Labor Code,for the performance of Ne work for which this pewit is Wind. -
My Worker's Compensation Insurance caeicr end Policy number am:
Cartier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(ThkaeNm reed not x completed Ifthe permit is feaaehunthW doRan(SIOr,
or las.)
1 certify that in to performance of the work for which this permit Is Wine.I shall am
employanyp osorimanymAnen c rat sub' o the Worken'CompensNw
Laws of California.Dam
Applicant �• �LY7b•�
NOTICE TO APPLICANT. L afar making dela Certificau,of Exemption.you shmhi
Wecmne Abject A dee Worker's Compensation provisions of me Labor Code.you mug
0O forthwith comply with such provision or this permit shall tic domed tended.
ryN.. CONSTRUCTION LENDING AGENCY
F I hereby aRiw that thea is a construction lending agency for the performance of
!Yi.moi Ure work fur which this permit Is issued(Sec.3097.Civ.C.)
Q Lemices Name
z Lender's Addreu
U Q 1 ceNfy that I haw mad this application and sane that the show information li
JX.^" caws I agree A comply with all city and county ordinances and sale laws relating to
0 VC building construction,and hereby sumodre representatives of this city In enter upon Ua
in
showmc judgments,
dproperty(an epection puryomg
LL (We)agree to arc,indemnify and keep harmku the City of Cupertino against
r.rN incommsome Of the snmmofthis Amit. may Inany wysceem galnnaidCity
U z APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
'k�-'&rCr2 - kind Cs� Re-roofs
BI{"tare of ApplicAVConRDO a
HAZARDOUS MATERIALS DISCLOSURE' Type Of ROOF
Will the applicant CuKnino forum building Co e.ChAlgefc a laddie he"rduus material
As defined by dee Cupertino Municipal Code,Chapter 9.11.and the Health and Safety
Cale•Section 15531(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑YaNo
Willua.ppucAt or future building oaumftt um eqmp rmilL or device which If a roof is installed without first obtaining an inspection,I agree to remove
ha"rdous air contaminants As defined by the Bay Am Air Quality Management all new materials for inspection,
Ulsvlet?
❑Yes AnNo
I hoc mad the haardmus mgeda4 requirements under Chapter 495 of the Califon
nu Hol d:Safcty Cedc,Sa =25505.15533and15534.1un@ ftifdc building
doe not currently hew a anu4 mat it Is my reapo"Ibility a notify lite eceup tat of the
requirements which mut x met prior A issusuo of a Ccati0cate of Occupancy. Signature Of Applicant Date
Owner or Athedrsd agent Date All roof coverings to be Class "B"or better