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CITY OF CUPERTINO:d
i
BUILDING DIVISION PERMIT
CONIT: tIUCT-O,R�NFFORMATIO,N,
BUILDING ADDRESS:
109 CARMEN RD
CARL FARSAI
PERMITNO. 06)090058
R'S NAME:
PERMIT ISSUE DATE
CARL FARSAI
NE:
SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER:
BUILDING PERMMNFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTORS DECLARATION
Job Description
P
1 hueby a07rm that 1 am retained atxma mcing
r pmvis s of Clrpmr 9 (cemen
with Section 7000) of Divitlon 3Orme Business and Profeadmis Coda,and my license is
in full farce end affect.
REVISION - REVISING. DRAWINGS TO REFLECT REMOVAL
License Clua Lk.
Dam Contractor
EXISTING WALL, REPLACEMENT WITH NEW SAME LOCATI
ARCHITECTS DECORATION
ORIGINAL PERMIT #05090233
I undewnd my plan shall be used as public weardt
Lu eased Professional
OWNER -BUILDER DECLARATION
1 hereby atTim that I am exempt from the Conlream's License Law for the
following mume. (&cited 7M I.S. Business and Profusions Cate: Any city or county
which requires; a permit in clnsmn, alcor, Improve, chin alLN, or repair any somehow
prior m itsissuance, than requires tim appliemt forsuch permit in file a signed ambient
dust le, 4 licensed paracent in to provisions afhM Commemes lxomc Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(emnmwncing wim Section 7000).[Divitan 3 of ore Buddevasb Professions Code) or
$354990
Nat M h emmpt merefmm and the but& far W alleged emmptoa. Any viWnion of
.. APN Number
Occupancy Type
Seaton 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not mom mm Bw hundred dollars (5500).
❑ I, u ownu of me pmPenY. W MY employca vim wµu u meirsem compensation,
Required Inspections
will do me work, and the suuumn 4 notWmnded oranend formle (Sm. 70", Budrcu
and limitations code: The Centra noes Lice= Law arca sal apply lo m awn« of
property who builds Or improv domon,end whadaysuchwork bimselfor aweigh his
awn employov, provided that such improvements an notimmrsdi t araaenA for salt W.
however, One Wilding or Improvement Is sold within ane year of completion, the mine.
builder will have dhe burden of proving that he did not build or Improve for purpose of
'
ATIN as owner of the property exclusively eenmming with licensed communist W
cornmeal the project (Sec. 7094. Rvineu and Professions Coda:) The Contractors U.
`<
Cave law dot not apply in m owner of proputy woo Words ar Improves thercon, and
(v
whoc,
orwhas for such project wit" ) llamsed partial W Lee Contractor's
v
License Law. -_
I,BaPCfar this moon
^
\ y
Dam
�'Sps-C-90-MMP-1
ATION DECLARATION
I herby Balm alyjury as of dm fallowing dalmaiav:
❑ I haveand will minus n s Cenifteam of Covn.l io selfAmure ra WulearsCompe.-
mtan, u provided for by Semion 3700 of rte labor Cade, ra me W fomaut of ft
work for which this permit 4 issued.
❑ 1 ham and will ointment W.ram's Compensation Incomes, u required by Sauon
3700 of the Labor COM, far me performance of the work fu which oris permit is hau d.
My Workers Comp ssecon twurnca cmicr ad Policy number art:
Cartier. Policy Na.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This vection need not he complete if IM permit Is follow hundred dollar ($100)
or leu.)
1 cerory mat in the pealomerce o ark for w this permit Is issued, l shall not
employ anyperon in my s omwvb'cam Rewyft Canpenvt.n
Lam of Cal((omiai--
Applicant �• .
-
NOTICE TO APPfMA!I 4 conirwas of Exemption, you mould
become subject 1. the Workers Compensation previsions of me Labor Cade, you must
forthwith comply with such provisions or this permit shall be deemed involved.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that inert is a eomruniv leading agency for we, perfarmaat of
the work for which m4 permit is issued (Ste. 3097, Civ. C.)
Landers Name
Lender. Add.
1 canify that I have read this application will sum mat On above information is
correct. I ague in comply win all city ad county ordlm nce3 and soon laws staling to
building convection, and hamby autbaim representative of this city to enter upon the
aMve-mentioned intercity for inspection pu poses -
(We) agree to saw. indemnify and kap harmless rte City of Cupcnino against
liabilities. judgments, Occur and M. which may in any toy acme against said City
In consequence o n rue .
APPLICA D AN LLC MPLY WITH ALL NON -POINT
G
Issued by: Date j / x✓
SOU EGU ON / Q
�(/
Re -roofs
Type of Roof
S p n moo MATERIALSDISCLOSURE Dam
Will lhoappli oust Wilding rccupanta.ma Nndlchuudousmamriai
Read by the Cupenlrm Municipal Cada. Ch tpmr 9.11, sad the Health mo Safely
SOmmn 25532(.)7 �/
All roofs shall be inspected prior to any roofing material being installed.
❑Yu /@Nu
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment a devices which
emit husedov ar canumivnu at &r,.d by to Bay Arta Air Quality Mmagemenl
all new materials for inspection.
District?
DYcs 124.
I have nal�b inns .mamra ionenmuntoChtpmr6.95afineGlifor-
.I.H.Uh uyc S uo)s 16605,1553 d25534.1amwou othatifdn Wilding
e
toes a mthly e R �i,t h 4 my r pavibilhy m noul'y the oaupmt of me
n mwns e m't ]oft allfKaaaf Q -m
w'" S p "0
Signature of Applicant Date
6
All roof coverings to be Class "B" or better
owner or aatharisd, Data