07070264 CIT�' OF CUPERTINO j ' `�
BUILDINCDIVISION PERMIT �`-����������������*`
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PERMIT NO.
BUILDING AD�RESS:
10221 STERN AVE TBD — TC� BE DETERMINED 07070264 •
PERMIT LSSUE DATE
OWNER'S NAME: ,
SAIDIAN JACOB 10 02 07
SANITARY NO. CONTROL NO.
NE:
BUILDING PERM1TiNF0
ARCHITECT/ENGiNEER: BLDG ELECT PLUMH MECH
� 0 0 0
i p p LICENSED CONTRACTOR'S DECLARATION JOb DOSCTIPtlOi1
; V� [ hcrcby a�rm �hat t am liccnsed undcr pravisions oC Chapicr 9(commcncine
; Z� wi�h Scction 7IXIU) of Division 3 of ihc Busincss and Profcssians Codc and my licensc is REV I S I OP 1— ADD ING FLOOR ING T� BA S EMENT DETA I L
�� y in full Corce and effec�
��z t,icenscctass ��•�► ORIGINAI� PE�IT #0705�232
• p Datc Contractor
: F" � ARCHITECI'S DECLARATION
i a
a ( undcrstanJ my plans shall bc uscd as public rccords
)yV
� Q y Liccnscl PniCessional
: y � OWNER-BUILDER DECLARATION
'r I hcrcby alTrm that 1 am excmpt Crom �Ac Coniractor's Liccnsc Law for �hc
j p o following rcason. (Scctian 7U31.5, Business and Profcuions Ca1c: Any eiry or rnunty
�,°, Pi which rcquires a pcm�it to consuvct, altcr, impmvc, dcmolish, or repair any svucturc
�" y prior �o ilc issuancc, alsu rcquires �hc applicant for such permit w filc a signcd s�atcmcnt �, Valuation
'? a that hc is liccnscd pursuant to thc provisions ot thc Contracwr's Liccnse law (Chaptcr 9 ,�q. Ft. Floor Area $
� t �(commencing with Section 7000) of Division 3 of �he Business and Professions Cade) ur 0
°�� that he is exempt thcrefrom and Ihe basis (or the allegcd exempdon. Any violuion o(
Section 7031.5 by any applicant fw a pecmie subjecu ihe applicant la a civil pcnalry of Number Oeeupaney Type
noc moro than five 6undred dollars (5500). 3�J S 11 O F) ����
Q I, as owner o[ ttie pcoperty. a my employca with wages az their solc compensa6nn,
will do �he work, and the swciure is not intended or offered for sale (Sec. 7044. Business Required Inspections
and Ptofessions Cade: The Conuactor's License Law dacs not apply w an owner of
prapeny who 6uilds or improves thereon, and who does such work himself ar tluough his
own employces, providcd that such improvements are nat in�ended or ollered fa sale. I[.
however. U�e building or improvcment is sold within one year of complcuon. �he owrcr
builder will have the burden of proving tAat he did not build or imp�ove for purpose of
sale.).
❑ I, as owner of the property, am uclusively convacting wiUi licensed rnnuactas to
construct the pmject (Sec. 7044. Business and Pro[essions Code:) The Contrxtor's Li-
cense Caw docs not apply to an owner of propeny who builds or improves We�ean. and .
who coavacts Cor such projects with a conJl a, toKs) Iicensed pursuant to the CanvactaY's
License Law. /
❑ I am weempt undu See. , B 8c P C for this n
�... �� s {,. ✓7
Owner
R S C rERSX'I'[ON DECLARATION
I h y�rm under penalty o[ pequry one of the (ollowing declaralions:
�] I hsve and will maintain a Cenif cate of Consent to ul[-insure for Workefs Compen-
sation, u providcd for by Section 3700 of the Labor Code, for �he perfortnarrce a[ �he
work far which Ihis permit is issucd.
❑ I havc and will maimain Worker's CompensaUon Insurance, az mquired by Section .
3700 of the Labar Code, for the pertormance of the work for which this permit is issued•
My Worker's Compensa6on lnsurance camcr and Poliry number are:
Cartier: Policy No.:
CERTIFICATE OP EXEMPCION FROM WORKERS'
COMPENSATION WSURANCE
(This scction need not be completed if the permit is for anc hundred dollars (S 100)
or Icss.)
I certify that in thc performancc of thc work for which �his permit is issucd, t shall not
employ any person in any manncr so u to becomc subject w �he Workcrs' Compensation
Laws of Califomia. Datc
Applicam
NOTICE TO APPCICAM: if, af�cr making ihis CcniCca�c of ExcmpGon, you should
become subjcct w �hc Workcr's Compensation provisions o[ �c Lalxir Codc, you must
, O forthwith comply with such provisions or this pccmit shatl be dccmcd rcvokcd.
Z "' CONSTRUCTION LENDING AGENCY
��-�. I hercby alTirm �hat there is a constnxti�n lending agency for thc performancc of .
(1� � thc wurk fur which U�is permit is issucd (Scc. 3097, Civ. C.) ,
W A Lendcr's Narnc
j z Lender's Address
U � 1 ceni(y �hat [ havc read this applieation and sta�c ihat thc above infortnatiun is
�� cortcct. I agrce to comply with all city and county onlinances and su�e laws relaung �o
0� building conswction, and hcreby authoriie rcprescntativcs of this city to cn�cr u�n lhc
� W abovomcntiuncd property for inspccuon purposes.
a (Wc) agree �o save, indemnify and kccp harmless ihc City of Cupertino agains�
H � IiabiliUes, judgmenLS, costs aad expcnscs which may in any way acccuc againsl said City
V z ia consequcnce oC the granling of ' permit. Date
� APPLICANT UNDERSTA ND WILL COMPLY WITH ALL NON-POINT Issued by:
SOURCEREGU • �
� �- ' Re-roofs
Signatu ApplicandConuactor �� ' 'r of Roof
HAZARDOUS MATERIALS DISCLOSURE YP
Will thc applicant or Cuturc building occupantstarc or handtc haiardaus matcrial
as defincd by thc Cupertino Municipal Codc, Chaptcr 9.12. and thc Hcalth and SaCety
ca�, s�cuo� zss3z(a)? All Toofs �hall be inspected prior to any roofing material being installed.
� y� �j No ,
Will thc applicant or Cuwrc building occupant usc cyuipmcnt or dcvices which
If a roof i� installed without first obtaining an inspection, I agree to remove
cmi� harardous air conuminan�s as dcfincd by the Bay Area Air Quality Managcmcnt all new m aterials for inspec ;lOR.
District?
0 Ycs `� Nu
1 havc rcad the ha�ardcws materials rcyuircmen�t undcrChaptcr 6.95 otthc CaliCor-
nia HcalU� & SafctyCodc, Scctions 25505, 25533 and 25534. I undcrs�nd thaziCthc building
docs not curtcntly havc a tcnan4 �hat it is my responsibili�y to notify Uic occupant of ihc
rcyuircmcnu which must bc me� prior to issuaricc oC a Ccnifica�c of Occupanc7'. S Ig'I13CUCe Of AppI1C8Rt Date
All roof coverings to be Class "B" or better
Owncr or authari agcnt ���