02100199 (2) CITY OF CUPERTINO _-- �,,
BUILDING DIVISION PERMIT CONTRACTORINFORMATION D .O�jp 13 �
tea::, .a,.
B u I RE. ' RANGE AVE - D & D CONSTRUCTION P17RMITNO2100199
OWIUBTNAM REZA JAVANMARD 1447 HAMPTON DR. APPLIcATIPT6CXR41TY2002
IFONE: (408) 666-5298 SANITARY NO. CONTROL NO.
ARCHI ECTIENGINHER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
O O 0 O
�Op LICENSED CONTRACTOR'S DECLARATION
s;� 1 hereby.[Frim that 1 am licensed under Prnviainns of Chapter 9(commencing NEW SINGLE FAMIP��eIER ING
�< with Scain�Dmsmn ❑usincssn Pr IcssionsGWc.unJ myliacnsv isin 1.111ome � 77� LIVING SPACE 2842 SQ. FT.
~q� rise II.ie.Noi_o DaCu�tr.atq� GARAGE 476 SQ. FT. �1,V� CT'S11IiQLARAn(pI ,v ■ I.g�
� a� I understand my plans shall be used as puhlic rcnfrJs A Y
bodu
is Licensed Professional OCT
p 2003
~'=0� OWNER-BUILDER OC Ce Contractors
lr O' O
5d u�e 1 hereby uflirm ince 1 em exempt from IM1c Cnmrapnr's Liccnsc Law for iM1c
E O G following reason.(Section 7031.5,Business and Professions Cnde:Any city or county
a�$ which mquires a PCvan to construct,alter,improve,demolish,nr repair any structure
prior o in lemance,also requires the applicant for such Permian Ele a signed statement
that he is licensed p...anun ec lannuioneo(the Contmcmr's License Lew(Chapta,9 Sq. Ft. Floor Area S"Wn
£�C (commencing with Scaion]IMl(q of Division 3 ofthe Bwtincse and Professions Code)or
cy $ that he is exempt therefrom and the basis for the alleged exemption,Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penallynf Occupancy Type
numb,
not then Eve hundred dollars($500).
P Y YP
❑I,.owner of the popeny,or my cmpinyecs with wages as their some computsatine,
will do the work,and the mumme is net intended oroffc.d formic(Sec.II44,Business
and Pofessinns Code:The Contractor's License Law does not apply to an owner of 102 - PIERS egwred Inspections
property who huilds or improves thcoon,and who eassuch work himselfor through his
own employees,provided that such improvcmenu are not intended urnlfered for sale.If, 103 — UFER
however.the building or improvement is sold within one year ofcompletion,the owner. 104 — REBAR
builder will have the burden of moving Net he did not build or improve for impose of
:ale.). 1 105 - ANCHOR BOLTS
❑ L as owner of the property,am exclusively contracting with licensed conuaclora to 106 - SEWER & WATER
construct the project(Sec.](144.Business and Professions Code:)The Contractor's Li.
pence Law does not apply to an owner of pmpeny who latedt or improves thereon,sed. 202 - UNDERFLOOR PLUMBING
who contracts for such projects with a comrazlnr(s)licensed pursuant o the Convector's
License L.w. 203 - UNDERFLOOR MECHANICAL
❑ I.m mumu in audit,Sec. ,B&P C to,Or,..,in 204 - UNDERFLOOR FRAME
Owner Data 205 - UNDERFLOOR INSULATION
WORKER'S COMPENSATION DECLARATION 301 - ROUGH PLUMBING
I hereby alarm under penalty of Prouty one of the following declarations: 302 — TUB & OR SHOWER
I have and will maintain a Cenmcate of consent to serf-intim for workers compote- 303 - ROUGH MECHANICAL
ation,u provided for by section 3]Igl of the Labor Cnde,for Ibe performance of the
work for which this permit is issurd. 304 - ROUGH ELECTRICAL
❑1 have and will maintain Worker's Compensation Insurance,as required by Section 3 05 — FRAME
3]fl(I of the Labor Cnde,for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number am: 306 — HOLDOWNS
Ce b,: ;-vitt. No.: Is /J/Za/_79 307 - INSULATION
Cni;ICATE OF EAE•M NFROM WORKERS'
COMPENSATION INSURANCE 308 - SHEETROCK
(This section need not he cnmplcued ilthe rurmit is former hundred dollars;(51(M) 309 - EXTERIOR LATH
less') 310 - INTERIOR LATH
I cavity that in the per(omuncrof the work for which this permit is issued.I shall not 311 - 'SCRATCH COAT
employ any person in any manner set u to Mrnme subject to the Workeri Companmtion
Laws of Cali fornme,Dam 313 - ROOF NAIL
Applicant
NOTICE TO APPLICANT:If,after making this Ccnificale of Exemption,you shimW 501 - FINAL ELECTRICAL ENERGY
become subject to the Worker's Compensation provisions of the Labor Code,you muss 502 - FINAL PLUMBING ENERGY
O z forthwith comply with such provisions to,this permit shall he deemed mvnked.
z coNsrRurnoNLENDING AGENCY 503 - FINAL MECHANICAL ENER
t= � 1harebyalmmmatOr.If.construction lending agency[or the permrmanceit[ 504 - FINAL BUILDING ENERG
IX > the work fm which this permhisissued(Sce.309].Ch,C.) 505 - FINAL ELECTRICAL
IL) Q Lender's Name
5 z Lenders Address 506 - GAS TEST
U O 1 certify that I have read this application and mute that the show information is 507 - FINAL PLUMBING
correct.l agree to comply with all city and county uNinances and suite tblaws Talmo,m 5 FINAL MECHANICAL
building construction,and hereby aunti'm mpmwnmtives of this city m cntar u(am the
Wabove-meminned popery for inspection purpmes. 09 — FIN GRADE
(We)agree m save,indemnify and keep harmless the way
of Commit id City
liabilities,judgments,ensu and expenses which may in any way accrue against said City 5 N N G
U Z APPLICANTc�UlnNfNDEHSTANDSthis
ANDfarm
WILL COMPLY WITH ALLXI OINT Issued by`51 WORKS Dales.
SOURCE EGULATIONS.
/D` t Re-roofs 603 -U60F BATTENS
tg sec a HAZARDOUS MATERIALS DISCLOSURE Date Type ofK8f4 - ROOF IN-PROGRESS
Will the applicant or future building occupant mora ser handle hamNous malarial
as defined by the Cupertino un¢ipal Code.Chapter 9.12,and the Ilcebh and Safety
code, Seri zss33(a):' All roofs shall be inspected prior to an roofing material being Installed.
❑ties Nm P P Y g g
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
emit hemom us air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
'uncia?
❑Yes `yp No
I have mad Ne hamNo e,materials requirements under Chapter fh95 o(Ihe Califor.
via Heave er Safety Coe.Sections 35515,25533 som 25534.1 uncle their(the luilJimg
does vol currently have.tenant.Nat it is my respm isihllily In and y e peril of Or
rut maintains which must lumet poor Orisananecof8Cadifica1OfOcCUP cy. Signature of Applicant Date
owner tar ammmriv.d.genr Data All roof coverings to be Class "B" or better
CIBUILDING DPv SIONNO
PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10071 ORANGE AVE 02050138
t OW� APPLICATION UB DA
Gfm"AM EZA JAVANMARD 05/22/
2002
i PHONE: SANITARY NO. CONTROL NO,
G Q zo ARCHITECT/ENGINEER: BUILDING PERMIT[NFO
BLDG ELECT PLUMB MECH
u u u
LICENSED CONTRACTOR'S DECLARATION s®O�Q �®
A, `"z IneseS affirm ONTRAunder Job Descri,pptiQQ��a LCtLf��• `
oEi-o prodPromofn$Code.Andmmecense NEW SINGLE FAMILY DWELLuLQ
F`=[_,y with Section]000)of Division J ofthe Business artl Professions Code,and my license
km2 is in full ionic And effect' LIVING SPACE 2842 SQ. FT- nn^'
oA,`u Da`^xe class Lic." GARAGE 476 SQ. FT. CCT $ WW
Date Lic.0Contractor
°-Ia ARCHITECT'S DECLARATION
h 1= 5 1 understand my plans shall be used as public records
I oLicensed Professional 13t11L®ING
ff OWNER-BUILDER DECLARATION
m 1 hereby afli that I mo exempt from the Contractor's License Law for the
!' < following...(Section 7031.5.Business and Pmfeasiom Code:Any city or county
F x O which requires a permit to construct.Alter,improve,demolish,or repair any structure
u`4it$ pnm to its is,u on,al q mea Applicant for such permn to flea sigrcd stat me s - _..... .. .. .__ ..._.__._._...._. .
d 3_ mA,pq�b n;<a(wi:„w,rotkpw ns of the cnntmctarsU..Law(Cng,,,9 _,� Sq:-F.L Floor-Area°- pp/� luation
(c mmenc nggwnitSe<ggn,7W0)o(Div sion3ofine Business And Prpfgss,ons Code) ;,{1ttT .4.ii..1401`la'e.l{4.lsrlf{lt•1�F_ : $3500 V®
or thathe 4k ekeidpi thekfro'Ward she basis for she alleged airn'ption.Any v olation
-of Section 7031.5 byany applicant far a permit Whims the applicant to a civil penala'
[ofnotmorethanrnahandreddogara(5500). 3571691$V910M .o Occupancy Type
01,as owner of the property,or my employees wish wages es their sole compensation.
-'will'da'me work.-Intl'the atmtv
cre isnot mflWod«
t 'offered for--sale-(Sec:7044;- —
`Bmimdti .mi Profexx ons Code:The Cammmora License Law does or apply man 101 - FOUNDATIIWkuired Inspections '1 "-
..at of property Who builds or improves thereon and who does such work himself 102 - PIERS
«shmugh his own employees.provided mat such improvements ere not intended« - _ __ ._...___.__...__._._._.._...._
'�fl dfi-alrlf-.however the building or improvement Id thidanz Year nr I03 '- UFER •=c' r.r::n
c0 Pierian.rhe owner-bmldcr will have she burden of proving that he did not Wild or
improve for paposeofule.t. 104 - REBAR
' ANCHOR'---BOLTS'
4'q rte fine propcny am oduu ly t t gwth l' udc mmct sto - -- -. _..___..__ __b- •:. ] rl I':I'n
_ t s he poled 6a.7044.Business and Professions Coda)The C drachm s 106 - SEWER & WATER
License Law does not apply to an owner of property who Wilds or improves thereon, -
_.and_who.rommcts.Wrsuch.prolena.wim.a.cantmcmr(sl licensod.pussuam aa.ma 2.0.'Z...___-LINDERF-LDOR—PLI:TMBING.—.—__._____.__._:—_—..__...___.._
-_ C
onbanore Licanu Law.F. -�....
H_ l.mexemptugder�sa. ee,Pefnru,isreas�n 203 - UNDERFLOOR!.MEGANICAL'
° Rsc D 9 1�-0 ? 204 - UNDERFLOOR FRAME
aRRE
t>sAnoN DECLARATION _ 205 - UNDERFLOOR INSULATION
"'• -Ihereby affirmunder penaltyofperjuryoneofthefollowingdccenumns: - 301 - ROUGH PLUMBING
:_f= 0 1 h6 eSd'wlil'mumabd @e fficeta of 476 iem'w self-insure me Wmkers 302 - TUB & OR SHOWER
71 Compenusion,-Ari provided for byr Section 3]00 of'the Labor Code; for me �
pArfnrmencd'ofdmworkfor which mit pemtd isissucJ.i , 303 - ROUGH MECHANICAL
0 1 Int4hadwillmat nWorkerACmmpensato InhrdnceusropiamdbySection 304 - ROUGH ELECTRICAL
-_ 377 of she Labpr'cadc,for rob per rinnance of the work for which this is"mit it vs 305 - FRAME
fsu d My Worker's Compensdt b into came and Pohry miter art
Cartl�r It l.`i: QIL:f Ii F'olmcY N' t ter„ r� `` ._.. 306.6}, HOLDOWNS...,
1, ( tGERT FICAT10NOF,E EMMON FROM',WORKER g S,T-+-A - 3.0.7 iY`,,'INSU'LATIONL III .
COMPENSATION INSURANCE^' !
_.,..... 308'.---SHEETROCK---.._ ---------
;(Thscdu36'need not ba�amphnma if the permit is far one hundred doors 309.a. EXTERIOR LATH ...r..•.1.r, �m-. up:%v t :p - -
(stool l ) t , . q LATH
31.0--- INTERIOR- J
` 'I can fy that`in the perf mu&of m work,forwhich tin pertnn n issued 1 r m i ...,.. .�T.
%h 0 nae a pl y any person m y n vs m becom q ,, thew e 311 - SCRATCH COAT -
Comp ns C l r m o
Aiih ___ __ -313_ - _ROOF_.NAIL_ . _
N�T LICA amt Am Sm:cert rc t re pones y a no la 501 - FINAL ELECTRICAL ENERGY
be blcilywitruithe racompe t npro nsones L6oCd;yo oust. 502 _ FINAL PLUMBING ENERGY
(Z 0 bi Z'ts comply with ch p v e onhu permit shall ft GLuour revoked.
ZcDlvsTxucrloNLervmlvcncENcr 503 FINAL MECHANICAL ENERGY'
(W. ' "' 1 hereM1y a/fm th nhcte const et on lendmg ligancy fo the perfortnenc "' "- '
Gr mew kro nines inn permn__ ea(se<309] Cv c) ��- _ 504 - FINAL BUILDING ENERGY
wq arNam '-"'505 -- FINAL_.ELECTRICAL,-`
Lend rx Adtlre
U p 50 GAS TEST .!„n :'..rr'::•It �/
a I censfy mat 1 he read mrs apphcat o^and stain shpt the above
ban
misting 5 - I NAL PLUMBING
(;'.Es cotrtm 1 g e Ip comply th II city and cuumy 9nl ces send rte lows
P-C:1 to bis ldmng const to adhemby amho ' teprtumeu aofsha coy to enmrupon 5 8 "INAL L
ry ,the above mentioned pmpeny for inspection pugoscs.,�_.. - , _._
.p„ lWJ'ugreetosove.indemnifylndkeepharmlesnhettyofC per oaguinsr 50 W liab Idi 3uagmenu,costs od expeou h chin y n Any,,ay accrue against saidUZ City in consequence of the gmnong of this pe n : 510
Date
6 RCIssued�]y
wnm�a-ianYContmct - ” Re-ro - N L
A I
t,: t l r HAZARDOUSMdini O&A15Dswribf UR6 ale (rs(1 R� BATTENS
P.., ppHA o r OUbisMATERI w tsort«Sawaimare,da material Type o UjC of_-_ - - r
as deo ed bythe Cupenmo Mune pal Code Ch pt«9liandme He hh ends fsy' - R F '•:IN PROGRESS
,CAG OcYea 2SJJ (N , iJ..r A- fl +dl 1> ��,Y
Cal
_ All roofs.shall be mspected.pnor,to.any_roofing.material.being.installed. .......
Will m,applicant r l Wilding oc pan, equipment re rices hien! If a roof is ins'talle'd"without first obtaining aninspection;4agree to'-remove
• riot hazed us air comm ti asdefimed by the Bay Area Air Quality Management, ,
D"mC1ppli
„•,all new materials for„inspection Acant understands,and;will Corn with ,-
'�'t �s , r. � r-, � •'4 rt'^ f�
all"non-point source regulauons;
ave .-_,II 'f-.,''t, •- '-�b '
hread�me harardouamaterials requirements wide,Clap,,,6.95'of me -
Cahn,min HeAhh'&Safety Code:Sections 25505,25533 and 25534.1.understand that
'
At it liiltlingdoes not cummly have a tenantisha it is myrespomiblitymnovfydie
accup est of the iequimm .,A h cit mu'themet pn r ho .mance of a Cenificase of - '
9 L =o Signature of Applicant _ Date
-___.. __ ...._ .. _ .. - - '---Owner or math ;egag ;„ Date'.., All roof coverings to be Class"B" or better• „
-OFFICE--