Loading...
05010149 CITY OFCUPERTINO I BUILDING DIVISION PERMIT p CONTR'ACTORNFORMATION , BU I LDING ADDRESS: HAYEDE NIUFAR PERM"N005010149 8791 ARATA WAY OWNER'S NAME: PERMIT ISSUE DATE HAYEDE NIUFAR 18791 ARATA WAY 01 /26/200r, ONE: SANITARY NO. CONTROL N0, ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT' PLUMB MECH 0 0 0 0 100 LICENSED CONTRACTOR'S DECLARATION M1 hcmby affirm that I am Ilanscd under provisions Of Chapter 9(commencing Job Description with Section 7")of Division 3 or the Business and Professions Code,and my license is thfull(one and effect. WATER HEATER/M. WATER,SERV. /REPIPE (PARTIAL) �t2= License Clazs Lie.x p �FDae Cmammar a9 L ARCHITECT'S DECLARATION �> C < I understand my plans shall be used as public¢cards u I7 lmyU � 1. / :,uLicensed Professional _ OS OWNER-BUILDER DECLARATION / r <P 1 bcrcby allirm be,1 am rnnnio fru.the Cmilmcmr's Lima.Low far the G• Z c,0 following reason.(Section 9131.5,Business and Professions Code:Any city or county .4 h ``e m which middles a permit to construct,alter,improve,demolish,or repair any structure s °xrpoor It)its issuanec,also reactors the applicant for such Permit to rile a signed summcat in (bathe ishoessedpursuant n thepmvamMnrtneco.aemrsua � ' nreLaw(Chapter9 Sq. Ft. Floor Area f .-� � /� . Valuation . 4' (Commm encing with Section 7000)of Division 3 of the Business and Professions Code)or (` n $ that heds eacmpl therefrom roti Ne basis for Ne alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3-AEPE24lf`ifffier00 "O V _Occupancy Type not more Nan five hundred dollars(SYM). � Pane Y YP 0.1,u Owner oflhe property,or my cmplorces with wages u their sok compensation, will do be work,and be income is not intended or offered for sale(Sec.9044,Business and Professions Code The Conuacmr's License Law dors not apply to an owner of Required Inspections property who builds or improves themon,and who does such work himself or through his awn employees,provided that such improvements are not intended or offered for ale.If. however,the building or improvement is writ within am year of completion.be owner builder will have the burden of proving Na be did not build or improve,for purpose of sols.). ❑ I,as owner Of the property,am exclusively contracting with licensed contractors to eonatect the project(Sec.9044,Business and Professions Code:)The Conlracmr's Li . costo law does not apply to an owner of property who Wilds or improve an themon, d who contacts for such projects with a contractor(s)licensed Pursuant to the Contractor', License law. Oil am exempt under Sec. -�- .B h P C or this m OP ^ 1vl.L>_- ✓ Dnte 2'l WORKERS COMPENSATENO "RATION I hereby affirm under Penalty of Per jury fthefotowingdatcarstiou: I have and will maintain a Cenificam of Consent to salf-insure for Worked sCompem cation,as provided for by Section 3900 of the Labor Code,for the performance of the work for which this permit is issued. ❑1 have end will maintain Worker's Compensation Insurance,as readied by Section 31M of be labor Code,lar the performance of the wort for which thea Pcrmil is issued. My Workma Compensation Insurance carrier and Policy number am: Carrier: Policy No.: _ CERTIFICATE OF EX EM Pr10N FROM WORKERS' COMPENSATION INSURANCE ('Dau sectitm sed notb tcompleted it the Permit is rarone hundred dnllartS100) or Loss.) I certify that in the Performance of the work for which this Permit is issued.I shall not employany peru anyanncr.waz c mome sat nmthc Workers'C mpcnsation Laws of Cal' Applicant NOTICE TO APPLICA :IL after making this sill ate of Eaemptic you should become subject to the Tl cra Compensation prove maim the Latur Code,you must Qforthwith comply with such provisions or This Permit shall be deemed mvoled. Z N CONSTRUCTION LENDING AGENCY (hereby of ons Nat dere is a construction lending agency for the Performance of :e 9the work fur which Ibis permit is issued(Ser.3099.Civ.C.) 17 0 Lender's Name z Linda's Address J 1 certify Nat 1 have read this application and sate that the above information is yU buildingommuoco,plyand with yaucity hori maresounty omives of and cam Laws terupongto (/ �(J abdow-gcansted Lafferty hereby authonp rposes, utives of thin city to caul upon the = C ahov9-mentionedpropene forimnify a keepha. (We)agree1.save,indemnify ad keep may any City oiCupenstsagainst fin incoisequca meth grand ng captions which may in any way acc.c against said City Jz APPLICAN ec NDERSTAN ul this permit. _ ) J'�0� '-" APPLICANT UNDERSTAN AND WI COMPLY WITH ALL NONPOINTIssued by: Date � !�' ?"RErLATIQNS. I I� _.IXIIALkaa� V 2-1 Re-roofs Sign sof pP cant/Contractor —t Data HAZARDOUS MATER $DISCLOSURE Type of Roof Will be applicant or future building occupant stare or handle havarduus material az defined by the Cadmium Municipal Cade.Chapter 9.12,and the Health and Safety We.Section 35532(a)7 All roofs shall be inspected prior to an roofing material being❑t'm C]No P P Y g g installed. Will the applicant or future building Occupant use eauip.enl Or devices which If a roof is installed without first obtaining an inspection,I agree to remove mit harerdous air contaminants az defined by the Bay Area Air Quality Management all new materials for inspection. saint' ❑Yes ON. E have mad the ha indous materials equimments under Chapter 6.95 of be Caliror ilia Heab ik Sarety Code,Secduns 25515.25533 and 25534.1 underentl that it be Wilding docs not currently haw a tenam,That it is my responsibility In moi Iy the omopant or the rcyui tswmrn.dal Ips uaoaora fim¢orOce anal. Signature of Applicant Date Aa cif`` ` ,r27�fij owner r authori. agent Date All roof coverings to be Class "B"or better Community Development , J 10300 Torre Avenue C Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 �UPERTINO Building Department JOB ADDRE(�.I A PERMIT # OWNER'S NAME: �ly PHONE # GENERAL CONTRACTOR: FAX # I am not using any subcontractors: _1 67 /QST ignature Date Please check applicable subcontractors and complete the followingmformation: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock i—:::ITile Owner/Contractor Signature Date OWNER-BUILDER VERIFICATION 1. (Check one) I or my immediate family (parent,spouse or child) will perform: A. the work authorized by this permit ® B. _ A portion of the work C. None of the work If B or C is checked,complete 2 or 3 below. 2. A state licensed contractor will be hired to do: A. _ All of the work B. A portion of the work (complete section below) Contractor Address/City Phone # State License # Type of work to YL �.LL VLLLiG4 3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or ® portions of the authorized work. I understand that I may be an employer (see reverse side). A Certificate of Insurance covering workers' compensation must be on file at the City of Cupertino Building Department office. Person/Firm Address/City Phone Number Type of work to be _performed ..................................................................................................................................................................................... I declare under penalty of perjury that the above is true and correct. I have read and understand the Owner-Builder Information (reverse side). Property Owner's Signature: I ' Date: I Job Address: _IC —? /�r( ct(1r Permit# Any changes to the information provided on this form shall be submitted to the City of Cupertino Build ® Department. _ City of Cupertino Building Department ' I CITY OF 10300 Torre Avenu CVPEQTINO Phone: (408)777-3 Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you should be aware that as owner-builder you are the responsible party of record on such a permit Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself,you may vrotect vourself from possible liability if that person applies for the proper petmit in his or her name. 1 Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the city or county. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work,with the exception of various trades that you plan to subcontract,you should be aware of the following information for your benefit and protection If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is$200 or more for the entire project, and such persons are not licensed as contractors or subcontractors, then you may be an employer. If you are an employer,you must register with the state and federal government as an employer and you are subject to several obligations including state and federal income tax withholding, federal social security taxes,workers compensation insurance,disability insurance costs,and unemployment compensatiore contributions. There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to workers compensation insurance. For more specific information about your obligations under federal law,contact the Internal Revenue Service (and,if you wish,the U.S.Small Business Administration). For more specific information about your obligations under state law,contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale,property owners who are not licensed contractors are allowed to perform their work personally or through their own employees,without a licensed contractor or subcontractor,only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an owner-builder building permit,erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors'State License Board in your community or at 1020 N Street,Sacramento,California 95814. Please complete and return the enclosed owner-builder verification form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. Very truly yours, Building Department, City of Cupertino • Printed on Recycled Paper SON Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408) 777-3333 ' SUPEkTINO Building Decutment NJOB ADDRESS: PERMIT # 11 OWNER'S NAME: r _ , 1 A 0 1-11, PHONE # GENERAL CONTRACT R: / `�G' C l •"- .hk, ( FAX # U I am not using any sJbcohtrkEt(fr-S? st-e? )I Signature Daie Please check-doplicable-subcontractors and complete the followin information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets&Millwork Cement Finishing _ _E~1'ectrical Excavation. n 1,', Y e 1� ,y t`� N I ��( T <x_ Fencing Flooring: Carpeting Linoleum / Wbod "t Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date CITY OF CUPERTINO REPIPE/SEWERS/MAIN SERVICE CUPERTINO PERMIT APPLICATION FORM APN# 3 7s, / Z Q .a n/ `ted Building Address: I O —7 G I ^ Owner's Name: Contractor: Phone: L s Contact: Phone: Cupertino Business License#: Building Permit Info: �—d, Bld Ele Plumo Job Description: n � V fi YY) "� 12Q,-p to Residential IS, Commercial ❑ Cost of Project: �aC5D Qty. if Applicable Fee ID Fee Description Fee Group / PPERMTTFEE Plumbing Permit Issuance PLUMBING BPREPIPE Re i e of Fixtures PLUMBING BPERMFEE Bldg. Permit Fees BUILDING BPFIXTURE Pbl . Fixture PLUMBING BPWS VCS Main Water Service PLUMBING BPSEWER Sewers PLUMBING BPSEWAGE Sewage Disposal PLUMBING BUSLIC Business License BUILDING 3;d' e � o �. 73 .