04110059 CITY OF CUPERTINO exrYaw'� '„t"'. " "` `' 'M *^'°' 'ser ''
BUILDING mvlslori PERMIT ,CONTRACTOR INFyORMATI.ON
BUILDING ADDRESS: _ - ALADDIN HOME - PERMIT NO 04110059
18977 13ARNHART AVE
vNER'S NAME: PERMIT ISSUB DATE -
DAVID JAMSHIDNEJAD 416 CORALW _
SANITARY NO, CONTROL NO.
(209) 915-0404
ARCHITEC(ENGINEER: - BUILDING PERMIT INFO
BLDG ELECT PLUMB - MECH
=00 LICENSED CONTRACTOR'S DECLARATION Job DOSCr1pIl0n
y U F I ncmby affirm Nat 1 am licensed under provisions of Chapter 9(rn urnmeing -
with Section IIkto)of Division 3 of the Business and Professions Code,and my license is
75 a- ummeanaerrttk STRUCTURAL REPLACEMENT OF (E)' SLAB
D#i Lt...ClassLk.x
^� Dam ommcor CONTRACTOR: ALADDIN HOME
ARCHITECTS DECLARATION
°y5 z I undersand my plans shall he used as public rtcmda .
D,U
;u� Licensed Professional
=�� OWNER-BUILDER DECLARATION
i I M¢by affirm that 1 am exempt from on,Contractors License law for IM -
0 0 following reason.(Section 103 I.S.Business and Profession Code:Any city M county
K m( which requirs a permit to construct.alter,improve.demolish,Or repair any slrucmm
ca "w prior o its issuance.also na uims the applicant for such Permit o file asigned mamment
l—' thatMislicensedpursuanttotheprovisionsoftheCinuvetor'sUcemscLaw(Chapter9 Sq.Ft.Floor Area Valu$:tjo;
pc (commencing with Section 7")of Division 3 of lM Business end Professions Cmk)ur _ _ ,
'y that he is;exempt therefrom and the basis fee IM alleged exemption.Any violation of '
Section 7031.5 by any applicant for a permit subjects the applicant as a civil penalty of - APN Number __ --Occupancy Type
not mem than nw<mmndrd dollars(s500).
37509
,8 . O'0^p1 �.i-�--�
1,as owner oflM X pmKnor my employees with wages u their sole compensation, l+-),
will do the work.and structure sure is not intended or offered for aide 7040.Business �' (+ ¢a ,
and Professions Coda:The Contractor's License law does rot apply o an owns of ` I•S 't1( +). equired-Ins actions+ - -
propenywhowildsorimpmvestheroon,and who doessuchwork hindai through his ! 1
own employees,provided Our such improvements are nothrended aroRered for sale.If. _-
however,the building or improvement is sold within ane Your ofcompleaon.the owner- 1t, -
huilder will have the burden of proving that he did nm Wild.,improve for Purpose of
salt.). i ��rddd
❑I,as owner of IM progeny,.B sines and
contracting with licensed contractors -
coue La dr projm(Sec.toad,Business and PruWho Wilds
Code.)The Convectors rad
wholaw enra am apply a an owner of progeny who sed p or improves thereon,and
Lim.Lacs for such projects with a contractor(s)licensed pursuant o the Contractor's
License Law. .
0Iem I"See .B@PCfor this rtawn __-
ne
R R' COMPEN ATIONDECIA ION _
I Mmby affirm under penalty of parjuy one of the following doelanoons:
❑IAeve anJ will mvnuina Cenifinm of Caruenuo self-iasurt for Wmrteh Camper- _ -. "—
weian,as which t u for by S.issued.3]00 of the labor Code.for Ne performance of the
weric dion.a which ed for
by
actio 3 _
❑1 have and will maintain Workers Compa aauon Insurance,u sequimd by Section
37W of the labor Core,for Ne performance of the work for which this permit is issued. -.
My Workcrs Compensation Insurance carrier and Policy number am:
Cama:+ Policy No.:
CERTIFICATE OF EXEIAMON FROM WORKERS'
COMPENSATIONINS RANCE
Masse tl olMcwnpletedif tis( onehumdreddnllars($100)
or less.) /v/L
1 certify the in N cc of lhc�ark for w� it u Wood.I shall not
employ any is in any in is,as o become bjecuo a Workere'Compensauon -
Laws of Cslir s.D -
Applicant
NOTICE PU :If. o a mg Ns Ccn me of Eaemptian,you shuuW
farm objec o the Worker's Compensation provision of the IaMr Code,you muse
.,� for with cam ly with such provisions or Nis permiuMll M dccmed tanked.
Z O CONSTRUCTION LENDING AGENCY
l" I hereby affrm that them is a construction lending agency for lM perfurmance of
y 7 the work for which Nu permit is issued(Sec.309'/,Co.C.)
ltl0 Lendcis
D. lsnders Address
U p 1 certify that I have read this application and state Net the above infmmetiom is /J�
(—' correct.I agree to comply with all city and county ordinances and sum laws misting to
0 U building construction,and hereby auNadae renCremstives ofthis city o enter upon the
}W shave-mcnuonW property(Or inipmoron purpemi
mnify and
City
F r%j liabilities,prig cots,Boss and expenses which may in any way ac cmc a rims said City
V z APPhICANTeof the.UNDERSTANDSIAhis
Dnno
WIL COMPLY WITH ALL NON-POINT Issued by: Date
SOU EGULATIONS.
Re-roofs
mfA HAZARDOUS MATERIALS DISCLOSURE Data Type of Roof
Will the applicant or
future building Occupant store or handle hvarduus maorial
as defined by the Cupenino Mu cipal Cont,Chapter 9.13,and the Health and Safety
Cod e.Section 25531(x)? //ryry All roofs shall be inspected prior to any roofing material being installed.
0Yes 70 .
Will the aPPlicanl or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit Mvardour air common, ons u c11, d by the Bay Arca Air Quality Management all new materials for inspection.
District?
�Ycs No
1 have mad the hnallous materials mquiomonts under Chapter695 of IM Califor-
niaH.INhSaferyCs ,Secti0n135505,8533and2534.1understsndthisdthe Wilding
does not Indy haw a mnanl,Nal it is y mspo ibility o noury IM cupanl ser the
Giro en w nelWmelpr;era,i Dan aCerancamof0mi,macy' Signature of Applicant Date
p All roof coverings to be Class '+B"or better
uthorar age am