02060036 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
1 BUILDING ADDRESS: PERMIT NO.
6393 BOLLINGER RD STEVE GHAFFARI 02060036
WNER'S NAME: APPLICATION SUB DATE
STEVE GHAFFARI 06/06/2002
% •' PHONE: :'t_"" _ .., SANITARYNO. : -CONTROL NO.
1 O O ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
C-7 I-J L_] I—_i
Z m Z I ! LICENSED CONTRACTOR'S DECLARATION Job DescriptionIh liy affirm that l am licemed under provisions of Chapter 9(commencing --�
Fyt� with Ston 1000)of Division 3 of the Busmeeand Professions Code,and my license INSTA
e
is in full fame and effect,
ao O License Class
Dale Convector 1
�sy p�^ ',>; xf l i, t n c' ARCHITE¢1';S DECLARATION to; JdeRr t8pd{gY PtiBne M Il,he used W Puhl c rFc'ords /. 1 .
vl p Limmct of«ions(
n OWNER BUILDER DECLARATION
a -y I hereby strum that I am exempt from the Contractor's License Low for the
C F< following mason.(Section 7031.5.Business and Professions Code:Any city or county'
FO which requires a Penni(to construct.alter,improve,demolish,or repair any structure $600
prior o ih omancc,alused[oft
provisions
of abe Coh ractoe m Nan slaaw(Cmemem
3-ldarlracAcceggd puesµwrop¢pradsmnsmf . io R.io,i License Law(Chelaer9 c-W, h[.• Valuation
.10.1 S,b mini Sdton Tmand the
art thelleged wand Profasyvi Code) ,-i; ( .36�J 1t�V'� /-�.YStJ A ..TjA L i',J.•
or Nat he ii exempt therefrom a the basis for the subjects
the
Any violation
-of out...!3nfill1.5 by undredicanfarepermssubjecrs the npplicam loscivil pcnelry- p yTyp
,of npumort them fill hundred call...(8500). APN NNuu��� 'I:+I " � .D000 ane e
or'.as even,of the pro,ii l 304 - KOUGH ELECTRICAL
i
P th Y my my«xwided ora orad for sal (Sec. S01
F -AA13ENERGY`will nesedo a work;Profesand sions
ode:strucn is not intended orae Law for no (pec. to ankl, - '- - - Md yirpr- --
'owner oa prorat fa:ions Code:The Coes thio s License Law does not apply m an SOS - F I NAL EUC'li 7TRtl l';FY]]CIIODS• •"'1'
owner of property em loebuilds or Improves a t such and ve does such work himself
of through his own employees,provided dm such improvements are not imendW or _
loffercdfor sale:ICgowevei then Wvc the
pin ofprovn sdW wdid not Wild
of :.,, . : .,.. y I t
completion,the owner-Willer will have the bunlen of paving that he did not build or
tropia«for puryom of salt.).
'Or'as wncr oP,the o '. .. .......... ..... ... ..___. _.. -.
onstiun de'p Project�(SmJ6W.Businesseland Professions with"
The Connector's
y
Lim.Law d«s onot apply to an owner of property who builds or impo as rhemon, �1 r such Polecu w d mountains)loemed.purauanl to that. ..__. . ..._. _._._ _.
_and h trace f
onw nor s Lcense W
I oin exempt and.r Spar
--''DDyq ��� �I'��J" P&P for this reason //�� •^ter �/l/
K 'S COP.ry✓3ATIOkYDE LA
I hereby affrm under had ofperluy We of the following dathommm: t
a O 1 he :and Wil h malmh a e Le uftc m of Consent to self-insime for Worker's
^.•t Cumpaninaooa as r provided.for',by,Section 3100 of the Ub6,;.Cbde; for the
'performance of the work for which this Krum hI issued. . 0
❑1 have and will malmaiu WmImi a Compeniondo'Insurance,aniregdirtd by Section 'V
37M of the Labo'CCocie,for Ne performance of the work for which this permit is 0 ,r
iu d My W clefs Compensation1 1 u caule m
and Policy nubrc
number a :
Gema f T CC
r ERTIFICATION OF EXEMXEM PTION FROM WORKERS(
'COMPENSATION INSURANCE
frrd tenon need riot be completed if the permit is for one hundred dollars
(SIW) les )
_...._:
1 an ry th i th pe 1 rm n e of New k', It
rhr perm r
shall n teropl y o y per m ny an er be
bj rl sW
Compen{aeon yf Cal Tum eApplicant
t'7 C AP A Y mr g s C o f am f E cmpuon-you should -
l3imiYlT'4bject to the Worker's Compensation pmvlxmris of the Labor Code,you must
Q O forthwith comply with such provisions or this permit shall be deemed revoked.
47 y tt 1CONSTR Cf10N LENDING AGENCY' '
W
' Ibe Irmo Jut Jmrelii a moswnron lend ng agency for rhe perfarin sa rwhich thispermit 5issued(S 3(N1, v.
CC)
r
of w df�
4, Le der Name .. ... .___ _. _._. ......... .. . .. ......._ ....... _ /
5„Z Lenders Address 1
U Q I n fy Jiai I ha a reed Ih ppl caro d ur that the bo information u
fz'f (arrest I gme,to cnmplY th Il any acrd w ry,ordinances and state I rclamg s
.0 Mich .
to WJdng consimcibui.and herfbyriudonze rtprcsemm«softhscitymanmy,am
�a r�
time bu a mentioned propcny f- span p p' es'
pa fWcl Sgrcaw, a 'dem fyaI keep harmlf:the Cit of Cupertino'gainst
�F Vyi ;lilFII tMa rydgmenls usL ¢J xppeminch m y m 'ny y c,against said
V a CIy In Ce sty cd«bfthe 8unung ofd Penn( - - ' .•'•s '4^
tXPPI,/CLX[pYDENSTAND4 AND W1LL C0MPLYWITH ALo\r POINT �� (JL/
SOURCE RECtn' ovs, Issued by: Date
runtumbfApillissarrucldaml., Da.-^,1. Re-roofs
u 'HAZARDOUS MATERIALS DISCLOSURE
aMe Seaton 255121e1 ding ocapam tort Intonations or handle dons mat _Type of Roof __ _ . . .,.._..-..... .-,�_.,.
WiIIN pplm t (
HAZARDOUS'
CJefned byd Copeman Mumapal Code Chapter 9.12.?oil the Health andSafety ` )� 1
❑Taft is s 1 I fa' I 'l, IC ,' 1.
Al] roofs shall be mspected.pngr,to.,any.roofing material being tgstalled. __•,_
Wrlllhe_pplimnlo mre ildig occupant use equipment or devices which If a roof is instaile'd'without first obtaining an inspection; I'agree to remove
' Mamgcmem
Dismm commitments as defined by the Bay Arw A Quality— emthauNoda ea all new materials for inspection. Applicant understands and will comply with
❑Yes q.
all non-pom[source regulations.
, ., r :�;, ,; • ' •
have r«A'thc Ilan d'us motedals requirements under Chapter 6.95 of the
Cal. 14 HeB in&Saf ty Code.Sections 25505.25533 and 23534.I undenurrd has- Ifde dii ding doe ria cumonly have emnant dant is my responsibility to notify the
& ponON
t of the req.r moral hich must W 1 Prior to issuance of a Cenificate of _
gccupa cy '.
Signature of Applicant_ _ Date
icor aurho sea gent, - Date All roof coverings to be Class Bir or better
r, .. . .. _... ._ OFFICE _.._. ... .- . . ...... _... .. .. .. ._