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CITY OF CUPERTINO"�
60NTRACTnR INFORMATIgN..
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
PERMIT N0. 06010074
19411 CALLE DE BARCELONA
NER'S NAME:
PERMIT ISSUE DATE
FARIDEH MISAMI ALIMOHAJE
04/06/2006
-HONE:
SANITARY NO. CONTROL NO.
ARC HITECTIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 � 0
LICENSED CONTRACTOR'S DECLARATION
Job DOSClIpIIOD
I hereby erRnm that 1 an licensed under pmvisim a of Chapter 9 (mmmencing
with Section 70(10) of Division 3 of dw Buaineasand Professions Cado.and my limare is
in full fmcc nderfal.
SFDWL-1 STORY 2307' LIVING/GARAGE 430'
License Clam Lk. g
DaHe Contractor
ARCHITECT'S DECLARATION
1 understand my plans shall x used as public records
Licensed Pmfasia..I
OWNER -BUILDER DECLARATION
I hereby affirm that I am aempt (nice the Contractor's License law for the
following reason. (Section 7031.1, Business and Rafossium Cade: Any city or county
$518794
which mimosa a Permit On eaneoucl alter. improve. demnlbh. ar p,psln any aauaup,
prior w its issuance. also requires the applicant for such Permit to file a signed statement
Lomas Law
Sq. Ft. Floor Area
Valuation
Ibex is licenced purmant to the provision of the Conuacwfs (Chap=9
(commencing with Section 7000) of Division 3 of the fb shment and Professions Can) or
that he b aempt therefrom and the bub far the alleged uempUan. Any violadan of
r
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the APPlkanuo a civil penalty of
not more dun five hundred dollua DOW.
property, ar wPloyon withwgvuthe'u mk mmpensdness
❑ Lu�wnerk.
D$ ections
TlTlrljjrjjrJj6..��I}}}��s DDD'77Att1CC''']]]mm���.a p
andI, 7064, BuahmOf
Will Pr thewon. and thestructureCornbmri License ate does,
Nd PwfwloCade: The Caseate-, License Law dors ant apply lf an oars- of
em who build,,prerIXiwpre, who aIXratch Work nlwmRarthmagh is
ter
fon Weir.
such If.
we
we employ=,
LLIi'la�
theWiprovidedm rouchem Is old idarenotwmMWaroRra.
year ofimroefor Ne owe r.
beaker. Nr building orImprovementbcoldto
did n% of
builder will have tM Nuden of proving that k did tat xild or improve for purpose of
with licensed mnoactara at
44W LU �tl,�-•
❑ I. as caner of the property am uelusively contracting
construct the pmlem (Sec. 76414, Business and Profeasiona Cade:) The Conwcwr'r U.
director, and.
cabseLaw do for such pmjecO with a onmcmrty who Wil pursnnt w the Cector, and
who conwdocsnouchplr wan owns of progeny whored martial to
License Law.
❑ l am comp,See B a P C ror 11,3rr.
IvIrNl7 �4ttly�
,r
•rm,�. M/,�,/y Data
RL'ir'S COMPENSATION DECLARATION
1 hereby arum under penalty of perjury cm of the fallowing declaration:
❑ I lmveand will main Wna Ceni0wte of Consentw selGlnvrt fm Worker's Compen-
smon, u provided far by Section 3700 of me Loon Cade. for du performance of the
work for which this permit b issued.
1 have and will maintain Worker's Compensation Insurance, as required by Section
3700.f the Labor Code, far No perform a ce orthe work formich this permit is Issued.
My Warker's Compensation Insurance carrier and Policy number am:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
a
(This action need not x completed irum permit is fmone nun0red dollars (SI00)
nn Irs6 )
1 certify Nes In the Parr ..ow o ark for which dos permit b imucd, l ,hall not
umployanymorminanY In an mx<om cab' Ito New,rimpe Um
Laws of California. Da
Appliant
NOTICE TOAPPLICA ,a -making bCeni0utea
Income subject to the Worker's Compensation prevision, of me labor Co& you mum
•
forthwith comply with such prevision or this permit anall be deemed rtwxd.
-
CONSTRUCTION LENDING AGENCY
that mere b s agency tan the performance: of
m.
1 herebyowhich
this ed (S 30 7. Ci,,
dte wort for which Ibis permit b issued (sec. 3097, civ. C.)
'
Lender's Name
I
Lender's Adder..
j I certify that 1 have mad this application and scow that Ne abom information b
Conan. 1 agree to comply with all Nty and county ordinances and sou laws relating to
building consuuctien. and hereby aumorim mpreanW ives of this city to enter upon the
for inspection
1 above-menuuned immmly purposes.
(We) agree to save, itwcmnify and loop hamtku the City of Cupertino agaimt
j liabilities. judgments. cotta and expenses which may In any my scene against mid City
in co empterem of irsnung or suis permit.
/
s APPLICANT ERSTANDS NO WILL COMPLS' WITH ALL IN -POINT
Issued by: Date
SOURC ADO S,
Re -roofs
Type of Roof
Signamole of Aplid6mlOcroactor Dow
HAZARDOUS MATERIALS DISCLOSURE
Will IW applicant arfmurt building occupant stop, m handle hasardom material
u claimed by the Cupertino Municipal Code. Chapter 9.13, and Ute Health and Safety
oIII. Section 215320)?
All roofs shall be inspected to any roofing material being installed.
❑Yes ON.
prior
If a roof is installed without first obtaining an inspection, l agree to remove
Will the applieaat or future building occupant um equipment or devices which
emit hxaadnu air contaminnu u dcRrmd by the Bay Area Air Quality Management
all new materials for inspection.
Dis0ict?
❑Ya l ON. ,
IIIave mad the Mendota materials requirements under Chapter6.95 of Ne Califor.
nb Health&Safcty Cade,Sccuaun5O5,35533a 25534.1undcrsundmatlfde Wilding
des act currently •teem, Nat II b myonpry� i ulity to nodry theoccupant of the
uiamc murex rpdanw
myuanceof.Cednwtearoc
Signature of Applicant Date
roof coverings to be Class "B" or better
ownefmautharimd ager DateAll