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CITY OF CUPERTINO
BUILDING DIVISION PERMITC,C1,1�I'R9LCTOR"INkIMi'TZ,QNNN;,
BUILDING ADDRESS:
ABCO CONSTPERMis.
06080202
18650 CRABTREE AVE
ER'S NAME:
PERMIT ISSUE DATE
SAADAT FADAIE
14880 LLAGAS AVE
6
NE
SANITARY NO. CONTROL NO.
(408)779-7577
ARCHTIECffENGINEER:
BUILDING PERMIT INFO
BLDGPLUMB MFCH
l� O O t�
LICENSED CONTRACTOR'S DECLARATION
Jab Description
P
I hemby affirm Net 1 me licensed under fountain" of Chapter 9 (commoming
with Section 7000) of Dlvison 5 of the Businessland Profession, Code,md my license is
infull fmcaandefrect.
HOUSE DEMO -REPLACES EXPIRED PERMIT #05060012
License Class Lm. Y
Dem Contactor
/
ARCHITECTS DECLARATION
I understand my Plans shall he used "public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby a1Rrm Nut 1 am exempt from the Committees License Law for ,be
following reason. (Section 7101.5, Business and Professions Cam: Any city or county
$5000
which .,.I. s Permit m construct, alms, improve, demolixh. or repair any structure
§,—F t. Floor Area
/Z� aluation
prior At is issuance. Alm requires the apple=, forsuch permit in role a signed mammcm
Contractor'stimme Law (Chapttt9
that he is liccmd penitent the provisions or the
(commencing with Section 7000) of Division l of the Business and professions Cask) or
that he is awn ft therefrom and the basis For the alleged Assumption. My violation of
AFN Miribbir
wccupancy Type
Sacaan 7031.5 by AM applicant for a permit subjects the appliesot In A civil Parramy or
not moa fan five hundred dollars (SSW).
❑ I,no afthepmpasy.wmycmploymwithng"uthamalecempmadon,
Required actions
e' P
will dodrowerk, and lhestructure is"a`"uvead"Offered forum (Sec.7044.Business
and Professions Code The Conmaerues Liceuse law das Out apply m a aeroof
q
pmperty who build, orireprowtionoWand who daosuch workhiAIM1101 Waugh his
own employees, provided tha,mch improvements beam!.', As oQertd for sale If.
however, the building or Improvement m sold within One Kar ofCOMPledon. the marcs-
.
builder MO hoe W burden of proving that ha did not build or improve for purpose of
am.).
As Owner of this property. am exclusively contracting with licensed mnmacon to
construct the project (Sec. 7044, Business end Profession, Code:) The COAUAcmes Li-
cense law docs not Apply to an owner or property who builds or improve themon, and
who contracts for such Projects with a canmactor(s) licensed Putman, an the Comm elor's
License Law.
❑nom exeoaps er Sec .B&PC far this mason
Data
WORKER'S COMPENSATION DECLARATION
1 hemby &Wl m under penalty of perjuryam of the folmwing d"Wadm:
rl I have And will maintain a CeNfsesm of Consent NO self -Insure fa W-keh Compen-
sation, As provided for by Seaton 5700 of the labor Cade, for the performance of the
work for which this permit is Issued.
❑ 1 have and will maintain Workaes Compemadon Inman, As required by Section
37M of the labor Code, for the performance of the wort for which this permit is Issued.
-
My Workeea Compensation Wurarec artier and Policy number am:
Carrier. Policy NO.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
-
(TTis seNan need no, beeumpmmd lines permit Is foramhundsed dollw (5100)
or leu)
1 anify that In the performance of the work for which this Fend, is Wood. I shall not
Compeadon
Amp lay anypeaon inmymanner s Qjcamcybjtt,mma Workeri n,
�$
Laws of Califor(rA. Dem _a ^ / P C'
ApPliesnI—
NOTICE TO APPUC vi4T: making this Ceniftnm of Exemption, you should
become subject in the Worker's Compensation provism, of the LINA-Crile, you mum
foMwith comply with such provisions or this Permit shall he dcemed rewked.
7
CONSm ON LENDING AOENCY
1 hemby Is a construction agency or the performance of
cDrm then thea Is aod
(Se.3ICOdwg
the work fur which this petrol, is iaslad (Sec. 7(19], Co. C.)
i
Lender's None
c Lender's Address
I certify that I have road this application And sum that the above information Is
" torten. l agree to comply with all city and county ordinances and sum laws minting to
building conviction, and hereby emthoria mpnsenutim of this city to enter upon the
above-memioned properly for inspection purposes.
(WA) agree to an. indemnify and keep harmless the City of Cupertino against
j liabilities judgments. costs and expenses; which may in my way acs7uc against said City
r in Conamneae of to grunting Of this NOMIL
` APP CAM UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date -moo d.1
SO 'REGULATIONS.
9'/3 o /o b
Re -roofs Z—
Type of Roof
Sign mu a ol'ApplicamlContracti Data
HAZARDOUS MATERIALS DISCLOSURE
Will the Applicant- future building occupant sort or handle hazardous material
As 4e0md by the Cupertino Municipal Code. Chapter 9.13, and the Health and Safety
le, Section 25573(x)? /
All roofs shall be inspected prior to any roofing material being installed.
❑Yes QNa
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment -devices which
MAIL h4zardnu,.1,contaminanu u defined by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑Yes gat
I hove msd the hvswo"materials requirements under Chepmr6.95 of the Collier.
iia Health & Safcry Cade, S mon,75505,25577 And 25574.1 unloo urw mmirthc building
_
dace rot c ntl have a umanL That 11 u my msponsihility m notify fa oceupant of the
anp w
roquiremc whl mustbeme dorolamnccaacenificamarM-31-1/c,
Signature of Applicant Date
$/ s �0 6
All roof coverings to be Class "B" or better
Owner or "thorned agent ` Dam