01020073 i<'>r«y #^s^'ygi� via EmF h 'r Nex-v
CITY OFCUPERTINO "ir`' Q"�r,T �i� }1` �jV;;
BUILDING DIVISION
PERMIT
o-r.;�r
� ,arf'h^nLPERMR NO.
BUILDING ADDRESS; - MOSTAFA OURAIE
PERMIT L%u Dtl 020073
OWNER'S NAME:
O SANITARY NO. 0 3/2 1
PHO
BUIIDINO PBRMR INFO
ARCHITECDHNOINEER: BLDG HLELT 0 MECH
O
C
LICENSED CONTRACNR'S DECLARATION Job Description
1 Mrchy affirm that 1 em li=ved under Provldw or Chapter 9(commenting
with S=don 701)0)of Divhlon 7 of Ne Budncatand Profcaslou Code.and my Ikon¢"
In full forte and effeel
License Cl.t Catur
Date Con NEW SFDWL: 4397 CONDITIONED SPACE, 420 SQ. FT.GA AacHHEcrs DECLARATION 10/29/02 SENT EXPIRED APPL LTTR-EXPIRED 8/14/02
l underuand my plans 0-11 be used As PON"=aid' 11/18/02 PER GREG-\t ,!r ED PERMIT TILL 3/15/03 .
Licensed Profculand !ry\
OWNER-BUILDER DECLARATION
I Wrchy affirm Net 1 em see=ps tram the Camrmtors License Law for the I
'o following mown.(S=tion 7fU 1.5,Budmu and Profcaduu Code:AnY ally ser rounty ^ -C'
which myuirm•permit m ennnruet,alter,Impaw,demnikh,nr rcpdr any nmdure \1 ` Valuation
pdarmiu i.venee.tlm mquircs dN applicant tor=ch penn(t to Hleadgudsungmant ''w.S FLl Floor>,(A'
ie IhatW i,l(=nsed purmammtW provldons of Ne ComracmrsUttuc law(Chapter9 q'
�g (cemmeming with Sectien7000)of Dlddon7 of theBnsinrn and Profeaw Ctde)ur„1 k�. !:1 �_ 1.
., that ha"stamp/dtem(rom end the b.k rue Ne dleged uempdon.AvY dol \?� 11 Occupancy Type
Seedon 70763 by my applicant fan permit mbjecu Ne epplkanl to•dull pe y at K pN er
$435294
not mom Nan Rw M1urdrtO dollus(SSOOL
❑I.uoweer of Ne pmpntY•or mYwPloyw with wageaulhelr tole compen - e wired Inspections
will do the work.and theawnurt ulwtinteMed arortertd foraate(5ee.70N,Bud 35918013 O,R (1
ane Pgofetdou Code:Tha COnhecmrs License Lew dons not apply m en owns U_
props Y. Wlld,or(mpcow,Neewn,antlwhodau aueM1work Nmadfmduough
own employee.. ft. Nal suchimprowmAnuwnotlnumundoro(ferrdfor ante. 101 — FOUNDATION
however,Ne Wilding m impmwmcnt Ir mid within aro yens of completion,the Owner-builder wlll hive the Wrdcoof Proving Net he did,mat Wild ser Improw fm Purp=e of 102 — PIERS
anis') 103 - UFER
❑1,u Owner of dte property am eacluo,ly=matting with li=nand conumton to
=uwct Ne pmkct(Sec.Todd,Business sed Profns,ieu Code:)The Contractor"U• 104 — REBAR
ewe law dote not apply to anowner of progeny who Wil"o,Improw.Nemo.,and, lO5 — ANCHOR BOLTS
wWco=nch fog such Pmjeele with•=nvmtor(a)licensed urtaanl=the Canma.ors
License LA B&PCs this 106 - SEWER & WATER
❑i c t ,see
T 3 zf p 202 - UNDERFLOOR PLUMBING
WORK ATIONDECLARA 203 - UNDERFLOOR MECHANICAL .
hemby atnrm under Pclwt of perjury sue of he following declan0ons: 204 — UNDERFLOOR FRAME
C thaw end will mainuin a Certificate of Consent taml6maum fm woo es compw- 205 — UNDERFLOOR INSULATION
,.Coll,.provided for by Section 7700 Of din labor Code,for do Performance of the 301 - ROUGH PLUMBING
want,for which this permit ra Issued.
❑I M1aw end win ,,am worker's Compenution Insunnco,As required by S=oon 302 — TUB & OR SHOWER
7700ofthe Lab.Code,for the performance of the wick for which this permit is Issued. 303 — ROUGH MECHANICAL
MY Worker,compensation immran=eanier and Policy number arc: 304 — ROUGH ELECTRICAL
Can'-
Policy NO.:
CERTIFICATE OF EXEMPTION FROM WORKERS' 305 . - FRAME
COMPENSATION INSURANCE 306 HOLDOWNS
(This seetitm need not he completed Edge permit Is for one hundred dallm is 100) 307 - INSULATION
m kssp
IcaNf I that In dmf deme t`Ne we
rue which this Permit is Island.1.1111 nut 308 — SHEETROCK
employ enypegwninm .Iden .NWcome mbjen mttr worken'Compewuon 309 — EXTERIOR LATH
arcdifvnla.
Leve B
Le" 310 - INTERIOR LATH
,PfdNOTICE APPU' t If,after making this Certificate of Eacteption,you,h d
become act m the Wmkm`s Compcmedon Provldons of the labor Code,you must 311 - SCRATCH COAT
zo forthwith comply with such pramil.1
d,lons or this pecall be deemed motrQ 313 - ROOF NAIL
Tom. CONSTRUCTION LENDING A0ENCY 501 - FINAL ELECTRICAL ENERGY
1 hereby afro Nal there Is a construction lending agency(ser Ne performance of
a� Ne work for which this PC-it 4 Issued(Sm.3097.Cie C.) 502 - FINAL PLUMBING ENERGY
Wo Leaders Name 503 - FINAL MECHANICAL ENERGY
M andertyedrt. 504 - FINAL BUILDING ENERGY
U O 1 ecology that haw mad this application and tate that the above Information is 5 - FINAL ELECTRICAL
conccL I asses m comply with dl city and county ordiw s.ad,tete laws Minting m
OSV'! Wlldinficonmction.mdhembyeuthodrempmscnutiw.of Niscitymcnwupm Nc 50 — GA
0[L7 show.mentioned Property fm inspection Purposes
G EST
(We)Agree m caw,indemnify and keep M1t^nku the CRY of CUpon(no against '� I NG
y Ileblial judgmenu.cuu andelpeluu which may in my weyeceme agein.uld City 5
U7 In consequence of the granting ser this pemilt. I CAL Dale
AEMMM!
STANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
U ONS.
Re-roofs 510 INAL PLANNING
ApplicanVContracmr eofRo5IL4 - FINAL PUBLIC WORKS
HAZARDOUS MATERIALS DISCLO RE a Typ 602 - ROOF PLYWOOD NAIL
ill thO applicant or future building a=upmutom m handle haurdous matedd
As by dte Cupertino MUnAlioal Code.Chafing,9.12,and the Health and Safety
Code. 25572(1)7 All roofs sloe ins�RQf'pri8�trF'3lSIdfibfing material be7ngYu NUIf a roof isUjilleB%M6Wfkrjj%bjjjAfArjj3 Eii84ection,
ill Nc applicant or future building on:upem use equipment or devi=`which all new materials for inspection.
rdnm Air canuminenu g defined by the Bay Arte Air Qudit Management
Y���`yas UhaveroW Iheh.ardnmmaterielarcq"Safely Code,Seedau25505,25533wW2553/.luma rMndllwifNe Wilding
c w e tenant N.II u my r sponsibility m 1Y new 7'of the DateUh slWmetpdurtuisspan=u(aceniGc,teo ry� Signature of Applicant
2 z All roof coverings to be Class"B"or better
Owner or,uNoriazd agent Dong