03050132 CITY OF COPERTINO N""
BUILDING DIVISION PERMIT WONT 'GTORNFORMATION ,
BUILDING ADDRESS: ABOLGASSEN NEHAWANDIAN PERNHTNO03 05 0 13 2
a.R'S NAME: PERMIT b'U ? ¢'�8/2 O O 3
OLGASSEN NEHAWANDIAN V�/ `
PHONE: SANITARY NO, CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LOp LICENSED CONTRACTOR'S DECLARATION JbDescrip non
rd U F I hereby affirm that I an licensed under pmviumo
u of Chapter 9(commencing
Out Satuar70lo)of Division 3 of NC goal.and Pmfessiom Code.and my hear.is
nim in full force and nRest UPGRADE STORAGE SHED (216 S FT. )
j12? Licnm Cissa Lic.N
t, Dam Contractor
DELL
ARCHITECT'S DECLARATION u ® t6ae
1 understand my plans shall W used as public records
oG LicensedProfessiom JUN 0 5 2003
5 OWNER-BUILDER DECLARATION
I I hereby affirm that 1 am exempt from dre Contractots License Law for the
p0 following mawn.(Sccilto Z8131.5.Business and Professions Code:Any city or county BUI
$ which rtqui.a permit intruct improve,demolish,or repair any lamero '
—Z0 pria to its issuance,also requires the applicant fusuch permit to rile a signed surement
£ < that he is licensed pursuant to the previsions of tW Contractor's License Law(Chapter 9 Sq. Ft.Floor Area $1#gtion
s((t� (commencing with Section 7")of Division 3 of the Business and Profcuions Code)or
�y that he is exempt therefrom and the basis for she alleged cumpdon.Any violation of
Section 7031.5 by a,applinns this. mrsh subjects he applicant to a civil pcmalty of 3 KPR3QFacr 0 0 Occupancy
not mom man fin hundreddollars(5]W). TYPe
❑I.ssawnu of me propeny,amy employer wire wages as hevsole mmpewsiw,
will arothetion.Coo, he ContrawtintendedLaw it an,
apply in ae,Busimss
,ata property
wh ous coin:The ComssemYs License who law dao or apply lf an caner of
is 102 — P I ERS 111d Inspections
own anywyces.dsaed damuchimprendwW acessuchwskedin ffeedmmugh his
hxwcm,lme Wilding
or thatmnrmantipwmmtsarennllelemmm°Rued for owner, 1O3 — UFER
builder,me Wilding dr improvement is sold within ore build
or completion.oonfor Ne owe of
builder will low the WNcn Rr Pmrmg that Ise ate trot ladle m imptnw rte purpose fir 104 - REBAR
"IC') 105 - ANCHOR BOLTS
0 I.u Owner of the progeny am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contsactots U. 106 — SEWER & WATER
cause law does not apply in an owner of pmpeny who Wilds or impmeas thereon,and, 2OZ — UNDERFLOOR PLUMBING
who contracts for such Projects wire a contracter(s)doused pursuant m the Contractors
Linenlaw. 203 - UNDERFLOOR MECHANICAL
Dismiss tondo Sec. ,B&PCfm this reason 204 - UNDERFLOOR FRAME
COn - HPENS ON'D L ND.CO 205 - UNDERFLOOR INSULATION
WORKER'S COMPENSATION DECLA N
`I herebyaffirm alt or 301 - ROUGH PLUMBING
Penalty perjury one of me fallowing arlatatioss:
O l bare and will maintain a Cenirias of Consent to sel6iuum fa Works's Compcm 302 — TUB & OR SHOWER
station.as providnA for by Session 37W of the labor Cone,fmW Performance of the 3 03 - ROUGH MECHANICAL
weak for which mi,Permit in issued. 304 - ROUGH ELECTRICAL
0 1 haw and will maintain Wakess
fs Compensation Insurance, required by Section
37W of the laWr Code.roe the andormurta of one work for which this Permit is issue. - 305 — FRAME
My Wonels Compensation lnsunna carrier ad Policy number am: 306 — HOLDOWNS
Canon' Pon
CERTIFICATE OF EXEMPTION N,RNoO: WORKERS' 307 - INSULATION
COMPENSATION INSURANCE 308 - SHEETROCK
nrlsss)
(Tha secure need not W completed if the permit is for one hundred dollars(SIM) 309 - EXTERIOR LATH
310 - INTERIOR LATH
e unify man in 1W perfoware of ore work for which this permit is(ssnea.I shall nm 311 - SCRATCH COAT
employ any pe ymanncasdo�y me subjncuo lac Workers'Compensation
Law'or c,ld ]�3SS 313 - ROOF NAIL
AP�Iic�t�t t wn�—� Ma
NOI]XM PPUCAN .1f, harmakingmisCcninamofa=ption,ymoould 501 - FINAL ELECTRICAL ENERGY
MlIme subjrt to me Woncrs Compcumion pmvisiom of the Labor Code,you muse
.JZ forthwith comply wit such prowisnm°rthis Permit"IWaanand nkad. 502 - FINAL PLUMBING ENERGY
'Z O CONSTRUCTIONLENDINGAGENCY 503 - FINAL MECHANICAL ENERGY
F IhcrebyaffirmtNlthem is.mosvuctinmlending agency lot mePerformance or 504 - FINAL BUILDING ENERGY
a hewonfor which this091
permitisissues(Ses.J ,Civ.C.)
Latrines Name 505 - FINAL ELECTRICAL
R]Q
� Z `"a sAd° 506 - GAS TEST
U p 1 certify Nat 1 haw read his application reit sum mat the above infona.ire is 5 0 7 - FINAL PLUMBING
ly caned 1 agree b comply with all city and county ordinances and state laws elating m
C" conning 21"" tion.dna hereby euhoris repmaentatiws°f mice city upon that FINAL MECHAN CAL
LQ .now-mentioned property for inspection purpotea
.Fi G (We)agree to sew,indemnify and kccp harmless the City of Canadian agaisnt 0 9 FIN �w
(q liabilities,judgmcnu,cosu and expenses which may in any way accrue against said City I A NG
J Z in consequence of he grousing of this Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:5 WORKS Date
SOURCE EGULATIONS.
-k — -- 20'5 Re-roofs
nature ofApplionVConuactor Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will me applicant or future Wilding mcup oral tom or handle hazardous material
defined by the Cupertino Municipal Code.Chapter 9.13,and the Health and Safety
.
section �No
zss3z(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Y
' wnthn. Gnntnrmtpre Wilding occu mute If a roof is installed without first obtaining an inspection,I agree to remove
applicator g N Nutriment or devices which g P g
e i irnt'�ous air contaminants ss dcrincd by tW Bay Arca Air Guiltily Management all new materials for inspection.
0 yea �Jo
1 have mail the huraNms mmerialsisminamenu under Chapter 6.95 of the Califon
nu Health&SafetyCode,Srsiou 25505.25533 and 25534.1 understand hntifthe Wilding
does trot contends haw a motet last it is my rusporm,ny us notify oc occupant of that
requirements which mull Wm es our It issuance or.Certificate of Occupancy. Signature of Applicant Date
net fir amm�risd.sent D,m 5 All roof coverings to be Class "B"or better
C["PY OF CUPEWFINO
BUILDING DIVISION PERMIT #,CONTRACTOR INI'ORMATION _ l ,w,5
BUILDING ADDRESS: ABOLGASSEN NEHAWANDIAN PERMIT N®3050132
0270 S FOOTHILL BLVD
OWNER'S NAME: PERMIT LSSUE DATE
AL ABOLGASSEN NEHAWANDIAN 2003
DONE: - SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
B� ELO PLO MECH
of
40 LICENSED CONTRACTOR'S DECLARATION O
UW as
❑ I hereby affirm that I am licensed coder provisions of Cham,,9 anmmeneing lob Description
sW withsecdon7m))of DiviaVonJof me Bulinus and Profczinn<CsWe.antlmyliansc ix
m�= in mum eanderkc'' UPGRADE STORAGE SHED. (216 SQ. FT. )
Licens Class Lk.M
41Fn Dam Contractor
f
as
ARCHITECTS DECLARATION
?c U i understand my pians shall be used as public records
o'er^ Licensed Professional
g OWNERBUILDER DECLARATION
<i 1 hereby affirm IMI I am exempt from Ne Contractor's License Law for the
00 following reason.(Section 71171.5,Business and Professions Code:Any city or county
m 4 which requires a permit to construct.alter,improve,demolish.or repair any structure
FZQ Poor n its issuance.also requires the applicant for such Permit o file a signed statement
°m0 that he is licensedpucmuntotheprovisionsofUnComractor'sLicensefaw(Chaptnr9 Sq. Ft. Floor Area Valuation
`x— (commencing with Section 7")of Division 3o the Business and Professions Cattle)or
N9$ Nat he is exempt merriment and the basis for On alleged caemption.Any violation of mr�� c�
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 5AM�VIGbel)0 OCCU anc Type
not more man five hundred dollars($500). p Y yP
❑ I.as owner of the property,or my employees with wages a their sole compensation.
will do the work,and me Stmemm is not intended or offered for sale(Sec.7014,Business
and Professions Code:The Contractors License Law docs not apply to an owner of Required Inspections
property who builds or improves thereon,and who docs such work himself orthrough his
oamn however,me uilding or ImrsOc ant is old wit arenot ear dedofc as mpletioffered for owner- /k
huilder illhaw the
rimprovement issoltlwiiinot year of improv for linpu owner- I y^++XI\I
builder will Mve the burden of proving that he did not build or improve for puryose of
sakJ.
Ej 1,as Owner of are property,am exclusively contracting with licensed contractors to
construct Be project(Sec.704,Business and Professions Code:)The Conmeari Li-
who contracts for such projects with a contractor(s)licensed pursuant me Contractor's
License La .
❑1 am exempt under Sec. ,B&P C fm this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby af0rm under penalty of perjury one of me fallowing declarations:
1 as ve and will maintain a Cenificam of Consent to self-insure for Worker's Compcn.
satin.,as provided for by Section 37W Of de labor COdc,for the performance of the
work for which tris Permit is issued.
❑1 have and will maintain Worker's Compensation Insurance.a required by Section
3700.f the labor Code,for the performance of me work for which this Permit is issued
My Worker's Compensation Insurance carrier and Policy numher ase:
Camcr: Policy No, '
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be complcmd time permit is forms,hundred dollars(SItM))
of It
I ccnify mat in the performance of the work for which this permit is issued,1 shall not
employ any person in any manner se as10 timmom Subject to the Workeri Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,at mr making this Ccni Bcam of Exemption,you should
become suhject 10 the Worker'a Compensation previsions of the labor Code,you must
., z fonbwi th Comply with such provisions or this Permit shall M deemed revoked.
z ;� CONSTRUCTION LENDING AGENCY
t" I hereby affirm that mere is a construction lending agency for the perfurmance of
'Ythe work fur which this permit is issued(See.3W7,Civ.C.)
aQ Lenders Name "
0 z Lendcr's Addmada
J 0 1 ccnify Nat 1 have read this application and sat¢that the above information is
If. U cofect.1 agree m comply with all city and county ordinances and state laws relating to
QhuiWiag construction.and hereby authorise rcpresenutives of this city to enter upon the
t!] above judgments.
ugmentioned property for inspection purposes.
F Q. (Wd agree to save,indemnify and keep harmless the City of Cupertino against
Bel Z inconsequnce of the costs and capcnusonit. may in any way accrue against said City
Oz AcPLICA T UNDERSTANDS
Sthis Permit.
^-' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Signature df ApphcanUContractor ante Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant store or handle ha.duus material
U dc0ned by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Cad-,Section 255J2(a)7
Ycs �Nu All roofs shall be inspected prior to any roofing material being installed.
�
7' Di5Will the applicant or future building Occupant use equip mcm ordevices which If a roof is installed without first obtaining an inspection, I agree to remove
trol7
mit hazardous air conuminam,a defined by the Bay Area Air Quality Management all new materials for inspection.
❑Yes [:3 No
I have read me buvallom materials requirements under Chapter 6.95 of me Califon
nits Hcalm&Safety Cede,Secdmms 25505,25517 am135]4.1 understand Nm if tM Wilding
does nm euncndy hate a tenant,that it is my mspeamisly to notify the......of me
mquo-cmemswbid,most tomet'dortOissuance of aCerdficamorOccapancyy. Signature of Applicant Date
Owner Or aommimil agent Date All roof coverings to be Class "B" or better