06070084 CITY OF CUPERTINO z.,�a7sr:ga'.w =tT'.fet ts�
BUILDING DIVISION PERMIT C�l,Xx{„ GT�nR Ile �QR�Ittk10 ,
BUILDING ADDRESS: MOHAMMAD MORADI PERMIT NO.06070084
10050 HILLCRE T RD
ER'S NAME: PERMrI ISSUE DATE
MOHAMMAD MORADI 08/29/2006
NE: SANITARY NO. CONTROL NO.
ARCHITEC tENGINEER: BUILDING PERMIT INFO
BLDG ELECr PLUMB' MECH
ioo LICENSED CONTRACTOR'S DECLARATION Job Description
i�F I hereby affirm that I am Reeved under proarta aisiof Claim'9(camma.kg P
S with Settle.7M)cdDIvWOn 3 of Na Deal.and Profesmon Code,and my license I.
I.full Come and effmt. DEMO OF HOUSE
; z ueenm ave Lw.{
F, Dam Connector
ARCHMCTS DECLARATION
U 1 understood my plans Mail W wed As Public records
:Ind� Licensed Professional
r.,5 OWNER-BUILDER DECLARATION
i C C 1 hereby Maso .(Tire on 1 em exempts a the Cmins Co :Any c Law for Ne
:D o which re moan.Permit
t 7W construes.
Business and ns.Professions Cade:Any city m county
$ which require a permit re cares the siW,Opens.duel W. fie a sig any thocroomemem $5000
•Zi Pdormiuissuance.
PU also requires the of far such permit Bkisiga (Chumerlll
•�o thmWbuanwapamr.mmthe provisionsarNecamtrmwrbLkevelaw(Chapter9 Sq.Ft.Floor Area Valuation
$ (cb amceing with Sad..7000)of Division 7 of Business Businend Profwions Cnde)or
.• Nmat he exempt therefrom and the bub for the alleged exemption.Any station
of
Section 7071.5 by any Applicant foe a pe mit subjects the apPlkant to a Civil penalty Of i Occupancy Type
et mom than five hundred dollars(SSW).
❑I,m owner of the propartY•m mY employe veld wage ss Nevmk wmpewtion,
wiU do dw work,and the awcmre b mtkmMW m offered fanala(Sm.70a4,Basics
and Profassias Code:The Commences Umma Law door ml apply An an owner of Required Inspections
property who builds Cir improws dwrcan.and who does tach work himml f Cir through his
awn employees,provided the such improvements.mtinteMed maReed fm We If. '
however,the building or Improvement b veld within o.year 9completion.the owner.
build.will haw the burden of proving Nal he did rot Wild or Improve for purposes of
sale.).
Q 1,As owner of Ne property,am exclusively contracting with licensed canhamon to
commuct the project(Sec.7044,Businrn and Profession Cade)the Cmucmh U.
tone Law does not apply be an owner of property who Wilda or Improwa thereon,and
who Contracts(or such PmJeN with a cmtrutm(s)licenre amm(ltacmusctara
Linens Law.
❑l.eemp nor See B It P�C�for this Means
69
Data —19 {ly{'
WORKER'S COMPENSATION DECLARATION
1 hereby slate order penalty of perjury,me of the following declarations
Ihave provided
Air
netion 37m of Code.
performance
of e
moan,as Proh this
(Pe by Section 77W a(tie IaWr Cade.fee the perfarmvwe of Ilrc
work for which Nis permit is issued.
❑1 have and will maintain Warkerl Compensation Insurance,As required by Section
37M of the Lady Code,(m the performance of the wok for which this permit is Weed
My Warkces Compe emm n Insumuw Cartier and Policy number are:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE -
(Thbsactiun reed no,W completed If the permit is free.hundred doll.($1 013)
or less)
I canify that in dc performance of the work for which this Permit b lamed.I Shall not
employ any person in my meaner se as to became subject to dm 9(rke ' m on
Law s of Califo am -
APPliemt
NOTICE APPLICANT:I s Comm Ung thb Genome m Exemption,Code.
should
become subject y the muh po Camperuatim provisions of the labor Cadc,you muse
,J O forthwith comply with smh proriiwru m Nu permit atoll W derr.a rtwkW.
'�� CONSTIIUC ION LENDING AGENCY
(~ I hommydibm the,Vert ba ca,usucOm lending agency for Ne perfoanenmuf
f1S > Ne work for which this permit is intend(Sm.3097,Civ.C.) '
It. QLender's Name,
a Z LendeesAddrw
U Q I certify that 1 have rend this application and saw the one,show:information is
U. correct.I agree to comply with all city and county on inances and state lawn rtlaung w
QU building convection,and hereby authorize Mmaxenutivn o(the tiny to enter upon The
IgA ahorc-memiuned property for inpeeuon purposes.
phi (We)agree to save,indemnify And keep harmpe
less the City of Curtino gain(
fA liabilitie,fudgenumnacusts and expense which may in my way accma against said City
L)2 In caneq..e of the{ranUn{o(Nia permit.
^ APPLICANT UNDERSTANDS AND OMPLY WITH ALL NON-POINT Issued by: Date
SOUR EGU ONS.
a •O�v Re-roofs
Signcurt of Appli.VContrcwr Daw
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will tW applicant wluwre WUding mmpantamc arbandk hvWms mawrial
As dell by tie Cupe:ninn Municipal Code.Chapter 9.12.and the Health And Safety
sC3Y-xss3x(.)? All roofs shall be inspected prior to any roofing material being installed.
❑Ye (�o
Will the appticam or future Wildlmg attvpant us equipment m dcAca,which If a roof is installed without first obtaining an inspection,I agree to remove
emit hanNous air cmtsminnts a defn.d by the Bay Area Air Quality Management all new materials for inspection.
District?
Dy. t6dlu
1 hammed the hmawaus mawriab mquimmsnu under C'hopmr6.95 of dm Cali(or-
nieHeaM&SafetyCode,Smtims 25505,x5533 wwx5534.1 uWcmm l dtuirt a Wilding
docs rot currently be a rot.the it b my responi 'lily w notify the amupmt of the
myulrcm i metpdar ertifie,marampeacy Signature of Applicant Date
Owncror outhar n e cm Dem All roof coverings to be Class"B"or better