06120092 CITY OR CUPERI'IN0 B �� ' '°° "' ""
BUILD ING DIVISION PERMIT C�NTRA.CTOR INk'�ORMATION ��'
BUILDING ADDRESS: PERMIT NO.
0 ER'S NAME: _FEYNifga UE
IOHAMMAD MASADI 12/20/2006
...NE:
SANITARY N0, CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
Op LICENSED CONTRACTOR'S DECLARATION IOb Description
1 search,affirm that 1 am licensed under Provisions of Chapter 9(commencing Job
with Sectian]OLlO)of Divisi0n]af the Budncss and PrOfcssium Cotic.antl my license is foundation detail revisions
s in full force and effect.
�q= License Class Lk.# original permit #06050059
•f C Date Contractor
ARCHITECTS DECLARATION
i -i 1 aril rsund my plans shall Ise used as public recmds
y
iU
oG Liocnsed Profcssioal
OWNER-BUILDER DECLARATION
I bcrchy alum that I am cacmpt from the Conuactah License Law for Ibe
:C O fallowing mason.(Section 7131.5.Business and P i fecsiam Code:Any city or county
•m which.quires it permit to construct,alter,improve,demolish,or minor any suucwm
prior an its issiame.also requires theii,icant for such Permit to fileasigmd summcm
< &IIkisliceosedpuwu
ranodiepmvisioosofdacCo uthoriUcchac Law(LTapter9 Sq.F[. Floor Area Valuation
�
�C (commencing with Section 7000)of Division 3 of the Business and Profuseions Code)or $0
a 5? that W is eacmpt titcmfoam and de basis for the alleged esemp ion.My violation of
Section 7031.5 by my applicant for a permit subjects the applicant to a civil Penalty ofNumber Occas
not mom Nan BK hundred dollars($500). 32616018 A Occupancy Type
❑1,u owner ortbe propmy,a my employcu with wage as Nee sok campevadon,
will do the wart and themacture is moniumnWaralfared rarsak(See.Trill.Business Required Ins ections
and Professions Cade:The ContrutoYs License Law does not apply m in owner of q P
property who Wildsorimprow d codon,and whodoessuch warkhimself or through his
Own employees.provided that such imprmmments art not intended maRered for We.If.
however.Ne building or improvement is to within am year of complcuon.W,owner-
builder will have the burden of proving Nat M did cot build or improw for purpose of
We.).
)I,as owner of the property,am emlusiwly contmming with licensed conummrs to
construct she pmjem(Sec.7006,Businav and Professions Cade:)The Contractor U.
cause law doss Dat apPl,ad an owner of property who Wilds ar'unpmvu thereon,cod.
who contracts for such projects with aconuactor(s)licensed pursuant in the Contractors
License Law.
❑ I am ea map,under Sec//__ � ,�, .B k P C for Nis masa/n
er A, vl��' Dem
WORK I's COMPENS ON DECLARATION
1 hereby affirm under penalty of perjury ane of the following dttlaradons:
❑ I ham and will maintain a Certificate of coment to salf-insom fw W bones Compen-
sation,as provided for by Section 3100 of dm labor Cade,fm the performance of use
work for which Nis permit is issued.
1 have and will maintain Workers Compensation Wh rance,as required by Section
3700 rfthe Labor Code.for Ne performance of the work for which Nu permit is issued. '
My Workers Compensation Insurance carrier and Policy number are:
Cartier. Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(this soNm need cot be completed if IW permit is foranc huMred dollars($100)
less.)
1:cnif,Nat in Ne perform arca of the work for which this permit is timed,I shall not
employany person in mym so w 0mc bject to she Workers;Conpcoundon
Laws of Califamia ppa�te- i�'�/ w
Applicam 01 x�
NOTICE TO AP OANT:If,aarwr malking&h Certificate of Exemption,you shauW
become subject to the Workers Compcvadon provisions of the Labor Cade,you most
,J,z foMwith comply with Inch p rn,vamm or this permit shall be deemed rwked.
Z O CONSTRUCTION LENDING AGENCY
[—' I hereby aMM that Nem is a crosswcti^n lending agency for the performance of
a
the work for which this Permit is issued(Sec.X197,Civ.C.)
W Landers Name
z Lender',Address
U Q 1 ccnify Nat I have read Nis application and sum Naz the above information is
Ul corms.1 agree he comply with all city and county ordinances and sum laws relining to
V building construction.and hereby authorim repmacmativat or Nis city to enter upon the
CL ahbvcmcmioredpmp my fadexpeses whichma
(We)since to save,indemnify and k P harmless the City o(Curamna against
.U., Z incoirieg consejUdgmquence Of
Umcostsandeapcnsusmit. may in any way aecmeagainxsaid Ciry
U Z APPLICAIfTOUNDERSTANDS Agranturg Of IND WILL COMPLY WITH ALL NON-POINT Issued by: Date , a�
SOURCE REGULATIONS.
t /�/-,b Re-roofs
Ssgrmum of�IsunuConuactor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Ne applicant or future building eccupantsme or handle heaardons material
az defined by the Cupertino Municipal Cade.Chapter 9.11.and dlde Heaand Safety
.
Sanction M32(0?
All roofs shall be inspected prior to any roofing material being installed.
$!o
Will dsc applicant or future Wilding occupant me cquiparam or devices which If a roof is installed without first obtaining an inspection, I agree to remove
emit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
D'auici?
❑Yn yhu
1 have MA the h malous materialsmquiremcaus under Chapter 6.95 alum Califor.
nia Health SidetyCode.Secuous 25505.25533 and 15536.1 umkrmnd dealt led Wilding
docs not curet y hate a mane that it u my mapomihiliry m notify Ne occupant of the
mquimmects . ^merrlas^asuaneco comficamofOceapanry. Signature of Applicant Date
/
Owner or avNorized agate Dine
All roof coverings to be Class "B"or better
'