04020172 CITY OF CUPER•11 0
BUILDING DIVISION PERMIT �CO4,ONTRAGTnR INFORMATION;-s
BU I LDING A DURESS: BAY AREA CONTRACTORS CORPO EkPtTNC04 O2 O 172
10640 MORRNGQ DR
OWNER'S NAME: PERMITLSSUEDATE
MARYAM NAJAFI 400 REED 2004
E: SANITARY NO. CONTROL NO.
(408) 986-0440
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
fop LICENSED CONTRACTOR'S DECLARATION
WU FF I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description
al with Section 7000)of Division 3 of NCBusiness and Professions Code,and my license is
�n infuBFor.and effect.
ADD 1130 SQ. FT
>✓2 Licenser Class Lu.as
CFa Date—Comrectof
£F ty ARCHITECTS DECIARATION
C 1 understand my plans shall be used as public records
0.JiU
O G Licensed Pmfcssiunal
g Oat I am exempt
from
DECLARATION
Za S I hereby affirm thin 1 oro cBusin from the Contractor's Co e:Any c Law for the
0 o folwhich re uresreason.Permit
t ]1131.5.Business and improve,
de i demolish,
Code:Any city or county
-
i m m which requires n permit m moms the .Iter,improve,demolish,lir repair any structure 3
ZEj that Imor riniensedprsuantce.also tothaahovisiosOf forsuch Compactor s Licensle a e
Lawdstammcm
Un lM1mWislimned pursuant to pmvixiotnnfthe Convaelur'a Licenx law(Chap¢r9 Sq. Ft. Floor Area ValUatlO❑
Un (cum meneing wi th Sell..7000).1 Division 3 of the Business and Professions Code)or
Q Nal he u exempt dominant and the basis for the alleged exemption.Any violation of �I�p���.sam1**Qc�
Section 7031.5 by any applicant for a permit Objecu an
the applicant to.civil Penalty of 3 Y1lar00 Occupancy Type
not mgrs than Five hundred dollars(15007. p Y YP
1�,{ wncrof..n property,or my employees with wagetheir so lea
11 do the work,and the swan¢is not intended or offeredsaz Nc'(Sea]
and Professions Code:The Crmfactor'a Licenu Law docs nut apply mRequired Inspections
progeny who builds or improves themon,and who does such work himulfaomu f?s
own employees,provided that such impro anent,arc not intended or offered for sale.It.
however,Ne building or improvement is sold within can year of completion,on,owner.
builder will have the burden of proving that he did not Wild or improve for Py'�C �I -2005�100ra
sale.). r C y ` J
0 1.as owner of the property,am exclusively contracting with licensed cmnbacmrs m
construct the pmject(sec.7044,Business and Profusions Code:3 Thc r'} �s �/�
cense law docs not apply m an owner of progeny who Wilds or improv n.tnp, ®� cf —
whoeonbacksfor such projects with a contractor(s)licensed pursuamm ad'AB \\U9
Llcrnse Law.
0lam.serot oder ec. .B&PCfor this reason
f
rel Owncr Dam q —Z- —O
1PESATION DECLARATION
1 hereby affirm under penalty of perjury oro of the following declanowns:
have and will maintain a Cettifieare of Conont m ulbinsum for Worker's CumPem
workN provided for by Section 3700 of the labor Codc,for the performance of the
for which this permit is issued.
0 1 have and will maintain Worker's Compensation Insurance,N required by Section
37M of thc labor Cale,for Inc performance of the work for which this permit is issued.
My Worker's Compensation asoma Ice,.artier and Policy number aa:
Cartier: Policy No.:
CERTIFICATE OF EX EMPIION FROM WOR KERS'
COMPENSATION INSURANCE
(This action need not he cumplc¢d if the Permit is formic hundred dollars(S 100)
less.)
I certify pmt in Life performance of the work for which this Permit is issued.I shall not
employ any person in any manner sn as of become subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If.after making this Ccni lima¢of ExemPoor.you should
become subject 1.the Worker's Compensation provisions of tbe labor Code,you must
.,O forthwith comply with such provisions of this perm i t shall W decmcd nvoked.
z'� CONSTRUCTION LENDING AGENCY
(~ Ihereby affirm that there is consum"inn lending agency llir the Performance of
a the work for which this Permit is issued(Sec.30)],Civ.C.)
W Q Lenders Name
=z Lender's Add.
U 0 1 certify that 1 have read this application and state that the above inf ner.ion is
Fenamel.I agree to comply with all city and county ordinances and state laws felling to
0U building construction.and hereby amthmflra mpreunutires of this city to enter upon Lha
show-mc judgadprogeny fon cxN=s which m.
tr,•� y (We)agree m Nye,indemnify and keep harmless the City of Cupenti m against
In consequence f the
granand of this csmit. may in any way accmc against said City
U Z in mnseyucncc of the graining of this permit.
^' APPLE UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Dale
S"
E TIONS.
�" ��.� jr S[iit `P-26-O r{ Re-roofs
Stgn toren ApplraHAZAR or Dae Type of Roof Z�
HAZARDOUS MATERIALS DISCLOSURE
Will the a Luper or future Muni huilding e,Chambre or handle Health andSafrmaterial 7
C defined by the Cupertino Municipal COM.Chapter 9,12,and the Health and Safely
Code.section 25532(a)?
❑Yea ❑Nm All roofs shall be.inspected prior to any roofing material being installed.
Will the applicant or future Wilding cecu enl use a If a roof is installed without first obtaining an inspection, I agree to remove
p o Air Qu of Manna which g p
horartlnus air conmminann as defnN by the Bay Arca Air Quality Manag<menL all new materials for inspection.
via?
❑Yes 0 N
1 have mad the mi,endous materials requirements under Chapter 695 of the Cali0,
nia Health k Safety Code,Sectuas 25515.25533 and 25534.1 understand out if tbe Wilding
dyes no dy ve n tenant,that it is my.,beihility m nutty the Occupant of the
mica tx h .,I beutusuanmofaCcmficamufOccupancy Signature of Applicant Dale
P 7 I cc `I-z -0V
wngr tie auwrneeaagem— Date All roof coverings to be Class "B"or better