06100099 CITY OF CUPERTINO
BUILDING DIVISION PERMIT xCONTRACT,9INFORMATJON ;
BUILDING ADDRESS: ED AVAKIAN PERMIT NO.06100099
0281 PHAR LAP DR
f" ER'S NAME: PERMIT ISSUE DATE
12/08/2006
P NE: SANITARY NO. CONTROL NO.
ARCHITECUENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
�0, LICENSED CONTRACTOR'S DECLARATION - Job DescriptionwI hereby affirm that 1 am licensed umkr Proviso.or Chapter 9(commencing
i05 wish Section 7")of Division 3 of the Badness and Prolessiom Code,and my license is
!=�N in full fares andeffm ADDITION': DEN, MEDIA ROOM, BEDROOM #4 W/ CLOSET
tqz Clear Lt.N
D.tc Can & BATHROOM #3 , LIBRARY, SM. HALL & REAR PATIO
Fp Date
ARCHITECTS DECLARATION REMODEL: (E) LINEN & WALK IN CLOSET
i m a I understand my plans shall he used Or public mmu&
)yU
o Licesued Professional
g OWNER-BUILDER DECLARATION
1 hcrthy a(Suc Inas 11. cBusin Imre Nc CantrxtCode:censeAny c Law far Ve
p O which ng msson.(section IID L4 Barinc,a and Profeaaom Any city s aunty
e m whim m9ulms a permit re cnmtrve,altem improve,h Permit t nr repair ed swnum
prior wiu issuance.also requires the applicant forxch permitrofile asignN sutemem
Npursuant at he u licensed pursuano dm provisions of ftCarman's License Law(Chapter 9 Sq.FC Floor Area Valuation
H C (commencing wish Section 70X)of Division 3 of Ne Business and Professions Code)or $182693
$ Nat he u..PL thocfmm and the bssis for Ne alleged cacmption.Any violation of
Section 7031.5 by sly applicant for a permit svbjecu the applicant to a civil Penalty of APN Number Occupancy Type
not mom Nan five hundred dollars(5500).
❑1,as owner of the property,m my employees wish wages as their sal.compensation.
will do Ne work.and the swaure is not Intended or offered for sale(Sec.?044,Bance,
Mad Pmresaans Cade:The Commences Licensee Law aces MI apply m an owner of Required Inspections
property who builds or ire proves Ihemon,and who does such work himself or shmugh his
awn emplayces,provided Nal such improvements are not intended or offered for acts.ff.
however.the building or improvement is sold within ane year of Completion.dee ovem,
builder will have the burden of paving Nat he did nm Mild or improve for pupae of
1,as owner or the Set.70Insparry,.B eatlus and ponuaninal wish licensed)Th Comranors m
come,La the project apply
to an Badness and property
who
Cade:)The Conmcmrs Li-
cense law data not apply b an owner of pmprny who builds or improves thereon,and
whofor such projects with aconvacmr(s)licensed pursuant to the Contractors
s
Lke e Law.
u
❑lam uemPt under See .BdiPC foe is n '
I
ATION
I hereby of iron under penalty or perjury ane or the fallowing decimations:
Q I have and will maintain a Certificate or Caracas de self-imure for Worlers Compen.
salion,an provided for by Section 37(10 of the labor Code,for Ne performanm of the
work far which this permit is issued.
1 ban and will maintain Workers Compendium Insuranc,m myvired by section
37M of Ne labor Cod.,for the perfcooMee of Ne walk for which Nu permit is WOO&
My Workers Campensadoe Insumna ander and Policy number am:
Cannot. Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This Merton need not to completed itth.Permit is farone hundred dollars(5100)
or less.)
I certify Net in the performance of the work for which this Permit is ismc0.I shall not
employ any perxninanY mantgrwslr pmc subj�Ne Wohcri Compensation
Laws of California.Date 1---ddeell L '
NOTICE TO APPLICANT:If,after making this CcniRcae of Exemption,you should
become subject as Nc Worker's Compensethm provisions of the labor Code,you most
.JO raMwish comply with such provisions or Nu permit shall he decreed revoked.
z y CONSTRUCTION LENDING AGENCY
[-+ Iwrebyafrrm Our lwrt it.construction lomdingagsne,for the performana of
ry'
the work fur which this permit i,issued(Sec.309],Civ.C.)
larder's Name .
a z Landers nddrear
U Q I eerily shat I have mad this application end Marc Nal she above information is
IL cornet L agree to comply wish all city and county o cimm.and ante laws mlMall to
O U building construction.and hereby authorize mPresemativca Of this city to enter upon the
r 0.
above mc judgm pmpcnt for inspccdom proposes.
(WO)agree to ave,indicant ry and keep harmless Ne City of Cupertino agairut
F'Z incomeopta ceofthecosuand expcmawhich mgin any way accmc most in Ciry //�
U z APPLLICAN'r UNDERSTANDS Aof rs Permit.
ND WILL COMPLY WITH ALL NON-POINT Issued by: Date / 2-
SOURCE
DISCLOSURE Type Of Roof
Will use applicant or to.building occupams seem or handle hamrdoa material
as de0ncd by Ne Cupenimo Municipal Code.Chapter 9.13.and thc Mouth and Safely
Section❑Yes 15533(a)? / All roofs shall be inspected prior to any roofing material being installed.
Will thea Bamarmture building can nt aM If a roof is installed without first obtainingan inspection,I agree to remove
pP e w equipment P
cmil ha'rardna air con taroinam
u u cd by Ne Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes C7
I have read Ne hvardtws materials requimmenu under Chaplerd.95 clam Galiter-
ria Health&SarmyCode,smatimtr 23305.M533 ave 25534.1 umcmand thatlTNe wilding
docs mol currently ban a tenant,that it a my forNmihilit,he notify the aCup.(of the
¢yvircmcnts whjph mal w aMet. ,na aracerdrateh!{gy0` Signature of Applicant Dale
own.rofaGdriri).rdagent /Date All roof coverings to be Class "B"or better