06040003 CITY OF CUPERTINO +4nn�w
BUILDING DIVISION PERMIT CONTRAGTORINIQRMATION
BUILDINGADORESS: FADI SEMAAN PERMTrN0.06040003
538PHIL PLACE
R'S NAME: PERMIT ISSUE DATE
FADI SEMAAN 04/18/2006
PHONE: SANITARY NO. CONTROL NO.
ARCHI'EC MNGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
i o o LICENSED CONTRACTOR'S DECLARATION
�us❑ I bcmby affirm that 1 am licenmd under previsions of Chapter 9(commencing Job Description
z with Section 70f)U)of Division 3 of the Business and Proressians Code,and my license is
in fall fare md,ff.L INSTALLING 8FT FENCE ALONG PERIMETER OF REAR YA
Litman Clea Lic.as
i p n Dale Cataracta,
i. ARCHITECTS DECLARATION
ire 1 understand my plan shall he used as public records
yyU
e
Licensed Pm(cssianal
5 Oat I am exempt
from
DECLARATION
i C I hereby alum that 11. ,Business
from thc Canoamofs License law for de
A141A
iO O following mason. Panni t R)31d,Business wd ve,de use Code;My city s county
re�+ which requires a e.also re cares the etre improve,b Permit t or a pair any etrmurtpv$3 4 0 0
°i< %at hor e its d ptalso requires thovism ant for CmauresmiHO ratecose signed(Chapter
Jeal�ecerwit pursuant rethe of Division
of Nc ConuaLansclaw sCode)9 Sq. F[. Floor Area
r�� that(commencinghe
exempt
Section 70nd the osis f r the
alleged
and on.My ns Code)r
4'j 3 that he u emmpt therefrom and de base for Ne alleged exempliaa My violation of
Section 701.5 by any applicant far a permit subjects the applicant to a civil penalty of
nom more Nan five hundred dollars(SS00),
r upancy Type
I,uowneroftlieprop,ny,ormycmployceswiNwgrau Neirmlecomp dan,
will do the wort,and Ne roc u,a not inwded or oftcted forsele(Sec.70M,Business
and Pto essums Cod.The Cmuwmfs Li.Law does at apply m an Owner of Required Inspec
property who buildsorimProm theraon,and whodoessnehwark himself arNrugh his
awn employru,provided Net such improvements ase not intended waRertd(orale lf.
builder Nebuilding orimprovementuwigwithinone year or completion,purpose
of
builder will have de burden of proving Nat k Oitl not build or improve for puryom of
ale.).
Of u owof droperty,
ner e pam exclusively contracting Men licem
nsed nmw.wm
rs
roristmct de pmjm(Sec.7064,Business and Professions Code:)The Comm sex's V.
term law flocs not apply m an owner of properly who builds or improm themon,and.
who comes for such pmjccu with a cunvacier(s)licensed pursuant m the Camrutofs
Lici:.Law.
mptund`tter See .B&PCIes Nism aeon
ua ` Q �t Data t 0 6
—iBQ KS CQMPENS iQD DECLAIUMON
I hascby afrm under perulty of perjury one or use following tlala,uiomu:
Cj
Ihzve and will mainuinaCerdficere of Comenttomlf-inwm fan Workers Cempen
satian,as provided far by Section 3700 of de labor Code,for the perform.of Ne
wort tar which this permit is issued.
❑1 have and will maintain Wortrfs Cempewtion I..as required by Section
3700 of Ne Labor Cotle,for the performance ofuse work for which this permit is issued
My Worgcra Compenwuon Insurance canner and Policy number me:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu rim need notbecompleed if Nemi t u franc hundred debars($P)0)
r
p
nr less)
I aoifr Nat in Ne performance of the wort for which this permit is owned.l shall not
employ any pawn in any man crs as wmc bjcctm the Wha tY Compcwsm.
Laws of California Dam
Applicant ^
NOTICE TO APP(iP,ab Msmaldngtfds Cenmmcam Excf'6� mpuan.you.should
become Subject m the Workers o penath n previsions of the labor Cede,you most
.JO forthwith comply with such PMA40M or Nu Permit mail be dccm,d revoked.
Z y CONSTRUCTION LENDNG AGENCY
F Ihemby affirm that Nem u a cansuucdon lending agency for de performance of
Ed the work far which this permit is issued(Sec.3M7,Civ.C.)
4 Leadefs Name .
z Lender',AM.
C) I certify that I have read this application and state that de above information u
ly correct.l spec m comply with all city and county ordinances and sum laws relating to
Q tF-) building construction,and hereby authoim representatives of this city to enter upon the
above mentioned property for inspection which ms
F a (We)agree to ave,indemnify and keep harmless Je City of Cupertino against
fq in COi0ulaxac ents.Of
owing apmuaous. may in any waywrnteagainst said City
V z m conmqucn' of th,granting of Nu permit
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
S RCEREGUIe0T10
Re-roofs
S g Mae
A�1tDOUS MATERIALS DISCLOSURE Type Of ROOF
Will the applicant or fume building Occupant at= handl,hwardous material
'fined by th<Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
e.Section 25532(a)7 KN.
All roofs shall be inspected prior to any roofing material being installed.
Will dm applicant or future building accup rd use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
,mil loommu air conumimm u dcOncd by the Bay Area Air Quality Managcmcet all new materials for inspection.
Dialdct7 -)
Dyes 04 No
I have mad the hasardnus materials requimmwts under Chapter 6.95 ofthe Califor-
nia Health&SafciyCodc.Sectio,25505,25533 and 25534.1 undcaland that if de Wilding
dao not current,hast a tenant,that It is my responsibility le notify the occupant of the
rqt� eau whm u m.Iran,m is.of a CeroOeam of en Signature of Applicant Date
�o
owner are aucat m All roof coverings to be Class "B"or better
Dae ' _ --