02090183CITY OF CUPERTINO
BUILDING DIVISION PERMIT
CONTRRACTOR'INFORMATION:
nulgD(!H59 E5PINOLE CT
ALI REZAI
PERMTTN92090183
�:�j5'�FJAhR.EZAI
APPLICATOVIVl Tf 2002
IONS:
SANITARY NO. CONTROL NO,
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
IherchyannthatIn.licensedunderprovisionsofChapmr9mornmereing
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with Section ]110)0of Division 3 ol'the Business and Profcavions Code. and my license is
WINDOWS/FRONT'B889M%N MOLDING
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InmlLforoeandeffect.
HARDWOOD FLOOR$/PAINT & TEXTURE
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License Clava Lb. al
Dale Cantucmr
ARCHITECPSDECLARATION
I understand my plan shall be used u public recordsLicensed
EXPED
PmfcuinnalOWNER
frDECe ON
exempt Contr
I herchy ,(Sent that 11. exempt from the Comunora License Law for the
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following nosh. (Section ]tomo... Business and
sol Cnde: Anycity orcounty
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.ve. de
which requiresa permit ratcnnsbucl, tiller,improve, demaliah,tar repairany suucwm
phot In it, issuance, atm requires the applicml for such Permit m file a signed saamem
that he is ranged pursuant to the provisions of the Contractor's License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
�$
(commencing with Section]pM) of Division] of the Business and Professions Code)or
that he H exempt thm erefroand the Buis for the alleged exemption. Any violation of
36934023.00
APN Number
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty of
not more men five hundred della. ($500).
101 — FOUNDATION
❑ I. as owner of rhe property, or my employees with wages as their rule compartment,
t02 —PtERS
Required Inspections
will do the work, and thesrucmre is not intended or offered for use Lei..]., Business
and Professions Code: The Contractors License Law docs not apply to an owner of
103 - UFER
property who builds or improves thereon, and who does such work himself or through his
own employers, provided that such Improvements are not intended or offered for sale. If.
104 — REBAR
however, me building or improvement is sold within one year of completion, the owner.
105 - ANCHOR BOLTS
builder will have the burden of proving that he did not build of improve for purpose of
cote.).
106 - SEWER & WATER
01, as owner of the property, am exclusively convecting with licensed conuecro.to
202 - UNDERFLOOR PLUMBING
construct the goatee, (Sec. 7044, Ratio.. and potassium; Code:) The Commicmrs Li-
censeLswdoesnotapplytoanownerofpropertywhoWildsorimprovesthncon.and,
203 — UNDERFLOOR MECHANICAL
who Contracts for such pm' vaclogs)littnsed pursuant to the Contractor's
204 - UNDERFLOOR FRAME
License Law.
I am ea under Sec. .B& P C for this reason
205 - UNDERFLOOR INSULATION
at m�lr
Z 301 - ROUGH PLUMBING
302 - TUB & OR SHOWER
W ER'SC SATIONDEC 10th
I hereby iffrm under Penalty of perjury, one of the following declaration:
303 — ROUGH MECHANICAL
1 have end will maintain a Certificate of Commi to self insert for Work,. Compmi
sation, u provided for by Section 3900 of the Labor Code, for the performance of the
3 04 - ROUGH ELECTRICAL
work for which this permit is issued.
3 05 — FRAME
❑ 1 have and will maintain Worker's Compensation Insurencc, m rtyuired by Section
3 0 6 - HOEDOWNS
311x1 of the Labor Code. for the performance of me work for which this permit is issued.
My Wnrkrr'a Compensation Insurance carrier end Policy number me:
307 — INSULATION
Cartier: Policy No.:
308 - SHEETROCK
CERTIFICATE OF E%EmmON FROM WORKERS'
COMPENSATION INSURANCE
309 - EXTERIOR LATH
(This sectism need not bccomplemil Huse permit is forma hundred do[].. (SIM)
310 - INTERIOR LATH
micas.)
311 - SCRATCH COAT
I cenify that in the gaffe c work for which 0'u emit is issued, 10.11 no'
313 - ROOF NAIL
employ any to anmLot u to become soh' a the Wmiums'Compenaetien
Lawao ornia.Data
501 - FINAL ELECTRICAL ENERGY
502 - FINAL PLUMBING ENERGY
t
NC A1Y6f,afl g isCcnific Ipuon,you shoniZ
Z
her ecllotheWurker'sCompcnsmionpress CUhnrCode, you hoot
he deemed
503 - FINAL MECHANICAL ENERGY
!O
forthwith comply with such provisions or this Permit shall revoked.
504 - FINAL BUILDING ENERGY
p ^
CONSTRUCTION LENDING AGENCY
I hemhyaRres that there is aconstrueion lending ngemy for the performmceof
505 - FINAL ELECTRICAL
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Q
the work for which this permirisissued (Sec.309].Civ. C.)
Lender's Name
506 - GAS TEST
507 - FINAL PLUMBING
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Leaders Address
1 0
1 cenify that I have read this application and sale that the shove information is
508 - FINAL MECHANI CAL
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conect. I agree to comply with all city and county ordinances and Siam laws relining m
building construction and hereby minnow representatives of this City LEI enter upon the
5 -1 FINAL GRADE
tai
eMwe-menti,nedproperty forinspection purpors.
5 0AN
'y
(We) agree m cove, indemnify and har the a of Cupertino against
ems hicp
in m
liabiliti(We)grents,cos,indenifyandkeech mryinmyeCityofCupenstcoidciry
y
rj L WORKS
1 z
in
APPLICANnce of dre T UND gnnung uS AND WILL C PLY WITH ALL O DINT
Issued by: Date
SOURCER TIONS.
Re -roofs
Type of Roof
omoo am
i aw HAZARDOUS MATERIALS DISCLOSURE
Will the applicant.. furorebuilding occupant sore or handle heurJuus material
defined by the Cupertino Municipal Code, Chapter 9.12. and the Health and Safety
da. Section25532(an
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All roofs shall be inspected prior to any roofing material being installed.
❑Yea
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant o Whom Wilding occupant use equipment ordevias which
emit hoom ous air commit aha u defined by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑Yea �70
I have read nusmamrisls reyuiremcmv under h.mrr6.95.fthcCelifor-
niallculth yCWc, Scninre25505,255JJ an 255] nJcrsand met i(thc building
mxs n manly have a ananl, that it is my res i ity to notify the recti int of the
red mentswhichmustbeme ceefacenieyat5�^ m
Signature of Applicant Date
%
All roof coverings to be Class "B" or better
owners m n vmagenl Date