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05070140 'CITY'OF CUPERTINO ' J °' BUILDING DIVISION PERMIT Cdl TY2AC OR N�'b'CLMAT�1'�y BUILDING ADDRESS: ROCKWOOD CONSTRUCTION CORE .reaMR"x'05070140 10(;14 RAI�MV T DI OWNER'S NAME: PERMIT ISSUE DATE NE: SANERY NO. CONTROL NO. (408) 868-9026 ARCHRECT(ENGINEER: BUILDING PERMIT INFO BLDG ELEL7 PET MECH l� l� 0 il+o� LICENSED CONTRACTOR'S DECLARATION J p �® 1 herby affirm WI 1 me Ikmtsed under provision of Chapter 9(Commencing < with Seedon70110)of Division 3 of the Business and Professions ChM,and my licenseis n Imfull fo=andefreer. TEMP POWER ^�Z Licunse C�leu'J�7 l.ic.M 9 Dave v — — AfFC"r1ELTSDECr O CH g / 2005 J sh 1 understand my plans ell be used an public records yG Licensed Professional B pIp ®IN� N OWNER.BUIIDERDECLARATION U L 0 y I hereby affirm that 11. exempt from the Canoactoet :An,c Law for the OO whnwingreason. Permit BIJt.3,Buainscand ve.da ion Cod,:Any city ar county $Ixi which requires n pertnh re err srthe alter.Improv,demolish,nr repair any mrecture f^ priwtoiu isuanec.alw requires the aPPlicanrfwaucumu Permit w BleatL w(Cammrnl < Nu W b Iittnsed per sent w Ne p hvisiou of the Conummuma i avec law(Chap e 9 Sq.Ft. Floor Area Valuation ,SCS (commencing with Section 7000)nr Division Jof the Businesend Professions;Code)or 3 that he u exempt therefrom and the hub for die alleged exemption.Any violadon of Section 7031.5 by any applicant for a permit subjects die applicant to a civil l ebally of 3 AM Sull 0 0 Occupancy Type not mom Nan five hundred dolbn(SM ❑I,u owner of the pmpeny,w my employees with wags u their mle compenudon. will do Newark,and thetwcture It not th¢nMd orofremd pertain(Sao.7044,Business Required Inspections and Profeamos Code:The Canto mme.Liaise Law does ani apply to an amour of q P Property who builds or improves Nurecm aid who dos such work himsl(m through his own employees.provided that such improvements as not Intended mortared for We.Jr. however,the building or Improvement is mid within one year of compledon,the owner. builder will base the burden of proving that he did not Wild or improve for purpose of sic.). ❑1,as answer of de property,am exclusively contracting with licensed mnuacmn to connmct Ne project(Sec.7044,Business and Prefcuions Code:)The Comector's Li. ce m,law does not apply to an matter or mapecy,who Wilda or Improvs thereon,and who Contracts for such projects with a Contrectar(t)licensed Paramount to the Carmarthen L'ensu law. I emexempturacr See .BAPC(wlhismumm Owner Date WORKERS COMPENSATION DECLARATION 1 hereby alarm under penalty of perjury one of the following declaration: 01have and will maintain•CeNficate of Cumene to self-mmor for WarkeesCompen- e,u providatl fm by Section 3700 of dx Iabsr Code.(m the performance or Ne work for which this permit b issued. E]I have and will maintain Warku's Compensation Insurance.u required by Section 3700 of the LAWf Code.for Ne performance of N,work far which this Permit is issued. My WorYees Compensation to wane carrier and Policy number art: Cartier. Policy No.: CERTIFICATE OF E)(EMFOON FROM WORKERS' COMPENSATION INSURANCE (This mcd ah reed not be completed t(tie permit b fw arse hmdmd dollen($101 or Iss) 1 century that in the performance of the work for which this permit's issued.l Nell not employ any person in my mannermu oro )est m tW Wp�urfCampensties Laws or Calf inaL&Dem�g -L-�y'� Applicant NOTICE TO APPLICANT.If.after i i cam plmn,you should became subject to the Workbh C pcsatlon provisions of the LAmr Code,you mum Orwthwith comply with each provision or 444 permit shall W dared raveled. Z CONSTRUCTION LENDING AGENCY ' ai E 4 I hereby mf lmn that there Is.construction l,ndinpgency for the perfurmanec of 7 the work for which the permit in issued(Sec.3097.Civ.C.) QLandces Name L.z Lenduea Address V Q I unify that 1 love and this application and stow Nn Ne move Informed.in r' correct.l gree to comply with oil city and county ordinances and caro:laws miming to O LrJ' Wilding ConsWCtion,and hCrela,w1hola representatives of Nin city the roto upon NC W aove-mendonW property far Impaction purposes Ly, (We)agree to use,indemnify and keep harmless the City of Cupertino against N Itabilitiea,judgment, expenses which may In my way&came against said City ()7 in consequence of the grmting of this permit. r1— APPLICANT UND RSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGU S. �� Z_ -7—Z Re-roofs Signature mf plicaDam HAZARDOUS MATMALS mom Type of Roof 44111 tie applicant w(arum building occupant mom or handle h Health and s d,McO by the Cupertino Municipal Code.Chapter 9.12,and the Hcsith and Safety Calc,Section 15531(a)? All roofs shall be inspected prior to any roofing material being installed. [:3 Yen Me Will the applicant or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hasrdnus air contaminants u defined by Na Bay Area Air Quality Management all new materials for inspection. District? (' ❑Yex on I have mad the hereabouts Materials requimmenu under Chapter 6.95 of the Califon nia Hca1N&SafetyCad,,Sccd.21505.13333 and 75534.1 understood that if the Wilding dean rat currently hew•taphru.Net it is my resp newhility to ratify the occupant of die roquiremcnuwhkhmuu metpriorwisuanmyrcCeidfism ar0miipancy. Signature Of Applicant Date Owner anal ren S� D,to All roof coverings to be Class"B"or better CITY OF CUPERTINO I� 1 of 1 PERMIT RECEIPT OPERATOR: kiersaw COPY # 4 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 31602064.00 DATE ISSUED. . . . . . . : 07/22/2005 RECEIPT #. . . . . . . . . : 30484 REFERENCE ID # . . . : 05070140 SITE ADDRESS . . . . . : 10614 RANDY LN SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : SHAHROCH DAILAMI ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : .CUPERTINO CA, CA 95014-2055 RECEIVED FROM . . . . : SHAHROCH DAILAMI CONTRACTOR . . . . . . . : SEAN TAGHANI LIC # 23339 COMPANY . . . . . . . : . . : ROCKWOOD CONSTRUCTION CORP. ADDRESS . . . . . . . . . . : 14583 BIG BASIN WAY, STE 3-A CITY/STATE/ZIP . . . : SARATOGA, CA 95030 TELEPHONE . . . . . . . . : (408) 868-9026 • FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS •REC NEW BAL __________ _____________ __________ __________ __________ __________ __________ BTEMP FLAT RATE 1.00 62.10 0.00 62.10 0.00 EPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT 100.47 0.00 100.47 0.00 METHOD OF PAYMENT AMOUNT NUMBER _________________ ------------ __________________ OTHER 100.47 VISA TOTAL RECEIPT 100.47 VOICE ID DESCRIPTION VOICE ID DESCRIPTION _ 103 UFER 304 . ROUGH ELECTRICAL • Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 F Fax(408)777-3333 OUPERTINO Building Department JOB ADDRESS: PERMIT # /06/ -? a OWNER'S NAME: a PHONE # GENERAL CONTRACTOR: FAX# I am not using any subcontractors: Z ignature Date Please check applicable subcontractors and complete the following information SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting • Linoleum/ Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile • er/Contractor Signature Date aK CITY OF CUPERTINO TEMP POWER CITY PERMIT APPLICATION FORM APN# 16 D / Date: Building Address: (O © G Owner's Name: Phone#: Sl. k A 2,x3 - zsi Contractor: Phone: License#: e WooCa h Lcz r 92-5-01sy Contact�,,, Phone: Cupertino Business License#: Building Permit Info: Elect 01, Job Description: Residential Commercial ❑ Cost of Project: 46- 1b�o Qty. if Applicable Fee ID Fee Description Fee Group BTEMP Temporary Power ELECTRICAL EPERMITFEE Elect. Permit Issuance ELECTRICAL BUSLIC Business License BUILDING •