05080083 CITY OF CUPERTINO
BUILDING DIVISION PERMIORMATIO E: .
BUILDING ADDRESS: ABCO CONST PERMITN0.05080083
10614 RANDY L
'ER'S NAME: PERMIT ISSUE DATE
SHAHROKH DEILAMI 14880 LLAGAS AVE 09/23/2005
PHONE: SANITARY N0, CONTROL NO.
(408) 779-7577
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
opo LICENSED I amCONTRACTOR'S DEConsof cON
lion 7( affirm NalIamli Me Bi underprovisionsPo imuof Chode. 9(commencing lob Description
b
with Suuon]Of1U)af Division 3af Ne Businessand Profrssians Code,and mylicenu is
in full force and effect. DEMO (E) HOUSE
gj? License Class Lie,g
;:1 au Contractor
ARCHITECTS DECLARATION
R U u 1 idenac nd my plans shall be used As public records
s G y Licensed Proressional
g 5 OWNER-BUILDER DECLARATION
4 q I hereby affirm Nal I em exempt from Ne Contractor's License Law for the
00 following reason.(Section 703 1.5,Business and professions Code:Any city or county
�m which requires a permit at consu et,alar,improve.demolish,or mpair my suucuum 6 $9000
i6 priorm its issmac.also rryuims Nc applinm for such pcnnis so file asigncd smlemcm
that he is licensed pursuant in Me previsions ofthe Contractor'sUcense,Law(Chapter 9 Sq.Ft.Floor Area i Valuation
91-0 (commencing wish Section 70)Z)of Division 3 of Me Business and Proreuipv Code)or
Q Nat be is sumps Uurtfrom and Ne baso for Ne alleged eumpUon.Any violation of
Section 7031.5 by any applicant for a permit subjects Inc applicant to a civil penalty of
out more Nan five hundred dollars(5500), r Occupancy Type
❑i,as owner of the property,a my cmploym wish wages ss their sole compensation,
will do the work and Neancsurt is not mended or offend Image(See 70".Business
and Rofeuimu Code:The Conuxnor's License Law does Ice apply m As owner of Required Inspections
property who builds orimprows durcon,and who doessuchwork himselfor through his
own employees,provided Nmsueh improwmena are samimcndeilt ro@red forsake.If.
however.Ne building or improvement is sold within one year of completion,Ne owner-
Wilder will have the burden of proving Nat he did not build or improve for purpose of
sake.).
D 1,as owner of the propcny,am exclusively contracting with licensed contractors N
conswct Ne project(Sec.7044,Business and Professions Code:)The Contractor's Lt.
come Law dors not apply N an owner of propeny who builds or improves Uscmon,and
who contracts for such pmjeets with a commemr(s)licensed pursuant to Ne Contractor's
License Law.
❑1 Am acmp,�un�der See.� .B dk PP�C/f�ff1or��this ppreas�oon�n
ri-2�� , Dale y�gL .
�ORI�EItS MPENS�ATION DECUBATION
1 hemby affirm under penalty of perjury one of the following dcclansions:
❑1 kw and will maintain a Cenifieale of Canunt m self-insure for Wmtrr's Compen-
sation,As provided fm by Section 3700 of she labor Code,for Ne performance of she
work for which this permit is issued. .
D 1 have and will maintain Worker's Compensation Imuran,As required by Sccdon
3700 of Ne labor Code,for Ne performance of Ne work for which this permit is issued
My Workers Compensation Insurance canker and Policy number art:
Carrier: Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
This section mccd notlecomplemd if the permit is i.e.hundred dollars($100)
or Icss.)
I cenify Nat in she performmec of Nc work for which this Permit is issued.I shall not
employ any person in any mmneEnm ernmc bjauo thewolmelycumpcssation
Laws of Cahfomia.Dam
Applicant
NOTICE TO APPLICANT:If,ober makin m iBcat ¢mptiW.you should
become subject m Inc Worker's Componsxtion pmvuiom of Ne Labm Code,,you mum
.JZ forthwith comply with men provisions or Nis permit shall he deemed mvoked.
ZO CONSTRUCTION LENDING AGENCY
�••� I hereby affirm Nat Nero is a eonasructino lending agency for Ne polormanee or
Inc work for which this .it is issued(Sec.3097.Civ.C.)
4 A tender's Name
a z Lender's Address
U Q I anify Nat I have read this application and sale Nat the above informative u
[s. P comet.1 agree N Comply with all city and county ordinances and sale laws minting to
0 building Conatmetion,and hereby authorize represenatim o(Nu city to enter upon Ne
shove-mcnudgm property for inspection puryoses
F 4 (We,)agree to saw,indemnify and kap Wool.Ne City of Cupenino Against
h incoraChu ec of M,cgsuand espouses;whichmay in my way a<ctw against cid City
(),'� inconsequence of the granting of this permit
^ APPLICANT UNDERSTANDS AV WILL COMPLY WITH ALL
NON-POINT Issued by:
CCOE Date
StgnewrcofAppbcanUContractor 6 m„ // Rofs
. L,
r
ze
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Ue applicant or too=building oceupam store or handle havallous material
defined by h Cupenino Munck Code,.Chapur 9.13.and the Health and Safcsy
.Sccuon 132 y,.
DYea Nu All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future If a roof is installed without first obtainingan inspection,I agree to remove
futurebuilding occupant tau cyuipmmt or devim which - P g
cosh haaardous air contaminants as food by Inc Bay Area Air Quality Management all new materials for inspection.
District?
D Ycs Nu
I have mad Ne hvsrdousmaurialsmquircrecou under Chapmr6.95 of the Califor-
niaHcalNkSxfctyCodc,Seetiau 25505.25533 mar 25534.1 undessund Nxtiftle Wilding
docs net currently haw A unans Nat it a my naponsibility m uodry she occupant of she
mgaimmen metpdor ee,nnCenifieauorOceupaney. ignature of Applicant Date
owner or,allonae agent D m All roof coverings to be Class "B”or better