01010108 CITY
DNC mvSONO
BUILDING ii ,CONTRCTOR NORMATION:,PERMIT
BUILDING ADDRESS: PERMIT N0,
22771 STEVENS CREEK BLVD 01010108
OWNER'S NAME: APPLICATION S B DATE
REZA NOROUZI 01/24/2001
,IH SANITARY NO. CONTROL NO.
NT W O O ARCHITECT/EN'GINEER: BUILDING PERMIT INFO
E BLDG ELECT PLUMB MECH
dad I—I IJ LJ L_2
fF- Z LICENSED CONTRACTOR'S DECLARATION Job Description
i Z vTu
1 hereby a1Rnn chat I ons licensed under provisions NChap¢r 9lwmmencIng
,_t5 with Section]OBD)ofDivisionJa(0eBi/essandProressmoiCode,andmyBcum, SFDWL 4041 LIVING/684 GARAGE
`
is in full I and t.
V Licen. I.ic.»mm PINALED
L— Co
ARCHITECT'S DECLARATION
so
O„Q,t I undernund my plans shall be used as public reroN.s pc'C 2 2 2003
l6 p O Licensed Proicssional
OWNER-BUILDER DECLARATION
1 hereby uffum that I I exempt boodle Cummer',License Law for the
tE°1SO •following re,asoa (Section 7031.5,Buiness nd Professions CodeAny city or county
Which requires .permit to constrict. her.Improve,demolish,or repair my simc urn BUILDING
0 -O..O
2 Pool 1.itsismaloc.rds.Haimp,theapplcat for such permrno fileasgned inmmmt
d3hath Junedi mishe moiHm, ._
fine C..umchn"Luna Law 9 (kk��sf, �s- ] Valuation
(co crigthSci 7M)) fDM,im 3 or the Business god Pryfapvons Code) C�(j;' -13 Q"•L'jZ����•'iJ®se ttt4"'7t"'h, ,
or that he exempt flau!b m and the buss for the alleged cie nfaton.An violation
.m
-'on]misa !um rornpe�banniect.meppEcmtto.ei.a penaltr
of hot
aore manlive hundreda»nor. ESnn). 10 lPN'i'�DATION Occupancy Type
❑1,as usher of the property.Lir my employees with wages as their sole compensation, ing _ PTFgq
Will
do the work:and the'smauum is not intended or o02red for sale sac.]Osa, - - - - s
'Rushe's nae Promsamns Code:The Commmors License Law does not apply o an 10 3 - UFER Required Inspections'
owner of propcny Who builds or improves thereon,and who does such work himself
or Kron h his own employees.Provided that such improvements are not imendeiior _1_04 _ - REBAR
oRcmd re ..-_ _. ___. -AN
_ __._...--.--_.._____.____'__—_
o7 sthe. whowever:thebuildinge improvements sold he
not year of 105 - ANCHOR BOLTS 3
iompletinn,the ownervbuilJ<r will hors the burden n(proving that he did not build or
mprove Bn parpost.f sale.). _106 -_ SEWER & WATER
_ .-_.. _... _.._ — - ' - ... --- -
= : z q,L'aa mvner nfttie p(Secnyam Business and mmfushmri Cpda:)aTlm mracmrsm - 202 - UNDERFLOOR PLUMBING----t"-_..i ---
construct the does
project(Sec.]t114•Business and property
who
b ills or improves
ves tin thereon,
!:: '
License Law tact nm apply wan owner of property woo builds ee impmvest.to the 203 - UNDERFLOOR MECHANICAL '`
and.who contracts.LicefLaw. .proja¢wim.e.commcmga).licensed pmsaam.m Ina, _._ _._......2.04' - UNDERFLOOR""FRAME"'` -'---- '
Contmcmrs License Law. ,:- :. ,!• --...-...- .--
❑IamexcmplunderSCC:' B&PCfmthis,Hmwm 205 - UNDERFLOORk' INSULATION
'
"t' "WORKER'S COMPENSATION DECLARATION 301 - ROUGH PLUMBING302 - TUB & OR SHOWER
l hereby affirm under penalty of perjury one of the following declarations: '
�
303 - ROUGH MECHANICAL r o I have and cons nsimam a'ceniBeaie
Of consent to scif insure forWorkers
Compensation, as provided for by Section 3]00 of the Labor Code, for the 304 - ROUGH ELECTRICAL
permm,me2enne work rer whmn Baa pemen is iaa»fie; 305 - FRAME
- 0 have and will'mbinminWorkout's Compensmionlairmnce. iroquirtdbySectors 306 - HOLDOWNS
7. 3700 ofNyaWLzkcfsC�e rtr,ine�mpI��on retie 0PP'itoI 3nMmtapennt, 307 - INSULATION
n7,1"/L"d Pe
No SCS n Y,fQo9 a .�, ,, 30.8,,:, ,SHEETROCK, .�'
�s 1.CERTIFICATION OFE%EMPTION PR M: ORKERS f v.. . '30t(3 g.ae k'It E,RtIbR"L'A;J!H
COMPENSATION INSURANCE,_
..- . perms E, „ --..—_. _
3'10`._..INTERIOR.. liATH..._.. -
arr (I0n6xdnetx completed for 311 SCRATCH COAT
SI 00)or less) "
::." p omane _ 313"=-ROOF,NAIL -.
lsenf lh t'nth nflh Work fa which this permsnissurA,-i -
:ban l mply ny.perann an mann as to become bjeamthe`sworken' 501 - FINAL EtttTRICAli`ENERGY "
Compcnsm on Laws dical Tom a'Data
OO 'bNUIforthµChuOAPLICANT.It.after kingthis nPsolsi ateneEiAn�rcmYydsh.;1d - ""502- --- RS NAL- PLUMBING. ENERGY.
Z mmeWorkerac 503 - FINAL MECHANICAL"ENBRGY
comply with such proos or the permit hall be de edrtoked
z .. - - G .504.._.-.. ..FINAL_BUILDING , ENERGY
rCONSTRUMIONLENDING AGENCY .I
� � �'� Ih reby olfnn that me ac nswctol Ling agencym the per(otmance 505 - FINAL ELECTRICAL „ i I
y;pLod which this pe li sued(S 309] Civ.C)
enhe rvm „-' .;,_•, .. 5-0.6---.-GAS TEST
::);zIsla Aaep - 507 - FINAL PLUMBING* '--__ .,
UO Icertify that Ihas.rtdmsapplicat'onandslmethattheaboveinformationis 508 - FINAL MECHANICAL
W-E, COMM,;1 agree to comply with all city and contny ordinances and state laws relining 509 - FINAL GRADE
O'er, mbuildin-mentionedon,and mpamyfrtnyaection oprc'senmtivetofthiscirymemerupon 510 - FINAL PLANNING
[� the mo a-mentioned property(r Inspection porpoises.
L. ' (W)agnui(b sae,indemnify and kap harridewheC7 f Cllpenho against
(n liabilities.pal,manit,costs nJ expenars.,Which m y i.any Way lat against said 514 - FINAL PUB.LTC WORKS
C.3 City neo q earth gmnn6 of this pvmt ' O�
A LICANTUND \ND$ANDWILLC MPLYWITNALLNO -POINT" 6O2 O NAIL
ule.E REeuL. s Issued Da[
_ Sumsureof "I em Contract., stet'•' Re-roof60'4 - ROOF IN-PROGRESS
"HAZAla' Wilt OUS
theaPPllcmaRObattle bud ngalupbmshotash dlelutimidaanumr;al _.,TypeofRoof. _,. _
as Def cd by Ina Cupe r o Municipal Coca Chapter 9 13 and me Health d Sof ty
CodeS n z3�33(e] - 7 t ,T ' A. a •,,, (.{ ' - it -
..... ❑N. All roofs shall be inspected poor fo any roofing mater a] being installed.
wnthe pphpam rr mrewuaing pat quem t ,see IaCa Whlen If a roof is installed without first obtainingan ins ection I agree to•remove
nit hazardouscomammam s defined by the Bay A a An Quality Maagcm t P g
O151io all_new materials for inspection Applicant understands and will comply with
6 q -
°Yr' -� CI all non-point source 2egulauons ) , ,.
21 hive reod.ihe haxmdove,mahaials re u rm,nus under Cb h,695'of the
California Health&Safety Code;Sections 25505,25533 and 25534.1 understand that
rds,building does nm clminly have p mnam,that it is msponsibilirymnotifythe
' - '-' -- --' ""—'-- - - - -- - - - - -- -- - - - -
- 9, I h met p o to ficme of •:
Deco a t f the re'ummunts Which mus auana of 6 C ni
V-rh
ro r
Signature of Applicant Date_
O her ro m r- `
r Bent oat -, All roof coverings to be Class "B"or better
.OFFICE