05060125 lur
CITY OF CUPERTINO ^* '� x '�"' ' '" � '' �
BUILDING DIVISION PERMIT r U .R - ; yq Z,0
BUILDING ADDRESS: HAMID ABTAHI PegMrr No.05060125
10560
R'S NAME:
PERMIT ODMS
HAMID ABTAHI 10560 S
PHONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
'BLDO ELECT PLUMB MECH
30p LICENSED CONTRACTORS DECLARATION I Job Description
I kmby aNlrm Nat I atn Rmiucd under provisions or Chaplin 9(mmmencing p
£
with Soetion 7009)orDividon 3 ofthe Eumnneand Profession.Cade,and my license Is� In fallferc.adeffec SFDWL-ONE STORY (1907 ' LIVING)
uarm Class Lk.K GARAGE 427 '
Dam Connector
ARCHITECTS DECLARATION
I understand my plans chart be used as public mood,
y u
e ad�a Licensed FmRssional
`y OWNER-BUILDER DECLARATION
1 hereby aRrm that I am smmpt from the Commences Lieenm Law for the
p o fallowing mann.(Secdan 703 L5,Budaea ad Professiam Code:Any city of county
5$9 which requires a permit W ennswcL alk..,Prove,demolish,or repair my someone
prior in its issuance.also mquires the applicant for such permit to rite a signed emament
< that he is liccmeJ pomwnl W the provision of the ConuscWesLlcemc Law(Chapter 9 Sq.Ft.Floor Area Valt( l3t0000
E $ (c trouncing with Section 7000)of Division 3 of the Business and Pmfessians Code)or
— that a um
empt ramfrom and We baud for the alleged aemUon.My violatiopn of
Section 7031.5 by AM appliart far a Permit subjects Jin mePlkant W a civil penalty of APN Number Occupancy Type
not mom than five hundred dollars(5500). 37537017 . 00
O 1,as awrer of he property,m my employee,with wage,as shevnlccompenatisr.
will do the work.and the structure Is not handed or offered forsale(Sec.70M,Budskss Required Inspections
and Profesdons Cade The Countesses License LAW dom Out apply W an owner of q P
pmpeny who builds or responses maroon.and who does such work himself ar thmugh his
awucreplayees,provided that such improvements art notin anded Ornfrcid fact IL
however,the building or improvement I.sato within oat)ear ogmmpledon,she owoer-
Wilder will ave he burden of proving that he did nt Wiwi or improve for purpok or
sak.).
❑1,as owner of the property,am eseludvely conaacnng with licensed cenuanan W
construct Jin project(Sec.7014.Business and Proremsm Code)The Coouanoes Li-
nde law arca cit apply an an owner of proper "ho build$ar hapeovev hereon.and,
who comsat,for such projects wish a contracmdU licensed punwnt in the CantrmWea
License taw. -
❑Imn pt ndu See .B APC roc Rmuseen
/
OR cR5 OMpEN5Ancmi DECLARATION
hereby a0hm under penalty of perjury mm of Jin following declmadmrs
❑1hawandw01malnminaCu Smkor Consentmmlf-imamfmWmkeeaCompn-
aanan,as provided far by Sutton 3700 of the Labor Cade.fm the Penn..of the
work for which this permit is issued.
❑1 have and will maintain Worees Compensation Instannce,as acquired by Section
3700orhe laborCode,for the peRamumx of he work for which Nis permit is issued
My Worker Compenutian insurance artier and Porky number sin:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
rlTk rtt0n and sal unconquered Irhe permit isfor.hunhedduilsrs(5100)
or 1.)
I certify Ont in he menume of he wart fn which hi,permsy a ianed I dWl
employ any pe Pp my mmnermes in me subject Wth o e' p .5
IAws of la IC
AppB
plarnat�: .�r making this Cenifiate of Escmption,you AouW
Wmme s W the Worees Cmnpemadon pmvWom of tits labor Cade.ysu mak
QM
fawith comply with such m W providothis permit fall be domemd ralmd.
z' CONSTRUCTION LENDING AGENCY
[r vN—i IWany affirm Jut Jkrt is a commotion Lending agency for he perfamaraz of
L>: he war for which his permit is Wood(See.3097,Civ.Q '
Lemices Name
a z Lenders Addmss
L)O 1 outify that I have mad this application and sum that the above kromutin k
comecL i acme m comply with all city and county Ordinances and ink km mlWng W
OU building conatroction.and hereby anthasim mpmsentarves ofthk city W mumutsm tits
fsd above-mentionud Pmpeny for hupecJoh purpoms
(We)agrm W save,indemnify and kap hsmrka Ok City of Cupertino against
r CA liabilities,judgments.eases and"Panama which may in any say aa7oe against said City
U Z in commitment of he granting of this Permit.
'-•'
APPLIPAPIT UNDERSTANDS&No WILL COMPLY WITH ALLN.POINT Issued by:9 Date
so nods. (J
Re-roofs
Si poli HAZARDOUS MATERIALS DISCLOSURE Data Type of ROOF
Will she apptinntOr future building acm part su e,male haadous material .
defimd by thin Culu nin Murdcipal Cade.Chapter 9.11 and the Health and Safety
Sued.25533(a)7 r fNa All roofs shall be inspected prior to any roofing material being installed.
WIII the applicant or future building oavpam sac equipmern Or lkriem which If a roof is installed without first obtaining an inspection,I agree to remove
emit aardnes it,nmtaminants as Jclined by the Bay Area Air Quality Management all new materials for inspection.
Distil
❑yes ONO
I haw mud the aradwsmateriW requimnknts undu Chapmr A93afthe Califw-
nkH"IhA alctYCodc,Senians25303.25533anal25534.1undmwdthalfdte building
Jan My have a knurl that It h my respmdNl'Y k nullify he aecupmt or he
ratio wh must IpriorW' ar 7kamnf. r Signature of Applicant Date
r mord spent oak. All roof coverings to be Class"B"or better