05060126 CITY OF CUPERTINO
BUILDING DIVISION PERMITCONTRAG�TQRAtk4RMATIO,N &
BUILDING ADDRESS: ABCO CONST PERMIT NO.05060126
ER'S NAME: PERMIT ISSUE DATE
HAMID ABTAH
P NE: SANITARY NO. CONTROL NO.
(408) 779-7577
ARCHI EC FENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
+Op LICENSED CONTRACTOR'S DECLARATION 76 Description
V 1 Wrathy affirm that 1 am li¢mcd under Provision of Chimer 9(commen0escrlP
cing
with Sacdon 7")of Division 3 of the Business and Professions Cade.an l my license is
j iin full rose and cffam DEMO (E) HOUSE
License Class Lic.a
i F z Dam Contractor
ARCHITECTS DECLARATION
I W U 1 understand my plans dull he used!u Public records
r6
seal Licensed Professional
3 OWNER-BUILDER DECLARATION
e2 1 hcrthy aRnn that I am exempt from tha Commodes License Law for Ne
C O following meson.(Section 703 1.5,Business and Prolessiuns Code:Any city or county
3$V which inquires a permit to cnnswct,ales.improve.darefdah,or repair any stmeure - $9000
_Ivo prior to its issuance.alw requsaf On applicant for such permit to Bk a signed summcnt
< that hculicensed pursuant Wthe pmvisimesm'meOmmact."sLiccnsLaw,(Chapter 9 Sq.Ft. Floor Area Valuation
Y (commencing with Section 7000)of Division 3 of the Business;and Professions Code)or
that he u eaervpt IhemOom and the bun for the alleged assumption.My violation of
Section 7031.3 by any applicant for a Permit subjects the applicant to a civilpenalty of
rm.m than low l aMmd dopase(ML r � Occupancy Typeme,
❑1,u owner of the property,or my employee with wage at Nei We compensation,
will do the wont and she structure u Out intended or offered for We see.7(14/.Business Required Inspections
and Professions Cade:The Conuacures Littss rowe
nse law dot apply to an oner of q P
Property who builds or improves thereon,andwho doessuch work himustfor through his
Own employed.provided Nat such improvemcnu ser not inundW aro@nd for We.if.
however.the building or improvement is sold within one year decrepitation.the owner-
builder will have the burden of proving Nat be did not build or improve far purpose of
.ale.). ,/\
uu owner of ct Property,,B eulusivaly canussi ns with tiansed mnuxtms m
cautmtt de project(See.)rano Business arM Pmfehsiom Cade:)Tie Conuamon.U. \
cense law does not apply r to an.surer of pmpeny'who
used p ra im to use
Norton,and
who contracts for such projects with a c.ntractm(s)licertsetl pvrsuam m du ContrtnoY,
Ucem saw.
Ell. pt oder Sec D. PCfor is seaspn
N RfndCOMPEN A"on arcDECLARATION l\
1 inbY alrnm under penalty of perjury a(tha following tlecluationc
Thaw and will maintain a Cer iGcam.1covem m self-insure fm Waukee,Compen. V�
anon,as provided for by Section 37M of No Labor Code.for the performome or the
wort far which this permit is iouoQ
❑f have and will maintain Woncmes Compemadon Inrmance,as inquired by Section
3700ar the labor Code,far Ne Pcdarmueeaf the wok for which Oct permit Is issued. '
My Wokefs Compensation buurmcc wrier and Policy number -
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thustttlun need not becomplced if the permit is W.hundred dollars(SIM)
or leas.)
I certify On,in Oc performance of the work for which this permit B issued,I hall not
employanyper3pn' anYmenncrsoutabecomembjectioWeilr+Lf�r pposado.
laws of Calif6rhiiE.%T/ / L6
ApPlic n / /'/1 ��'���
NOTir I malung uta eniOcaN of Exemption,you,MuW
becomes
the Wohees Compenvdon pmvisioiu of On labor Code,you muss
.J Z forthwith comply with such provisions or On permit,holl W deemed mvakcd.
Z O CONSr'RUC ION LENDING AGENCY
[—� I herthy oRm,Nu dsert Is a construction lending agency fothe�ped rm y/
94 > Ne wurk fur which Ni conn B cooed(Sec.3097,Civ.C.3
/ y
GL,M :Namc
=Z landeeAdd
V O I to s' I d thin appliwion and sou Na the aWw ofoematiun u
U. f-^ corrett 1 agree m comply with all city arw county odinarees arW sou laws mlaung m
�U
bow
-mcnOmcdon.and hcinbyauNodmmpmxnuuwsofNuci,ytoenurupnn Ne
r C[7 .hove-(W)agree
to s property for imnify an purposes
v (We)agme,o ow,indemnify and kith hart tan Ors City of Cupertino s against
t3Z in
thecasesandof this expenses which may Many way acrneagalmtsaid City
C?z in eonuquenee of the ganuni.r Nu permit.
APP NT UNDERSTANDS AND WILL C MP7.H W •AUyNON-POINT Issued by: Date j(J'Z, x -f'—
S0 EGULATIONS. 717" /
Re-roofs
Sig Appl;anUConuacmr Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applieent or future building acupantoore.,handle huardod maudal
u tlefloed by the CaPeomen Municipal Code,Chapter 9.12.and the Healdt and Safety
'ale.Section 255320)? �s/�`l All roofs shall be inspected prior to an roofing material being installed.
❑Yes ON. /! P P Y g g
Will the APPliesom of future Wilding occupant use equipment or device which If a roof is installed without first obtaining an inspection,I agree to remove
emit haeardam air contaminants at dcrined by Ne Bay A.Air Quality Management all new materials for inspection.
Diavict?
❑Y ��/�hx�
in ON.
1 have mad roc mosohes materials inquiremenu under Chapter 495 of the Califon
min Flea1Nh Safety Cade.Sodom Z505,25533 am125534.1 undemvd the if the building
does nut nOy haw a meant Nat it a my responsibility to soil,de occupant of We
ingaim % Manma„bcmet pri IWC .racenlBealCorocapatu��/ Signature of Applicant Date
6 a
e, N ri>ed ager, Dam. . All roof coverings to be Class'B”or better