05060115 BUILDINCGUDIIVISIONNO PERMIT c1NTI2ACTOI2INFORMATION
BUILDING ADDRESS: BEHROOZ ARAM PERMITN005060115
OWNER'S NAME: PERMIT ISSUE DATE
BEHROOZ ARAM 10660 TANTATJ AVE OR/26/200S
E: SANITARY NO. CONTROL NO.
(408) 779-7577
ARCHITEL VENGINEM: BUILDING PERMIT INFO
BLDG ELECTO PLUMB MECH O
yap LICENSED CONTRACTOR'S DECLARATION Job Description
r� i hereby affrrm that i un Heaved under provisions or Chapter 9(commencing P
with Section7070)a(Divtslon 3 of Ne Bteiravand Profession Code,and my license is
a „ infull areeand nrren NEW 1-STORY SFDWL (1971 ' -LIV. )
;g= LkenxeCles Lk.N GARAGE-427 '
t Dab Contractor
ARCHITECTS DECLARATION
Ni 1 understand my plans shill he used u public retards
o Licensed Prufasiuml
OWNER-BUIDER DECLARATION
�I 1 hereby affirm that I am exempt from the Contractor's Ucenm Law for tie
O O following moan.(Section 7031.5,Business and Professions Coln:My city Or county
$ which requires a permit to construct,alar,Wpmve,demollah,or repair any atnlLnse
prior to its issuance,else requires the applicant forsuch permit in file a signed statement
tm?< that heislleenscdpersonal toshe pmvisionsofthe Corrector's Limme,Law(Chapter 9 Sq. Ft.Floor Area VagS2ffoll000
i<F (commencing with Sedan 7000)of Division 3 of the Business and Professions Once)or
lv R..$ NBI he is exempt tMrefrom and the basis for the alleged exemption.My violation of
Section 7031.5 by any applicant for a permit subjects de applicant in a civil penalty of APN Number Occupancy Type
.rat team wn raw hundred dollars(1500). 37537007 . 00
❑I,u omu r of de property.army employcu with sagas as their sok compenastion.
will do the work and thettmabre is not intended u offered Posters(Sec.7044.Business Required Inspections
and Prefasiom Code:The Canlracbet Liceem law dm Trot apply m an owneer of q P
property who William Improve thereon,ad who deal souk himself car through his
own employca,provided that such improwmenuate wt intended or offered for ask.If,
hewevm,the Wilding or improvement is told within arc you of mmpledon.the owner.
Wilder will have the burden of proving Nat he did On build or imp.far purpone of
tato.).
❑I,a owner of the property.un aclusively wmracling with licensed anuacmn an
commucl Ne gamines(Sec.7w,Baines and Profaeon Code:)The Conuanm'e Li-
ave yaw dos not apply an an owner or property who injus or improves dmman,and,
who canuacts for such projects;with•canuacton(s)licensed pmsuam to the Cantnctaet
License raw.
0 Iameasounro�unMSce ,BAPCforthuresson
Owner LS-+_ 1I%2 AfA s.... D.m
WORKERSCOMP SATIONDECLARATIIN
4111 hereby affirm undar penally of perjory one olden following declarations:
1 haw and will milmaio aCerdfiatecar Consent m anlf-iuum for WmIcesComen
p -
alem,all pmvitld for by Section 37M of the Labor Cradle.for(e performance or the
work for which this permit is instant.
❑1 haw and will milntsin Workees Compensation Incomes,as required by Section
3100 of the labor Code.for the performance of the work for which this permit is issud.
My Workees Compensation resonance arrim and Policy number are:
Carrier: Feller No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Masectim and trot W completed flood permit laformen hundred dmlua($100)
nr toss)
1 modify Nat in the performance of the work for which this Permit is Wood.I&bill not
employanypesson in any M.orw bbec0 c I'm the Workers'Campendon
Laws
of Cablomia.Dab //��
APplicanl 9171`63C"
t-k _ ".ItFC Z .y(;
NOTICE TO ct P e Wort es ager making this rn Ocaof of Exemption.you Mould
become sojas y is Works re Coon or this permit
m the mead rCoke,you muss
,J O foMwiN amply with such prevision or this permiuhill W deemed revoked.
z CONSTRUCTION LENDING AGENCY
[—r4 (hereby affirm Wt Nem it a contravention lending agency for the performance of
C> the work for which this Permit it issued(Sec.3097,Cl,.QJ
W Eundoes Name
0udees Actions
U O 1 eenify Nal I base read this application and sue tut the allow information h
I7r FCOMM.I agora to comply with all city and county ordinances and rob laws relating to
0. building construction,and hereby amborim rep esentatives of this city to enter upon the
above-mandond property for inspection purposes
(We)agree all ave,indemnify and kap humkas 0m City of Cupertino egaiul
liabilities.judgments.case and expenses which may in any way acme against said City
in COMomanU APPLICANT UNDEOf 1W RSTANDSof IANhisD WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGUL S.
r. f�c k Re-roofs
SnYnatum alAp re rticomractor
HAZARDOUS MATERIALS DISCLOSURE Date Type of Roof
Will the applicant or too=Wilding occupant nom mhandle hammon material
U defined by the Cupertino Municipal Code.Chapter 9.13.and the Health and Safety
Cade,Section 25532(.)7 All roofs shall be inspected prior to any roofing material being installed.
0 ❑Yes ONa
Will the applicant or future building occupant use equipment or dcviva which If a roof is installed without first obtaining an inspection,I agree to remove
I hamodou sir contaminants as deMcd by the Say Area Air Quality Management all new materials for inspection.
Diatrict7
❑Yes No
I haw mW the harardnusmaterisla requirements under Chapmrii of the Califon.
niaReal"SarciyCuae,sectors M%5,75533 md25534.I undemmokthotdone Wilding
dos not currently how a tenanL that It is my responsibility b notify The mcupent or the
requimmcnu which must he met poor to Issuance aft Ondficam of occupancy. Signature of Applicant Date
Owner or mitsmixed agent Dole All roof coverings to be Class nBn or better