03020022CITY OFCUPERTINO
BUILDING DIVISION PERMIT
CONTRACTORINFORMATION
W
BUILDINGADDRFSS:
PURMITNO,
10413 TORRE AV
01020022
EMS NAME:
APPLICATION SUB DATE
r�RAY NEZHAD
02 06 2003
PHONE:
SANITARY NO. CONTROL NO,
ARCID ITCT/ENGINCHR:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MUCH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm Ihm 1 um limnuJ u otons of Chapter 9 (commencing
Job Description
P
with Section ]111gB of DivisionJof the Dusi nd Prommiom Cale,andmylicen.¢cis
eC
moulloree 1.
PARTI- ALLS
ADDITION
Datealts
Cum
Date Lic. N mJ
(ALV �
T ._I
af✓ ANCIIITEGTS UPGT.ARATIOus
I undcrsmnJ my plans shall be used as public rcnndi
l
Licensed I'mmo Tonal
OWNER-BUILDER DECLARATION
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1 hereby affirm that I am exempt tram the Contractor's License Law lin In,
j
following reason. (Section 7031.5, Business and Professions Code: Any city or county
which raptures a permit to construct, alter, improve, demolish, or repair any structure
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prior to its issuance, also requires the applicant for such permil In file a signed statement
that he is licensed pursuonuo the provisions of the Convector's License lzw(Chapter 9
Sq. Ft. Floor Area
V alion
t
(commencing wish Section VgX) of Division J of the Business and Professions Code) nr
$500
that he is exempt facedown and the basis for the alleged exemption. Any violation of
APN Number
Occupancy Type
Section 7031.5 by any upplesum for a Permit subjects she applicant to a civil penally of
not more than five hundred dollafa (5500).,
36940008.00
❑Las owner or she property, or my employees with wages ae their sale compensation,
��..��,�� Inspections
will do the work, and the slrucmac is not intended oreffereJ for sale (Sec. 70m. Business
and Pmfessions Code. The Common's License Law does not apply In an owner of
property who builds or improves thereon, and who doessuch work himself or through his
101 -
FOUNDA'ggigd
own employees. provided that such improvements are, not intended or mfemd for sale. It.
102 —
PIERS
hmveveq the Wilding at improvement is sold within one year of completion, the owner.
builder will have the burden of proving that he did not Wild or improve for purpose of
103 -
UFER
.is1.
104 -
REBAR
01. as owner of the property, am exclusively contracting with licensed contactors to
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ANCHOR BOLTS
construct the perfect (Sec. 4044, Business and Prometheus Code) The Conuaclora Li-
moselawdoesnot apply to an owner ofpropenywho Wilds orimproves commit, and
106 -
SEWER & WATER
who contracts for such projects with a contemearo) licensed pursuant to the Contractor's
l.¢cnsc La W.
202 -
UNDERFLOOR PLUMBING
I me exempt antler Sec. .B&PC for this tun
203 -
UNDERFLOOR MECHANICAL
` °ate
204 -
UNDERFLOOR FRAME
`` W Rncerp Oh PEN TI E ATION
205 -
UNDERFLOOR INSULATION
Ihandyll under penaByof shefnsum fordedarafians:
301 -
ROUGH PLUMBING
mai ofConene
❑?have end will for by eCen3700cate of ConantCodeto , for( foreromrame of the
cation, u provided for by Section 7]1X) of the Labor Code, for the perfonnence of the
3 0 2 -
TUB & OR SHOWER
Workfm which this Permit is Issued.
303 -
ROUGH MECHANICAL
❑ 1 have and will maintain Worker's Compensation Insurance, as required by Scctinn
3 04 -
ROUGH ELECTRICAL
That of the labor Cale, for the pefformanec of Be, work for which this peonil is issued.
My Workers Compensation Insurance carrier and Policy, number are:
305 —
FRAME .
Carrier: Policy No.:
306 -
HOLDOWNS
CERTIFICATE. OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
307 -
INSULATION
This section need not In completed Rik Permit is for one hundreddonars(sign
308 -
SHEETROCK
.'r lCSs)
1 ccnify mal in reap flarmancc nl IM1c work far which IM1i.¢ permit is issued, l shall not
309 -
310 -
EXTERIOR LATH
INTERIOR LATH
oy any pdsgpgh boy manner ¢y ap to hycomesuhjecl to me Workers' Compenetinn
of Calif.gle� {
�N'er,TOAg p
PPL TAT. alter ma in Nis ani m of Euro tion, yet ahnulJubjecty
311 -
313 -
SCRATCH COAT
ROOF NAIL
the Wurh ri Coons or thisermisimu of rhe Lehr Code, you mon
forthwith comply with such provisions of thrs PernJ shall bedeemed revoked,
SOl —
FINAL ELECTRICAL ENERGY
502 -
FINAL PLUMBING ENERGY
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
503 -
FINAL MECHANICAL ENERGY 6-t4
the worfolk rat Name which this permit is issued (See. 3(19], Co,C.)
Le
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505 -
FINAL BUILDING ENERGY
FINAL ELECTRICAL
Leader's Add..
I ecmify that I have read this application and stat. that the above information is
506 -
GAS TEST %�J
comet. I agree to comply with all city and county ordinances and state laws relating to
building eonesuuction, and hereby audenfirz representatives of this city to enter upon the
FINA PLUMBI G
aMwcmcminned pmfcny for inspccdon purposes.
OB
FIN
(We) agree to save. indemnify and keep harmless the City of Cupertino against
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liabilities, judgments, costs and expenses which may in any way seem against said City
5
A
in consequence of she granting of this permit.
CANT UNDERSTANDS AND WILL COMPLY WITH ALL NO POINT
Issued by:5
NG Date -
CE
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Re-roofs
Type of Roof
rULATIONS,
VW e I t-F��� 1 (.—. //--/o
Signature of ApplicanBComranor �
HAZARDOUS MATERIALS DISCLOSURE
Will the applit am or lemse building nscupanl store ser handle hrardous material
efined by she Cupertino Municipal Calc, Clarinet 9.12, and the Health and Safety
:. Section 25532f')'!
All roofs shall be inspected
prior to any roofing material being installed.
❑Yea 3gn
If a roof is installed
without first obtaining an inspection, I agree to remove
Will the applicant or future buildingrxcupanl use aptipmenl or devices which
ram, haeardeux air conmommumx as defined by the Buy Arca Air Quality Management
all new materials for inspection.
District? _�,�/
❑Yes UNIT
1 hast read the hroodous numnalsroquiremenH under Chapterii.95of the Cable'.
nia Ilcxdh& Safety Calc, Stud oes 25505, 25533 red 25534.1 understand that iflbe building
docs not currently have a tenant. Nan i1 is my responsihilmy In modify the occupant of me
requirements w' hmuxlhcmelpmmoissuanccata(cni0came roupancg
Signature of Applicant Date
("
3
All roof coverings to be Class "B" or better
nranmorxedIg D, e