05010081 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRAGTUR INFORMATION t,
BUILDING ADDRESS: PERMIT 440.0 5 010 0 81
0731 CARVER DRIVE
ER'S NAME: PERMIT ISSUE DATE
ESMAEIL NEMATI 01/03/2006
E: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
ELECT PLUMB MECH
3 p . LICENSED CONTRACTOR'S DECLARATION O O
e 1 hereby of inn Mal 1 am licensed under Provision of Chapin 9(commencing Job Descrip n ¢s„
ntj wish Sectors 7").f Dlvusian3afshe Busineuand Profeulmu Code.and my license is thin
In lull torte and effect. HOUSE DEMO n,
License Clw Con r,f3Y 15 2606
9 Dam TS DEC'meLARATION ARCHITECTS DECLARATION
I undcmand my plan shall he used as public records
a Licensed Professional
5 OWNER-BUILDERexemptDECe ConsoON 1 q I'V tl
<� I ressub arifn That I 1 .Bumps Ban the Cossom o License Law for the
p O fallowing nvaoa. emit t 71014.B.cher.and Prafesdan Code: put,
city or tcounty
$� which myulma a permit m construct.alter.Improve,demnlush,nr mpdf any nmclum
pnmmitacensed Innocentto be provisions
of for mchpcter'to rile aaiaw(Chapter
statement -
< shm wis pursuant to be pro vision of these Business
and Pro law(Clupmr9 Sq.PI. Floor Area Valuation
FC$ so(Commencingas13 wish Semites 70W)aft Division r of al Bniocu and on.myons Code)of $8000
3.. Nn he bexempt1.5 bany applicant
li and the bub for the alleged ewnant to Any violation of
be,a than n airy red doll for a permit mbjean she applicant a civil penalty of All Number Occupancy
Ml more then lies hundred dalWt(g500} TYi?e
❑I.as owner of the propmy or my employes with wage,or Lack sole compenuoton,
will do she work,and the =turn is not intended oraffemd forule(Sec.7044,Bordner,
and Profession Code:The Contrumts Liam Law don sot apply an an owner of Required Inspections
property who builds or im proves Nemon,and who does such work himsel f n through his
awn employees,provided that such improvements art notinanded oronesed fnsah:If,
however,the building or improvement Is sold within one year of compledon,the owner.
builder will Mw the burden of proving that be did not build or Improve for purpose of
sole.).
u-nor of the property,am exclusively cannming with licensed contractors to
convect the pmject(Sea 7044,Business and Profession Cods:)Too Connmors U.
conn Law does not apply h,an owner of propeny.who builds or improve,Batson,and
who cannot,for two projects with a eontncmr(U licensed pursuant tome Conuaclah
License Law.
❑I am axe its on 4 Sec. ,B As l - 3-06
P C Barr thus asoon ,
r - Dam l.- 3_06
MPENSATION DECLARATION
1 hereby aflison on or penalty of perjury one of the fallowing decimation:
13:11�00,afshd,
an end will maintain a Ccmftam of Consent Ire ulGinaum for WofkerlCompen-
,u provided for by Section 3700 of the Labor Code,for the performance of do
for which this permit is Issued.
aw sod will maintain Wnkera Compensmtlon Insurmu,u rtyuirtd by 5ecdon
LaborCade,for she performance ofshe work far which Nb permit b Wued.
orkers CompensNan Inmance arousod Policy numberam:
r. Polity No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thus smite need ret occompleted Issue Permit is forone hundred dollm(SI00)
or loss.)
I ceni(v that In she performance of the woh for which this permit is]wood,l Nall not
employ any person in soy TIT seb omembjmsto Ne Workert'Com emesion
Laws of California. n
Aps, I 4
NOTICE TO AP A a mg thusm r
Ceoue of Exemption,you should
become subject m the ars Compensation provision of the Low code,you man
,J O foMwith comply wish such provision at this permit Nall be deemed revoked.
Z" CONSTRUCTION LENDING AGENCY
[r o-N. I hereby Ilam shat them is a construction lending agency or she perrormame of
C'r+ the work for which this permit is issued(Sec.3097,Civ.C.)
ALenders Name
z Lenders Adduces
U Q 1 cmllfy,dust I haw mad this application and tete dui the show information is
0.F, comm 1 agora to comply with all city and county ordinances and state laws rchul"s to
Q U building construction,so
d hereby authorize representatives of this city to enter upon the
�I37 ahove-mentioned pmpcny for Inspection purposes.
"(L (We)agree to an.indemnify and keep harmless the City of Cupertino against
ti rA liabilities,Judgments.eau and expenses which may In any way amore against said City
U 7 in canxquence c panting of this permit.
A APPLICA NDE TANGS AND ILL COMPLY WITH All NON-POINT Issued by: Date —'
SOU LAE S.
1 '3—d� Re-roofs
StimoV ofApli o Dr MDampH teUSISCLOSURE Type of Roof
Willsheappll orfutre building occupmssomearthandle huardow material
as darned by the Cupertino Muni I I Code.Chapter 9.13.and the Health and Safely
IMAHeafth
SLdian'Z5533(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes, a
Will the applicant or future building occupant uta equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
hanfdou air commer. nu as recd by she Bay Area Air Quality Management all new materials for inspection.
ict?
YesoI he.read hmaNen materials requirements under Chapter 6.95 or thus Califon S yCade,Sow ma35505. 25534.IurWe berrolthatifthe building
nos how a ml thus u responsibility m nobly thud occupant of Ne
hon rel o a,amceafa Cmsirresoof Ocespsucy. Signature of Applicant Date
wore, .mN Dam All roof coverings to be Class"B"or better