06090086 (2) CITY.OF CUPERTINO
BUILDING DIVISION PERMIT '+[S1'1`•:T.RACTQR��1�I'k�U,RMA'PIO
z
BUILDINGADDRMS: ARCO CONST PERMITNO.06090086
18650 CRABTREE AVE
OWNER'S NAME: PERMIT ISSUE DATE
SAADAT FADAIE 14880 LLAGAS AVE 09/1 'A/2006
NE: SANITARY NO. CONTROL NO.
(408) 779-7577
ARCHREC'ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
O O LICENSED CONTRACTOR'S DECLARATION
1 1 hereby of im that I am licensed under provisions of Chapter 9(cammencing Job Description
with Section 70M)ol'Division 7 of the Business and Professions Code,and my license is
in full force and effect. INSTALL TEMPORARY POWER POLE
Licenm Class Ltd.A
Date Contractor
rp. ARCHITECT'S DECLARATION
i I understand my plana shoo her need u public records
C Licensed proressional
OWNER-BUILDER rot.DECLARATION
I $ I hereby mnrm that ISO exempt from dm f sM,,m rS License I.S.far the
O o following mason.(Saation 71mictre Business and nae,de ins h.or Any city or counry
$� which requires a Permit an cnvtrucL eller.hnpmve,demolish.or rtPNr any structure $150
prior to is issuance.also requires the applicant fonuch permit to rile ulgned mtemcnt
Q thuheis licensed Purmmstothe provisions oftheConuacmrilicense Law(Chapter 9 Sq.Ft.Floor Area Valuation
$ (commencing with Sedan 7000)ofDivision 7 of the Business mot Indications Cade)or
that he is exempt therefrom and the been for the alleged e....pdon.My violation of
N
Sean 7071.5 by airy applicant for a permit Subjects me applkanue•civil penalty of er J Occupancy Type
not more than five hundred dollars(5700).
❑1,u owner of tha property,a my employee,with wsgn u Nov Sule eompevation,
AndPr fe work.C d: Suucture 4 maimewled ora fiancedw do fare t Apply tow,ouner of Required Ins ectio?n
end Prop work Cade:The Burn 4 ma, mewled Law dote not apply man owner of q P
property who build,orimprowatherem,and who dessuch workhineself or through his
awn employs,,,provided Nat Such lmprovemants are renimended oroaertd for sale.IL
however,do building ar improvpmant iamld within ons)ear ofcempletion,die.
builder will have the burden of proving that he did set Wild or improve for purpose of
,ale.).
[-fR'u matter of the property am ascludwit,co anstaing with licensed emanon to �V
crosuun de pmjea(Sec.7044.Business and Procreation,Cade:)The Caobw.mr',Li-
cove law does oat apply an an owner of property who builds or improves thereon.and,
who contracts for such projects with a contractor(U licensed pursuant to the Contractor's
License Law.
❑lamuemmundo See a ,(� ,B&PCforthismamn
137100
ner ,l _.,,f✓ r as rite"C., Data � 13 06
WORKER'S COMPENSATION DECLARATION
1 hemby affirm under penalty of perjury ons of the following declare lav:
I ism and will maintain A Certificate of Content m self-haum fee Warker's Compen-
ion,u provided far by Section 7700 or the labor Code.for the performance of tha
rk for which Nis permit Is Issued.
1 have and will maintain Workers Compensation Inmrmc,u required by Section
of Ne lobar Code,(a eve periamsece ofthe v oh for which mus permit 4 Weed.
y Workers Compe cation Inmranc artier and Policy numberam:
rrier. Palley No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Th4acetlan nsed Active cmnplced It ale permit Is formic hundred dollar($100)
nr less.)
1 crtiry Out In Ne performance of the work for which this Permit Is blued.I shall not
employ any petaon in my mannsrrquZm �bjncI an to Woken Compevadan .
laws Of CAIifOmlt Data ``tt
Application Q^- --�^
NOTICE TO APPLICANT:If,after making this Certiftua of Exception.you should
become subject an the Worker',Compensation provisions of the labor Code you must
.JO forthwith comply with Such proviSiis or this Permit Nall to devoted revoked.
CONSTRUCTION LENDING AGENCY
[ti 1 bermley Arm thm thmrc i,a construction lending agency for the Performance of
fY
the wart for which this permit 4 blued(Sec.7097,Co.C.)
W Q Lenders Name
lL z Lenders Accurate
(J 1 cutify dust I have mud this application and Sus Nat me above infoma tun is
U, F comm 1 agree to comply with all City and county ordinances add state laws totaling 10 '
Q U building convection,and hereby auNorive reprvcmaiiw or this city to cntcrupnnNe
[S.l ahoy mentioned property for inspection purposes.
t.4 (We)agree to San,indemnify and keep hamlets the City of Cupertino against
wH.o rA Iiabilide,.jodgencnts,cosu and expenses which may In any way accrue against mid City
V Z in consequence of the granting of this permit.
.. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by; Date
SOURCE 0.EGULA770' � ��3/� 6
�j-� Re-roofs
SigtWurt of AppUwsUCoARDOU °ile of Roof
HAZARDOUS b MATERIALSDISCLOSUREo SURE Type
W01 cute a Cupertino
furore building e.Chapter
ar handle Health ad Saeial
As deRnsd by the Cupertino Muniripel Code.Chapler 9.13,and Ota HpIN and Safety
Cade,Section 35773(x)7 �_N� All roofs shall be inspected prior to any roofing material being installed.
❑Yes
Will me applicant or future building Occupant uee equipment or devices,which If a roof is installed without first obtaining an inspection,I agree to remove -
emlt homrcov All cantaminants Ad dcOnc by the Bay Amo Air Quality Management all new materials for inspection.
D suictT
❑Yrs u
1 have real the hwrdnus matcriah requirements under Chapter 6.95 aide Califor.
nia Health&Safety Cade,Satiov 35505,35577 and 35534.1 understood thin[[the building
date not c ly ban a tenant.that it 4 my responsibility an notify Oe acupanl of Ne
requirecea hichmustge mpriarto Wuance ofe Certificate or Ocepancy' Signature of Applicant Date
I>, 40 G All roof coverings to be Class"B"or better
Owner or m6aHled agent Data
CITY OF CUPERTINO
!m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 3
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 37526056 . 00
DATE ISSUED. . . . . . . : 09/13/2006
RECEIPT # . . . . . . . . . : 36020
REFERENCE ID # . . . : 06090086
SITE ADDRESS . . . . . : 18650 CRABTREE AVE
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : SAADAT FADAIE
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : SAADAT FADAIE
CONTRACTOR . . . . . . . : LANA CULJIS LIC # 24759
COMPANY . . . . . . . . . . : ABCO CONST
ADDRESS . . . . . . . . . . : 14880 LLAGAS AVE
CITY/STATE/ZIP . . . : SAN MARTIN, CA 95046
TELEPHONE . . . . . . . . : (408) 779-7577
�EE ID UNIT QUANTITY AMOUNT PD-.TO-DT THIS REC NEW BAL
--- ---- ------------- ---------- ---------- ---------- ---------- ----------
BTEMP FLAT RATE 1 . 00 62 . 10 0 . 00 62 . 10 0 . 00
EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 100 . 47 0 . 00 100 . 47 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 100 . 47 1044
TOTAL RECEIPT 100 .47
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
103 UFER 304 ROUGH ELECTRICAL
Community Development
ue
OTY
I0300 Torre AvenueCupertino CA 95014
Telephone(408)777-3228
OF Fax(408)777-3333
41UPEkTINO
Building Department
JOB ADDRESS: PERMIT #
�.-
OWNER'S NAME: a,' t o i� - << a i e PHONE # L ds 3 g Z _ L-4
GENERAL CONTRACTOR c s-t,- FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
60 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass/ Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
ile
c
Owner/Contractor Signature Date
-� CITY OF CUPERTINO oI cgOO&
TEMP POWER
,CU1NPEkT
O PERMIT APPLICATION FORM
APN# ���j� nr 051 /1 Date:
Building Address: / / �0 lV /
Owner's Name: Phone#:
Contractor: Phone: License#:
-�9 a 2 9
Contact: Phone: Cupertino Business License#:
Building Permit Info: _
Elect S/
Job Description:
Residential Commercial ❑
Cost of Project:
Qty. if
Applicable Fee ID Fee Description Fee Group
BTEMP Temporary Power ELECTRICAL
EPERMITFEE Elect. Permit Issuance ELECTRICAL
BUSLIC Business License BUILDING
41