05110107 (2) CITY OF CUPERTINO mxrwgw , r�-TkF3:;;aa€t «ar'j" Y /'`p ^r
BUILDING DIVISION PERMITiCONTRALC' UR I�NF'OXtM�1TIQI 4:
BUILDING ADDRESS: PARVIN SYAREI-I FERMrr140.05110107
ER'S NAME: PERMIT ISSUE DATE
186 ED 12/21/2005
NE: SANITARY NO. CONTROL NO.
ARCHITEC 71ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�oo LICENSEDCONTRd under
DECLARATION Job Description
1 Wreby eflirm that 1 am licensed under provisions of,Coder 9(commencing I. P
nal with Section 7OW)ofDivldan3of NC Bmitess end Profnssinm Code.And mylicenseis
m m.Class erect REVISION--ADD SKYLIT/2 TUB
j — License Class
Lk.Y
t Dem Contractor ADD WINDOW (GARAGE) /DOOR/REMOVE WINDOW (FAM. RM
tppp� ARCHITECPSDECLARATION NO NEW PERMIT ISSUED/ORIG. #05040163
0
6 1 undenrsnJ my plans shall m used u public recmN
trd
Licensed Pnsfcsaional
OW NE.BUILDER DECLARATION
AN 0 0 I hereby,(Sect on I em exempt form the Cessions o License law for the
E 00 following muoa.retentive
Eo s ru t,Business and Improve,
demolish,
Code:Any city or county
$ which royulma•Issuance,alsore mresrthe a@A Improve,demnniti car repair any structure
actor ns its easedpalso toithe the vision of forsuch iennil m me s eLamtl ssaemcm
p C
and heialicenwdpurwaolNthe ir)ofDivisiu3oftheausemsa dProfeaw,Codc)9 Sq.Ft.Floor Area Valuation
a I.exempt
with Section Nair)the basis
for of Nc Busalleged
exemption.
on.An vi Codc)of $0
— that W is emmPt Nem(rmn end the bu4 far de atteged esemptim.Any violation of
Section 7031.5 by any applicant for a permit ubjects the applicant in a civil penalty of APN Number Occupancy
not more than five
hundred dollars($3004 P Y�YPe
❑I.as owner of the property,or my employees with wages As Deb sole compensation,
will do the work And Ne structure 4 not intended or offered for Bele(Sec.70M,Buvnen 37526612 .
and Pmfessloes Cade:The Conuactors License taw does oat apply m an owttr of Required Inspections
property who build,or improm,thereon,and who donssuch work himself or through his
own employees,provided theuuch improvements Am not Intended oraRered forsale IL
however,the aveth gorlmprowmving cat,has will"Act year of mproeuaq the ower- A \
builder will have the burden of purring WI k did ort Wild or'unprovc for purpsse of `,
sale.).
ak ea owner of the property,am eucholvely contracting with licensed contractors to
Wet the project(Sec.70th,Business and Professions Code:)The Comranmr4 LI-
ttnse Law dace not apply m an owner arpropertir who Wilds w improve thereon.and, /\
who contracts for such projeau with a mouracmr(e)licensed personal m she Contractor. \)
Liccttse law.
❑Item/e/xem�''�ptun/d1eaS�e/e� / ,Bd PCforthismathen
ter J/e-V/AIS �i4YARZH' Date �2 O
WOR& COMPEN ATTON DECLARATION
1 hereby dam under penslry,of perjury arc o(Ne following docluations:
1hsw and will maintain a Certificateaf Consent in If-insurefor Worker'tCompen-
se0on,an provided for by Section 3700 of the Labor Code,for the performance of Ne
work for which this permit 4 issued.
❑1 have and will maintain Wnkces Compensation Insurance,a required by Section
3700 of the labor Code,for the performance of the work for which this permit is issued.
My Workers Compensation Insurance carrier and Policy number are:
Cartier. Policy No.:
CERTIFICATE OF EKEM MON FROM WORKERS
COMPENSATION INSURANCE
Cruesectien need mot W compleed rims permit 4 fm one hundrtd dollars(SIm)
or teas.)
1 certify Nmt In the performance of Ne work for which this permit 4 issued.l sWII nm
employ any person in any mannerso sa b become anbjmt to Ne Wmkcn'Compensation
Applilaws ofCje -
,ant' ZZ
NOTICE APPLICANT:If.afar makiri this CenlOcno of Eacmpfion.you should
.J Obttome m jmp m the Woheo Coir or th l provisions of is IaWf Coda you most
raMwiN comply with such rynvisions or Nis permit shall W dttmcd rewkcd.
,Z.t CONSIRUC ION LENDING AGENCY
I hereby aR W that there is A conametinn lending agency for the pe6monancc of
the work for which this permit is issued(Sm.3097,Ci,C.)
W�0 Lenders Name
7 z Lenders Address
U O 1«m!y Nn 1 have reed this application sed fuse that the above information is
carted.I agree to comply with all city and county ordinances And sum laws relaung to
0 buildingconstruction,And hereby authorim epreeenu0wa of this city to enter uponf
abovomenfioned Property for Inspection purposes.
(We)egrtt to ss q i arm y end kap hue less the City of Cupertino against
fag Iiebilitia,judgments,eosu dexpemseswhichmaylnanywyac lgaintWdCify
U 7 inconsequenceof Negra neo(Niapermis.
F7 APPLICANT UNDE ANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
7 e SOURCEREOU011LA
Lf Re-roofs
SOW of HAZARDOUS
Dae
HAZARDOUS MATERIALSDu(se or URE Type of Roof
WIII y t applicant or future building e,Chanumrc orandit H moms m,eriat
sa ft.Section
by the Cupertino Municipal Code.Chapter 9.13.and Ne Health and Safety
tle,Schon u533(a)7
❑Yes /ONO All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
f1As4
t hazardous air contaminants as defined by the Bay Ama Air Quality Management all new materials for inspection.
mict7P❑Yea 2ONo
Ibew lead theta N""amerlala myuiroments undcrChaperb.93o(NeGlifor-
HcalNhSafctyC ,Sections 33N)3,7337J and 357J4.IundemmM Net ifthe Wildigf not cmmmly h a tenant that it 4 my eapontihill y M notify tise axupent of the
airenents whin �IWmmpdorm4,uaMear,canincemorampeney. Signature of Applicant Date
Ow.rer a,norixed agent Date All roof coverings to be Class "B"or better