02090111 (2)CITY OF CUPERTINO
'• sOILDINO DtvtstON PERMIT
CONTRACTOR INFORMATION:
BUILDINGADDRESS: "
PERMIT NO.
1109 MILKY'WY
VARUJAN NAJARYAN
020901�E11
NAJARYAN
SUB
APPLICATION 09/17/2002
A
'IPHONP p a', 4 l I, ,Lg '4Yr,I
SANITARY NO. CONTROL NO -
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T3',
ARCHITECT/ENGINEER ”
BUILDING PERMIT INFO
„
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
Ihercb•,afrmnthmIs. b<en.eaana<rprori.mn.nrChap¢r9mommen<ing
ELECT SERVICE UPGRADE
with Section YbOO)of Division 3 of rhe Business and Professions Code, and my license
is In full force and even'
PAID ON #02090046 (VOID) RECEIPT#19618
Lieen.e Clara•: Cc."
Dat[.!M1' ''
ORIG. 402030132 IS EXPIRED
�, S DECLARATION ARCHITECT'S DECLARATION
I understand my plans snail be used as public records
-
"
Licensed Professional
OWNER -BUILDER DECLARATION.
I hereby affirm that 1 am exempt from the Contractor's License Law for the
following ren ran. (Section 7031.5. Business and Professions Code Any city of county
which requires n permil m amstmcr.pec improve, demolish, or repair any swcmrc
'
- .._...., _.__._...._.__._-_._....
-prior m its issumtt. also requires meapplicam for such permit to fileusignd amemem
- ._• ) Sq. -Ft; Floor,Area t
l'f1ta C;ti:=.q i:0)-,
$15 Ygluation
that peA licpeged puimpnt to the pmvisi.m.1' me Comrrcme, License Law (chapter 9
Division 3nnwBuxrnes<agdProf ... mnsCoael
(<omin'ta wiurySecrqa,]WB)pf
arthritic is lxe pt ihbrefnim and the basis for the alleged exemption. Any violation
t Iei�;:'3X1,ION
-°f nation 7031:5 by any vpplicmh fora permit subjects the applicant ro a civil penalty-
ImmorarcmaoBvenundreddagaaa5ool.
36268KN4m1tY0 -
Klt.H,I..: Occupancy Type
❑ 1, as owner of the pmpeny, ur my employees with wages m their wlc comp<n...ion.
3 04 — ROUGH EL r D'.rr
Ti coons t%' p
--will 'do -the work. -and structure Is not intended' or'oB<red'for sale (Sec. 7W.-
r Business and Professions Cale: The Connector's License taw does oat apply m an
owne rnr mnpeny who baud. nr improve. thereon. dna won ams .a<b work nim.elr
501 - FINAL ELECTRICAL ENERGY
or through his own employees. provided that such improvements are nm intendedyear or
,.0redrr.dla'y.Iowa:er,theWildinsarimprovementt. olawimianMr era
I:iompleaon:
-_ __-_ __-_-
505 --FINAL" EliECTRICPL— ti,r.r a
'
tk owner W ildei will have the burden of proving that he did not Wild at
•. s t '
improvefo puipo'. f''Icf
1
❑I:as°wner°fine p(Sec.7n,Businiv<lycomraaingwi Codc:)aThemmawsm
.1 f:�-1"'+I•t +:IIT P'f•-'-_-_----
(Sec. ]BU, Business and Professions
cncron, taw or The Contmma's
.:.: ul r.l li - Pi .',l: '•C • r
Law dces n Wild,
it. apply t nc f p pony who M1 Id pro es N c
_ r. /�
e
o contracts for such p 3 ¢ with vacrortsl licensed. pu mot to. the.
f
_._ ._ _ _-..... _ .. -
nse 1
` dine. t nae 5
(� JJ �9/\ i7ohreason
SEP %'0
I(yWORKE0.S-ON] SATION DE CLARATION
a` In' byaain d a 1.Ityofpelvry on f.hef lloaing Jmlamtions:
/�
I1tlg,r.
Itlwns
❑ I have'and will mmmmn'a1'Cenificam of Consent In self -insure for Worker's
��'��
Compensation. ras provided -for by Section 37W of the LaWr Cale. for the
Performance of the work for which this p<zmit is fssucd- ,
❑ I hove'und'will aZimaio Woikcr's Compcnsotiuri In'iumnce, as mcorcd by Section
3]00 of the Labno Cale, for the performance of the woiklfor'which this permit is
issued.'My Work;Is Compensation Insurance carrier and P6lic)'number'am:
C 6.7- l'4!Policy N6 ,..,. -
a`
�S Pl
t t CE RTIPICATIONOFE%Eb1P1'IONFROMWORK RS,1 �'-
v s , l\..i-1.1f�`6:
COMPENSATION INSURANCES _
: .Wilt': t '.a O: l'j'.-S4j)C'
's' �(Th ssectinri necdnot&cnmpineJ Tthc pcnnit is far one hunJrcddollaa
or cssl
Y pc n amu m t l t t�J t2 WjZ !'s
C II t mop�lo�Ya
�a nfClf -j,t11�—
Y _
cam V
..... .. _-
`qlr; II"
f�'t�11y'IiatiO APPLI A'T If. ape souks mCeritct al LxemPtmn,yov ahoulJ
bcnnne subleat to tAc WoAcrs Compensation provisions of me Later Calc, you must
fnnhwitli comply with such provisions or this a rrou sholl be deemed revoked
` _
o- CONSTRUCTION LENDING AGENCY - -
I hereby pff nn mm there is a con. t coon lending agency for the Per f_omtd i�e
N„ 1.11
s d f r qX, ` I Mi) s.
of wh ch th pcntit. .''e4 (S .9P9]C'v C)v:_..0
-
-U Vera Name
n 'itAddress'
I n fY that l h rcJ th. fission d st re that h W information s
correct I glee m comply with II'city d county tiro. d sot • retat ng
/
A
toWla g t a dh b aidd rep _cn tiv of this ityt Incineration
'tM1
W i ed p perry f spat pmT,w II ..
j,. ave, indemnify andk against
mayinthe wayaCupertino
liabilities, judgmems, costs and expensesfthi which may in any way accrue again'[ said
es, judgments.which
Cry qucnce bhne g i ng of this pemdt.
APPLICANT'ANDERSI NOS AND WILL COMPLY WITH I N. olur "'
'f -
Issued b Date
y
tiblN EREGOLATIG
y
RO-roof$
nawrctfAppli<anV °mmm r',,, _" :' - �' "' Date "�;:.
t .. HAZARDOUS MATERIALS DISCLOSURE
W 11 die eppl c t or r tote Wilding oc W t tore or handl baxvanus °weml
Type of Roof .- _ .. . -. _ --- ... -: r..: _. _ _�. • �•_ .....,. - ._
es defined by the.Cupen Municipal Code Chapter 9 12 and the Health and Safety
e \s.e} t ;:1 3,, .. s • _ l ,' I
,CodsSei 25{j2fv1 ti ' t, :r str�
❑ve. '•'".°'
5 sa. ,as {d,it''".(.��}:
_All roofs.shall be.mspected prior to any roofing material being installed. _._._...__
:" „
c a tuseequipment devices which
' - Wllth apply t future aoccupant
If a roof is in wi[Fiout first obtaining an'inspectton; I�agiee'to Ye'Inove
e n't her N s it comam none a. Jef d by,hBay Are.A Q I ty Management District?
all new materials for, inspection. understands and will comply. with
❑Ya g"= ;,�.Nn • I .
,Applicant
all non -point source regulations,... -
;.
• 1 have rcvdvh; hazardous mvrenals ieyuiremem.i under Chapter 6.95 of, the
California Healthy Calc Sections and75531Iitytounderstand that.
tribe building does not currently M1arc a mnme that it is my rtsponxibiliry to notify the'
ofsafetycur it
7
'occ p t df the req e e i hick ani st W ma pour m s once n Ccmfca¢ or
°c n"y".ri- ' 2i9��
_SignatureofApplicant _ ;_'_ _.- Date;
All roof coverings to be Class "B" or better ,
Date
41 i'Iligl i
. " -' --OFFICE
CITY OF CUPERTINO
�ia 1 of 1 PERMIT RECEIPT OPERATOR: suem
COPY # : 3
Sec: Twp: Rng: Sub:
Elk: Lot:
CONTRACTOR .......:
LIC # *OWNER*
APN ........:
36219011.00
ADDRESS ..........:
DATE ISSUED.......:
09/09/2002
TELEPHONE ........:
�Sv0'�
RECEIPT #.........:
#
19618
/
i7(,Y
REFERENCE ID ...:
02090046
SITE ADDRESS .....: 1109 MILKY WY
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OWNER ............: VARUJAN NAJARYAN
ADDRESS ...........
CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-5064
RECEIVED FROM ....:
VARUJAN NAJARYAN
CONTRACTOR .......:
LIC # *OWNER*
COMPANY ..........:
VARUJAN NAJARYAN
ADDRESS ..........:
CITY/STATE/ZIP ...:
CUPERTINO CA, CA 95014-5064
TELEPHONE ........:
/SEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL
BELEC200 METERS 1.00 22.20 0.00 22.20 0.00
BENERGY PERMIT FEE 1.00 23.10 0.00 23.10 0.00
EPERMITFEE FLAT RATE 1.00 35.52 0.00 35.52 0.00
BSEISMICRE VALUATION 1,500.00 0.50 0.00 0.50 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT 81.32 0.00 81.32 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ _----_-_-----_-_-_
CHECK 81.32 490
TOTAL RECEIPT 61.32
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY
505 FINAL ELECTRICAL
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