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CITY OF CUPERTINO'�
BUILDING DIVISION PERMIT
CONTI2ACTOR`INFORMATION
RUILDINQ ADDRESS:
18850 NEWSOM AVE
ADAMS GLOBAL CONSTRUCTION
PERMIT NO.
08050243
)W NEWS NAME:
PERMIT ISSUE DATE
HAZEM RASHED
10573 GASCOIGNE DR
05/30/2008
NE:
SANITARY NO. CONTROL NO.
(408) 661-1525
ARCHITECT2ENGINEER:
BUILDING PERMITINFO
BLDG EIECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Chapter 9
o
Job Description
1 hereby affirm tum t l licensed under pe viuo, of (commencing
with Section 7M) of Division 3 ofthe Business and Profession Code, sed my license is
DEMO PATIO WALLS
In full forte and e6 -
License Lk.I
Da¢ Commtnr
A CHITECrSDECRATION
1 undersand my Plans shall W used as public mourtk
Licensed Professional
OWNER -BUILDER DECLARATION
1 hcrehy atirm that I am exempt from tic Contractors License Law for the
following ... (Section 7113 1.5, Business and Pmksuons Code: Any city or recnty
which requires a permit t. construct, almq improve, demnluh, or ¢pair any someone
Prior al its Issuance. also m(fd ut the applicant for Such Permit W file I Signed alammCfd
he is licensed m the of the Contractor's Ucenm Law(CTapm? 9
Sq. Ft. Floor Area
Valuation
that pursuant provisions
section 70(1 of Division 3 or the Business and Professions Code)
$2500
(commencing with or
that W is exempt therefrom and Ile basis for the alleged eaemption. My violaddo of
App Number
37530020.'VV'
DGGU
Occupancy Type
Sedon 7031.5 by any applicant fora permit subjects the applicant to a civil penalty of
not mare than five hundred dollars (m).
❑ I.uowder oftu propcdy,omY wplayea with wagsastuk ank compewdon,
Required Inspections
will and the knokmdcdo 7046,
Out
he Con Lawdoes water of
Pronation Cade The Contsanmrs License law does Out apply, m m owner of
Professionapply
q P
proand
edywhobuildsaimpratsuch oro dfolNough his
ownc impr.adwW so not intended
Own oo@md for sok If.
that such improvemanuin not ear
,deeee•pmWdad
Of
within one year or comrerm
hwew,in
fo,toowner-
antiebrimprowmrmttssold
win haw Ude burden of pmHng that Ito did not build m improve for purpose of
sak.).
sok.).
_ '
1, as owner of the property am exclusively, contracting with licensed conuacross to
-
construct de project (Sec. 7064. Business and Productions Cade:) The COntsac,ons U.
.
cease Law does oaf apply man owner Of pontoon, who Wild.., impmws Wm nt, and,
whecont?ects for such projects with acenua hers) licensed pu?snnt to the Canuacuses
Licertse law.
❑ I am aaempt under See ,B&PC For this mason
w er Dam
WORKER'S COMPENSATION DECLARATION
I mby affirm under penalty of perjury one Of the following decluations:
aw end will maintain a Cenifinm of COncm m self -inure fo WorkersCOmpe.-
.led, as provided for by Scene. 37M Of the tabor Cade, for the perform. of Ile
wort for which leis Permit is issued.
❑ 1 haw and will mainuin Warkers Compewdan Insurance• as required by Section
3M of On Lakr Code, for the perfomam. of Into work for which this permit i, issued.
My Workers Compensation Insurance artier and Policy number are:
Cartier. Polity No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(Thi,xWw deed Out W completd note Permit is foam hundred robust ($100)
of less.)
I certify that in thc Perfomuuc of dm work for which this permit is issued. l Audi no
employ any person in any mance to We a et to the Warkces' Compensation
Laws of CalifDae�b( O�
Applicant
NOTICE TO APPLICANT. If, are? m ng Thu Cenfricam W Eamptian, you should
become subjcn to the Worker's Compensation pmvuion of the Laha Cade, you most
foMwith comply with such provisions or this remit shall W dcemcd ewkcd.
CONSTRUCTION LENDING AGENCY
I urebr affirm that Nem is a..mrnei.. lending agency for the performance of
the work for which this Permit is issued (see 3099. Civ. c.)
Landers Name
faders Address
1 mufy that I haw red this application and sum Thu the sinew information i,
comet 1 ajret On comply with all city and county Ordinances and sum laws relating in
_
Wilding consumed... a?W W.by ambmia rtpreunutiw of this city to enter upon the
akvcmcnummd pmpcnr for inspectionN. purynses
(We) ag?ee m saw. indemnify and luep humka the City of CuPcrdna against
cons and expcnawhich may in anywy ane,de againat aid City
incoiueedemjudgments.thu
APPLICANT of Negamingof Nu permit
APPLICANT UNDERST SAND WILL COMPLY WITH A L NON -POINT
Issued by: Date
SOURCE REGULATION %
51 � � �
Re -roofs
Srgnuure of Ap�ahuDenun cur DateType
HAZARDOUSMATERIALS DISCLOSURE
of Roof
Will the applicant or future building occupanLpom or handle haardow mleonA
as defitmd by de C.Penino Municiryl Code. Chap c, 9.13. and the Hcalusue Ssfcty
Code. Section 25532(x)?
❑Ya d N.
All roofs shall be inspected prior to any roofing material being installed.
W01 thea applicant or future Wildin Occupant Ym which
PP gequipment
If a roof is installed without first obtainingan inspection, I agree to remove
P
emit ha'rardous air contaminants a defined by to Bay Arca Air Quality Management
Mara
all new materials for inspection.
D'uvict7 J
❑Yes 1p Nu
I haw real the lace d.n rtuerialsrequimments under LLsper6.95 ofta, Gdifo-
.ixHadth&SafetyCode,Sections25505, 25533 and 25534.1 ude?sund uutifNe Wilding
does Out currently haw a e,unl drat it is my?aponsibility to rpufy IW oj(ry�/1.� cc�'upnt nde
ar
requirements which must bomgt r m issuance of a Cenikam arcaP{'
Signature Of Applicant Date
All roof coverings to be Class';?." or better
Owner ler auNome gent Date