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06040071 (2) CITY OF RA NT CUPERTINO CILDINC DIVISION PERMIT C® CTQR I BNFURMATIO.N:' NT BUILDING ADDRESS: BNS CONSTRUCTION INC PEftMiT No.06040071 OWNER'S NAME: PERMIT ISSUE DATE BARRY SHAMLOU 2457 NE: SANITARY NO. CONTROL NO. (408) 605-7777 ARCHrtECTIENGINEER: BUILDING PERMITINFO BLDG ELECT PLUMB MECH !op LICENSED CONnBdunderSDECLARATION fClau IObDeSCnpt � a 1 Z C I Wrcby affirm Nat I am Ileenrod under provisions of Clupter 9(commencing <tJ onto Scaion]((IU)of Division3oflhc Business and Pro@ssium Codc,aM my license is asA -ey imm� Cha and erred. � _ INSTALLING POWER POLE /apAyyr—w�'� p to 2 License Clan FO Dao: Contractor ARCHITECTS DECLARATION e'AV f¢< 1 uwerstand my plans shall W used ss Public record, NA/ coG Livcmcd Pmfcssional r r/ l`UUci' g OWNER-BUILDER DECLARATION y■a'i�r aur.. I I Wrchy slTum Nat 1 am exempt from the Cantranah License Law for Inc L/p®IBOg 00 following mason.(Swoon 7('31.5,Business and Rafessium Cole:Any airy ar countyAff 2 EE which requires a permit to ennsmsct,alter,impnow,demolish,or repair my stmetum 10 0 z Photo,its issuance,als.requires dmapplie.rn(.'such perunilmlik.,ug.dstateamm tan be is lieemad pursuwant mine provision of Ne C.nuvcmr's license law(Cbapter9 Sq.F[. Floor Area al i�0 (commend.,with Soon]000)of Division 3 of NC Business and Professions Cartel of '5 _ that he u exempt therefrom and Ne basis f,the alleged exernpdar.Any Aolauaa of Section 7031.5 by,try applicant for a permit subjects Ne applicant to a civil penalty of r Occupancy Type oat mom dun r hundred dollars(S5o0L L a Me wor of Ate pmperty,,my etimeycu with wages as Nei(ek c.mpeneuon, will dofework and Neswaumbnnes License affemod wdoe!,sale(San.](114,wnerof ness and nywh bis Cade The reausecbrl ndw1h.lJw.h and apply lf,d Owner of Required Inspections own em loyees,pared Met uch Improvements who m,not imworth roffred for tighWe his awn employees,provided Nm such improvements arc not intended lued for We.if. however.Ne building or improvementg rola within one year of completion.,manfor due owner. Wilder will tiK Ute burden Of probed,WI W did MI Wild m improve f,purpose of sale.). ' ❑1,as nwrcr of the property,am sxlmN.1y contracting onto licensed mnvicmrs to construct the project(Sec.1044,But..and Pmfessmas Code:)The C.ntraemrs Li. came raw does not pply m an owner of pmprny,who Wilds or improvss Nemon,and who contracts for such projects with a convactar(s)licensed pursuant to Ne[.mutons Lk..Law. Fl I am asampt ander See ,B&P C far Ads rtuoo Owner Data WORKER'S COMPENSATION DECLARATION I hereby alrum under penalty of perjury ons,of the fallowing declarations, �] I nam and will maintain a Cenificam ofeouenuo elf4ruumfor WarkersCompcn- sation.as provided for by Section 37W of the labor Cada.for Ne performance of the wart for which Nu permit is issued. ❑1 have and will maintain wartces Campeamuon I sum.,,as required by Section 3700 of the labor Code,far Ne performance of Ute work far which NU Permit is issued My Workers Compertmuon Inmran er and Policy number art: Cartier. Policy No.: CERTIM OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE (ITu xnim reed noI W camPkmJ if the permit is f,oee hundred dollar(EI W) or Icer.) I cemfy Net in Ne performeme of tte ooh for which this pcmnit u issued.1 shall not employ any permm in any manrrMu m Wrefifcs 'total Worteri Compensation Laws or California.Dam fit •iiJ� Applicant NOTICE TO APPLICANT:If.aft "sting Nu Certificate of Exemption,you should become subject m the WorterS C motion provbiorn of Me lab,Code,you must .J z forthwith comply with such provisimes ar this permit shall W deemed kad. zOCONSTRUCTION LENDING AGENCY [••i 1 herebylimb Nem is a coun trucu. int agency Inn Ne Perfurmanm of Ora> Ne week for which Ads permit u issued(sec.3097.1,Ci,C.I 1 Q Landers Nana . z Lenders Address U0 1 certify that 1 nave rem Nis applicxion and sum Nat the aWw information is D. F^ Comm 1 agree m mmply with all city and cwnty oNinarwrsand sum laws mladng m pU building Construction,and hemby authorize mpmsmtsdi of Nis city m enter upon Ne above-mentioned property for inspecuon purports. F y (We)agree to save,indemnify and lamp harmless Ne City of Cupertino against _ r/y liabiliuu.jw,ments.c.sts and expense wnich mryin any way acrncagaiml miO City C)zs Permit. APPLICeof Me graming of UNDERSTANDS I AND ND WILL COMPLY WITH ALL NON-POINT Issued by: Date �—�-1-0 SOURCE REGULATION Re-roofs ` Signature or ApplicandConuacmr Dau HAZARDD MATERIAL DISCLOSURE Type of Roof Will the applicant or ful Wilding awupaaL MM or hawk harsedom material as deface by the Cupertino Munici al Cods.Chapter 9.12,and the HedN and Safety ewe.Sccdnn:ss3z(a)] All roofs shall be inspected prior to any roofing material being installed. ❑Yu No If a roof is installed without first obtainingan inspection,I agree to remove Will the aPplicant or rum, Min,wmpant tax equipment or&A.which P g emit Wvardom air canumivnb Jell ray IW Bay Ama Air Quality Management all new materials for inspection. District? ❑Yu Nu 1 have read Ne harardm t materials rcquircments under Chapter 6.95 of Ne Califor- -is H Id,&Safety Code,Seen.25505,25533 and 25534.1 umcomaw tan if ft Wilding doo not mrren0y ham a¢runt,Nat itmy ran I try to Imdfy Ne occupant of Ne requirements hrmcaW its. pf.certificatecro',upanc. Signature of Applicant Date owner nr anma be enl o te All roar coverings to be Class "B"or better CITY OF CUPERTINO om 1 of 1 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 37523035 . 00 DATE ISSUED. . . . . . . : 04/13/2006 RECEIPT # . . . . . . . . . : 33975 REFERENCE ID ,# . . . : 06040071 SITE ADDRESS . . . . . : 10518 STERLING BLVD SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : BARRY SHAMLOU ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : BARRY CONTRACTOR . . . . . . . : BAHRAM SHAMLOU LIC # 25829 COMPANY BNS CONSTRUCTION INC ADDRESS . . . . . . . . . . : 2457 HUERTO DR CITY/STATE/ZIP . . . : SAN JOSE, CA 95128 TELEPHONE . . . . . . . . : (408) 605-7.7'77 •FEE 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 0 . 00 0 . 00 0 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 62 . 10 0 . 00 62 . 10 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ OTHER 62 . 10 VISA TOTAL RECEIPT 62 . 10 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 103 UFER 304 ROUGH ELECTRICAL • a e Community Development 10300 Torre Avenue i Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 •CUPEf�TINO Building Department- JOB ADDRESS: �©` PERMIT # J �S � 06OL-( 00 -7 r OWNER'S NAME: PHONE # GENERAL CONTRACTOR: t FAX # I am not using any subcontractors: i Signa ate Please check applicable subcontractors and com Tete the following information: 21 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 i Tile • Owner/Contractor Signature Date 1 0(004001 1 CI'T'Y OF CU PIERTINO �a7- TEYWPOWER OCUPERJINO PERMIT APPLICATION FORM APN # 3�5^ n —�G Date: CJ /_ Building Address: pC J < Owner's Name: Phone #: 1&o' 177 Contractor: one: 065 7777 License#: �5�g� F Tvy Contact: Phone: Cupertino Business License#: Building Permit Info: Elect ❑ oh `�OOBpj /4S� Job Description: Residential Commercial ❑ Cost of Project: 417�0 • Qty. if Applicable Fee ID Fee Description Fee Group BTEMP Temporary Power ELECTRICAL EPERMITFEE Elect. Permit Issuance ELECTRICAL BUSLIC Business License BUILDING •