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07060085CITY OF, CUYLK'171NU BUILDING DIVISION PERMIT BUILDEsSTERN AVE OWNER'S NAME: SAIDIAN, JACOB oNE: ARCHITECT/ENGINEER: LICENSED COM"KAt:1 UK ur%- - .nr 1- 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professiu Code, and my license is in full force and effect. lj `,%2 79 /y License Class Lic. # Date Contractor ARCHITECTS DECLARATION I understand my plans shall he used as public records Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason. (Section 7031.5. Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500). 0 I, as owner of the property, or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Conuactoes License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sal. If, however, the building or improvement is sold within one year of completion, the owner - builder will have the burden of proving that he did not build or improve for purpose of sal.). 0 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a conuactor(s) licensed pursuant to the contractor's License Law. 0 I am exempt under Sec. B & P C for this reason Owner Date WORKER'S COMPENSATLON DECLARATION I hereby affirm under penalty of perjury one of the following declarations. - ADVANCES DEVELOPMENT/JACOB 2933 BENJAMIN CT (408) 891-1639 PERMIT NO. 07060085 PERMIT ISSUE DATE 06/12/2007 SANITARY NO. CONTROL NO. BUILDING PERMIT INFO Job Description INSTALL TEMPORARY POWER ON EXISTING SHED T1 1 have and will maintain a Certificate of Consent to self -insure for worker's compen. ation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number are: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars (SI00) or less.) I certify that in the performance of the work for which this permit is issued. I shall not employ any person in any mantrf�er� so as to b gree subject to the Workers' Compensation Laws of California. Date �] Applicant 311 Z NOTICE TO APPLICANT: If, after making this Certificate of txcmpdon, you should become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) Lender's Name L.cnder s Address I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and sate laws relating to building construction, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the granting of this permit. APPLICANT UriDERSTMDS AND WILL COMPLY WITH ALL NON -POINT SOURCI tFRUtATIO % n ure of ApplicanUConuactor l C• Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Code, Section 25532(a)9 0Yes NICNo Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District? 0 Yes �Q No 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Code, Sections 25505, 25533 and 25534.1 understand that if the building does not currently have a nt, that it is my responsibility to notify the occupant of the requirements which met prior to issuance of a Certificate of Occupancy. C,I12lo7 ;,q. Ft. Floor 3691106►' Issued by Re -roofs Type of F roof $350 Occupancy 'lype Required Inspections All roofs shall be inspected prior to any roofing material being installed. If a roof s installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant All roof coverings to be Class "B" or better Date INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO PERMIT INVOICE OPERATOR: christya Sec: Twp: Rng: Sub: Blk: Lot: APN ......... 36911069.00 INVOICE DATE......: 06/12/2007 REFERENCE ID # ...: 07C60085 SITE ADDRESS .....: 10221 STERN AVE SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OWNER ............: SAIDIAN, JACOB ADDRESS 10,'',21 STERN AVE CITY/STATE/ZIP ...: CUPERTINO, CA 95014 CONTRACTOR YAGHOUB (JACOB) SAIDIAN LIC # 29078 COMPANY ADVANCED DEVELOPMENT/JACOB SAIDIAN ADDRESS 29'3 BENJAMIN CT CITY/STATE/ZIP ...: SAN JOSE, CA 95124 TELEPHONE (408) 891-1639 FEE DESCRIPTION DUE FOR AMOUNT DUE PAID ---------- ---- BALANCE -------------------------------------------- TEMPORARY POWER PRINTING ---------- :?ERMIT 62.10 0.00 62.10 ELEC PERMIT ISSUANCE PRINTING :?ERMIT 38.37 0.00 ---------- ---------- 38.37 ---------- 100.47 0.00 100.47 VOICE ID DESCRIPTION VOICE ID -------- -------------------- DESCRIPTION -------- ---------------------------- 103 UFER 304 ROUGH ELECTRICAL 2 ITEMS OF 2 CITY OF 2UPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: B1k: Lot: APN 36911069.00 DATE ISSUED.......: 06/12/2007 RECEIPT #.........: BS000001622 REFERENCE ID # ...: 07060085 SITE ADDRESS 10221 STERN AVE SUBDIVISION ...... CITY CUFERTINO IMPACT AREA ...... OWNER SAIDIAN, JACOB ADDRESS 10221 STERN AVE CITY/STATE/ZIP ...: CUFERTINO, CA 95014 OPERATOR: christya COPY # : 2 RECEIVED FROM YACOUB SAIDIAN CONTRACTOR YACHOUB (JACOB) SAIDIAN LIC # 29078 COMPANY ADVANCED DEVELOPMENT/JACOB SAI ADDRESS 29=3 BENJAMIN CT CITY/STATE/ZIP ...: SAN JOSE, CA 95124 TELEPHONE (4(18) 891-1639 FEE ID UNIT QUANTITY ILMOUNT 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 ----------------- CHECK TOTAL RECEIPT : AMOUNT --------------- 100.47 --------------- 100.47 REFERENCE NUMBER -------------------- 3153 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ------ 103 UFER 304 ROUGH ELECTRICAL