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07040249 CITY OF CUPERTINO BUILDING DIVISION PERMITi"#4 PERMIT N0. BUILD,(NfJQ1�614ILLCREST RD COLOA CONSTRUCTION, INC 07040249 l�J(J (J �j PERMIT ISSUE DATE OWNER'S NAME: MOHAMMAD MASADI 1671 CANYON VIEW DR. 05/08/2007 SANITARY NO. CONTROL NO. NE` (408) 89'.-2449 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH i a p LICENSED CONTRACTOR'S DECLARATION Job Description U 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing ?z with Section 7000)of Division 3 of the Business and Professions Code.and my license is STEEL G.i_RDER CHANGED IN FAMILY ROOM ?may in full force and effect. �jO IGINA., PERM#06050059 v�z License CI�s Lic.N o Date Conuactor ARCHiTECI'S DECLA ATION j a a 1 understand my plans shall be used as public records >yU U.y Licensed Professional OWNER-BUILDER DECLARATION N 1 hereby alTinn that 1 am exempt from the Contractor's License Law for the 00 following reason.(Section 7031.5,Business and Professions Code:Any city or county <.0 which requires a permit to constructalter,improve,demolish,or repair any structure Ll— prior to its issuance,also requires the applicant for such permit to rile a signed statement t;q.Ft.Floor Area Valuation -Z< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 $0 t= (commencing with Section 7000)of Division 3 of the Business and Professions Code)or axethat he is exempt therefrom and the basis for the alleged emption.Any violation of Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3261601 3 bT Number not more than five hundred dollars(5500). I,as owner of the property,or my employees with wages as their sale compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's 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 We.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 sale.). ❑1,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- ccnse Law does not apply to an owner of property who builds or improves thereon,and. who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. ❑I am exempt under See. B&P C for this reason Owner Dale WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a Certificate of consent to self-insure for Worker's Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 0 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 ate: Carrier. Zk S 00 l y S 1—1 Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is formic hundred dollars($100) 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 manner so as to become subject to the Workers'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must Z forthwith comply with such provisions or this permit shall be deemed revoked. z, CONSTRUCTION LENDING AGENCY ( h ham-. 1 hereby affirm that there is a construction lending agency for the performance of Q! the work for which this permit is issued(Sec.3097,Civ.C.) Lea A Lender's Name z Lender's Address U 0 1 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 state laws relating to O U building construction,and hereby authorize representatives of this city to enter upon the W above-mentioned properly for inspection purposes. GL (We)agree to save,indemnify and keep harmless the City of Cupertino against Hliabilities,judgments,costs and expenses which may in any way accrue against said City V z in consequence of the granting of this permit Date 0-4 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: S URCE REGULATIONS. ii ��c���� $l6��_ Re-roofs Signaturtdf Applicant/Contractor Datc HAZARDOUS MATERIALS DISCLOSURE Type of F:oof Will the applicant or future building occupant store or handle hazardous material as deftned by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Cole,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes ZNo Will the applicant or future building occupant use equipment or devices which If a roof s installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? O Yes VrNo I 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 doesnot currently have a tenant that it is my responsibility a notify the occupant of the req . which mug be met prior to issuance of a Certificate of cupancy. Signaturf of Applicant Date M 'S a All roof coverings to be Class"B"or better Owner or horizcd agent Date