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06050059 7777 CITY OF CUPERTINO BUILDING DIVISION PERMIT G ? I'I'IZAGT�i I�1UR]V� TTf�I : BUILDING ADDRESS: MOHAMMAD MORAD I PERMIT No.0 6 0 5 0 0 5 9 10050 HILLCREST RD PERMIT OWNER'S NAME: ISSUE DATE MOHAMMAD MORADI 10/04/2006 -NE: SANITARY NO. CONTROL NO. BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH O p LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that I am licensed under provisions of Chapter 9(commencing Z Z uj with Section 7000)of Division 3 of the Business and Professions Code,and my license is =y in full force and effect S FDWL-2 STORY 4 , 884/GARAGE 736 ' 'a Date Contractor License Class Lk-8 1ST FLR 2974/2ND FLR 1532/BASEMENT 378 ' � ARCHITECTS DECLARATION mI understand my plans shall be used as public records U ,a O H Licensed Professional y 1 OWNER-BUILDER DECLARATION -<2 I hereby affirm that I am exempt from the Contractor's License Law for the OO following reason.(Section 7031.5,Business and Professions Code:Any city or county <m ff which requires a permit to construct,alter,improve,demolish,or repair any structure Z prior hi 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 Sq.Ft.Floor Area Valuation F- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $1088478 L 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 APN Number Occupancy Type not more than five hundred dollars($500). ❑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 Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner of q p 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 sale.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.). ❑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 contractor(s)licensed pursuant to the Contractor's License Law. ❑I am exempt under Sec. B&P C for this reason 11wner ±­— Date 1D�Ei�D WO ER COMPENSATION DEC RATION 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 Compcn- sation,at 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 Polity number are: Cartier, Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less.) I certify that in the performance of the work for which this permit is issued,1 shall not employ any person in any manner Zk t bcco a subject tot Workers'Compensation Laws of Califorgia D e Applicant NOTICE TO,PPLICA :If,after makinj this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must Q forthwith comply with such provisions or this permit shall be deemed revoked. Z(A CONSTRUCTION LENDING AGENCY E r tom. I hereby affirm that there is a construction lending agency for the performance of (y the work for which this permit is issued(Sec.3097,Civ.C.) W A Lender's Name az Lender's Address U 0 I certify that 1 have read this application and state that the above information is V. correct.I agree to comply with all city and county ordinances and state laws relating to O Vbuilding construction,and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes. /17 LL (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 U Z in consequence of the granting of this permit. Date APPLICANT UNDERS NDS AND WILL COMP WITH ALL NON-POINT Issued by: SOURCE REGU ATIO .4. Co A/ el Re-roofs Signature of Applicant/Contractor Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof 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 rode,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes 01/0 Will the applicant or future building occupant use equipment or devices which If a roof is 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? ❑Yes dNNo I have read the hazardous materials requirements under Chapter 6.95 of Ute Califor- nia Health&Safety Code,Sccti 25505,25533 and 255Clir-�catc ndcrstand that if Ute building does not currently have a ten that it is my responsio no the of cupant of dtc requirements whit ust be l prior to issuance of a of Occup Signature of Applicant Date r. 106 All roof coverings to be Class"B"or better Owner or authorized agent Datc