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07100111 REV1 CITY OF CUPERTINO ` ' ' ` ' BUILDING DIYISION PERMIT ���'�R� �'��� Z���������� , ,::: ,:: ::: , ; . :... . _ , BUiLDING ADDRESS: PERMIT PIO. 18881 ARATA WAY ADVANC D DEVELOPMENT/JACOB 07100111 � cR'S NAME: �T PERMIT LSSUE DATE JACOB SAIDIAN 29 B �NJAMIN PHONE: SANITARY NO. CONTROL NO. ARCHI'fECT/ENGINEER: BU►LDING PERM1TiNF0 REVSN; ADDING DETAIL BASMNT HLDG ELECT PLUMB MECH � � � 0 i p 0 LICENSED CONTRACTOR'S DECLARATION JOb DeSCflpt1011 � V � I hcrcby affirtn �hat [ am liccnsed uncier provisions af Chap�cr 9 (commcncing -- - ----�- --- -.-- --� -�---- _-- - --- — --- - ; z� with Sec�ion 7000) of Division 3 of ihc Busincss and ProCcssiuns Cadc, and my liccnsc is '� y in full Coree and cftect � v� z Licenx Class L�. # � t, � Datc Conuacinr � ARCHITECCS DECLARATION i a Q I undcrstanJ my plans shall bc uscd u public rccordc )yV ' u. y Licensed Pni[cscional � y � OWNER-BUILDER DEC[.ARATION >' 1 hcrcby atTirm tha� 1 am cxcmpt from U�c Contractor's Liccnsc Law far thc j �� foliowing rcason. (Sccuon 7031.5, Busincss and Profcssions Codc: Any city or county �$ which rcquims a pertnit to conswc4 alter, impmvc, dcmnlieh, or mpair any sweture � Z y prior u� i�s issuancc. alsu rcquires ihc applicant for such permit ta filc a signcd sutcmcm , Ft. FlOOi AI'E3 Valuation ��< thai hc is liccnscd pursuan� �o thc provisions oC thc Convacwr's Liccnu Caw (Chapicr 9 :��] � F- �(commcncing wiih Sccuon 7000) of Division 3 a( Ihc Busincss and Profcssinns Cadc) or ,�, �� that he is ezempt thcretrom and Ne basis Cor the allegcd eumption. Any violation oC Section 703I.S by any applicant for a pennit subjccu �hc applicant to a civil pcnalty of APN Number Occupancy Type not morc �han five hundred dallars (5500). � I, ss owner oC ttie property, or my employcu with wages az the'v solc compensation, arill do thc work, and U:e strucwre is no[ in�ende� or of[eceG fo� salc (Sa.7044, Business Re uired Ins eCtIOIIS and Pevfessions Codc: The Canuacror's License Law docs not apply w an owne� of q p propeny who builds or improves �hercon, and who does such wurt himul[ or throngh his awn employces, providcd U�at such improvemen�s are not intended aro[Lered forsala IC, howevu, the building or imp�ovement is sold within one yesr of compledon, d�e owner- builder will have the burden o( proving �at he did not build or improvc for purpose af sa�.). I, as owner oC the property, am ezclusivety conuacting wiU� licensed rnnuactors w conswct the project (Sec. 7044, Business and Professions Code:) The Conuutor's Li• ccnse Caw docs not apply to an owner of propeny who builds or improves Wemon, and . who convacls for such ptojects with a con�ractor(s) licensed pursusnt to Uu Contrxtoc's License Law. ^ I am aempt undu c. , B 8c P C f r Ihis n rcr C.Ya C �� G' Date/ �p �� _. . WORKER'S OMPENSATION DECLARATION I hereby afficm under penalty of perjury one o( the following dxlarations: ❑ I hsve and will mainuin a Cenificate of Consent to self-iasurc for Worker's Compen- sation, as provided far by Section 3700 of the Labor Cade, far the performance o[ the worlc for whieh Ihis permit is issucd. ❑ I have and will maintain Worker's Compensauon (nsurance, u myuired by Scction 3700 of thc Labor Codc, for thc perCormance of the wwt far which �his permit is issued. My Worker's Compensatian Insurance carticr and Policy number aze: Carrier. Policy No.: CER7'IFICATE OF EXEMP!'[ON FROM WORKERS' COMPENSATION INSURANCE (This scction necd not 6c complctcd if the pertnit is for onc hundred dotlars (S I00) or Icss.) ' I ceni[� U�.t in ihc performancc of the work for which this pertnit is issucd, t shall not employ any person in any manncr so az to bccomc su6ject w �he Workcrs' Compcnsadon Laws of Califomia ��tc_ � ! �\ Applicant „) N01'ICE TO APPLlCANT: If, alYcr making this CertiGcatc of Excmpuon, you shauld become subjcct to ihe Workcr's Compcnsation pmvisions af Wc La6ar Codc, yau must �,Z fonhwi�h comply with such provisions or this permi� sha116c dccmcd mvokcd. z O CONSCRUCTION LENDING AGENCY E ►�-� I hcrcby aRrm that �hcre is a conswction Icnding agcircy for ihc perCortnancc of _ �'(, � �hc wurk fur which Utis pertnit is issucd (Scc. 3097, Civ. C.) W� Q Lcndcr's Namc ' � z Lcnder's Address U � 1 ccrtifY thal 1 havc rcad Ihis application and siatc �hat thc abovc informatiun is w � cortcct. 1 agree to comply with all city and county oniinances and state laws rclating �o � U huilding conswct�on, and hcrcby authori�e rcprcscntativcs of this city to cntcr upon thc � a aM1ovc-mcntioncd property for inspccuon purposes. (Wc) agrce to sare, indemmfy and kecp harmlcss ihc City oC Cupcnino against �„�„� � liabiliva, judgmcnts, costs and cxpcnscs which may in any way acccuc against said City V,'� in consequcncc oC granting of this permit. 7 l,��� �"� APPLICANT U STANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date /Q� � SOURCE R noNS. � e I� ^ �� � � Re-roofs ure o pplicant/Convactor Datc HAZARDOUS MATERIALS D[SCLOSURE Type of R � )Of Will thc applican� or futurc building occupantstorc or handlc haiar�dous matcrial tcfined by the Cupenino Municipal Codc. Ct�aptcr 9.12. and thc Hcalth and Safcty �, Scction 25532(a)? All roofs : hall be inspected prior to any roofing material being installed. � ycs �] No Will the applicanc or Cuturc building occupant usc cquipmcnt or dcviccs which If a rOOf 1 installed without first obtaining an inspection, I agree to remove - emit harardaus air conu �nan�s as dcfincd Ay �he Bay Area Air Quality Managcmcnt all new m; iterials for inspec!ion. Disuicc? ❑ Ycs � Nu 1 havc reaA the ha�ardous ma�crials requircmcna undcr Chaptcr6.95 of thc Cali(or- nia Hcal�h & Safcty Codc, 'ons 25505. 25533 a�u125534.1 urnkrsund �hat if �he 6uilding ciocs not curtently ha unan4 that i� is my responsibility w nouCy thc occupant of �hc rcyuircmcn�s w' t bc me� pcior to issuancc oCa Ccrtifica�c of Occup • S1gIlfltlllC �f Applicant Date �v�rorau�horizcdagcnt '' ` p� All roof coverings to be Class ��8�� or better