07100118 CITY OF CUPERTINO ' ' '' h,� ' `
S�iJ[LDiNG 3IVISION PERMIT ��������� ����
...::. ,,;.. _ _
PERMIT NO.
BUIL njr�g��ss��TA WAY ADVANCE DEVLLOPMENT/JACOB 07100118 .
OW NER'S NAME: ��� PERMIT LSSUE DATE
JACOB SAIDIAN 2933 BEPIJAMIN CT � 10/16/2007
,NE: SANiTARY NO. CONTROI. NO.
(408) 8��1-1639
ARCHiT'ECT/ENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
� � 0 �
i p � LICENSED CONTRACTOR'S DECLARATION IOb DeSCTlpt10❑
� V� I hcrcby �rm that I am licenxd undcr provisions oC Chaptcr 9(cammencing
; Z W wiu� SccGon 700U) af Division 3 of ihc Busincss and Profcssiuns Cadc, and myliccnsc is TEMP P0� JER POLE
�� y in full (acce and effecl
�� ? Licensc Class Lic. #
� f , �p Daic Contranor
�� ARCHITECi'S DECLARATION
) a Q 1 undcrstand my plans shall bc uscJ as public rccords
)aU
' u. ,F Liccnsed Pm(cssional
� y � OWNER-HUILDER DECLARATION •
I hcrcby alTirm that 1 am czcmpt Crom ihc Con�ranor's Liccnsc Law for thc
� o O following sason. (Secuvn 703 L5, Busincss and Profc.csions CoSc: Any city or county '
�,°, � which requires a pcimit to rnnswct, ahcr, improvc, dcmolish, or repair any swctucc
'? Z} priar ui i�s issuancc, alsu rcquires thc applicant far such permit to filc a signcd sta�emcnt
- < �hat hc is liccnscd pursuant to thc provisions o[ thc Contracwr's Liccnsc Law (Chaptcr 9 ; iq. Ft. Floor Area � 5 O 0 Valuation
x I �(commcncing with Sccdon 7000) of Division 3 of Ihc Busincss and Profcssions Codc) or
i�� that he is eacempt therefrom and ihe bazis for the allegcd exempdon. Any viotation at
Section 7031.5 by airy applicant far a peimit subjecu ihe applicam to a civit penalty of 3 7 512 0 3 �� � Number Occupancy Type
not morc than 6ve hundred dollars (5500).
0 I, as owncr o[ tl�e property, or my employces witA wages az their solc compensaUon,
will do thc worlc, and ihe suucwre is not intendcd or offeced for sak {Sec.7044, Busin:ss Re uired Ins CCt10IIS
and Professians Cade: The Co�Uactor's Licenu Law dacs nat apply w an owner of Q p
property who builds or improves thercon, and who daes such work himself ar Ihrough Ais
own employccs, provided that such improvemenls are not intended or oRered Cor sala I[.
however, the building or improvement is sotd within one year o( complction, tl�e ownu-
builder will have �he burden of pmving U�at he did no� build or improvc for purpo.0 af
sak J.
❑ 1, as owner of the property, am eacclusivoly conuacting with licensed rnnvactors w '
conswct the project (Sec. 7044. Business and Profcssions Code:) "ILe Conuacwr's Li-
cense Law docs not apply io an owner of propeny who builds or improves �haeon, and ,
who contracts tor such projects with a conlranor(s) Iicensed pursuam to the Convac[ors
License Law.
❑ I am ezempt under Sec. , B 8c P C for this n
oWUr �(�b � �n ih � oa� 1�( 6� _. _
WORKER'S COMPENSAT[ON DECLARATION
I 6ercby afficm under penalty of perjury one of �he following declazuions:
❑ t hsve and will mainiain a Certificate of Cansent to self-insure for Workcls Compen-
sation, u providcd for by Sectian 3700 of the Labor Code, for the performance o[ the
work tor which Ihis pertnit is issued.
❑ I havc and will maintain Workefs CompensaUon Insurance, u �cquircd 6y Scction
3700 0( thc Labor Codc, Cor thc performancc af �he work [or which Nis pertnit is issued.
My Warkefs Compensation Insursnce cartier and Policy number are:
Cartier. Policy No.:
CERTIFICA7'E OF EXEMPIiON FROM WORKERS'
COMPENSATlON INSURANCE
(ihis section necd not tic complctcd if the peemit is foronc hundred dottars (S1IXl)
or Icss.) '
I cenify that in thc performancc af thc work Cor which ihis permi� is issucd. 1 shall not
e.^.�ploy any person in any manncr so as to bccomc subject �o ihe Workcrs' Compensation
Laws of Califom� D tc ,� �
Applicant �� �
NO'I'ICE TO APPLICANT: If, aftcr making U�is CcrtiGca�c o[ Excmption, you should
became subjcct to �hc Worker's Compensation provisions of �hc La6or Code, you must
� O forthwilh eomply wi�h such provisions or lhis permit shall bc dccmcd revokcd.
Z "" CONS7RUC7'ION LENDING AGENCY
[- r�-� I hcre6y afGrm that chere is a constructinn Icnding agency for the perfortnarrcc uf
� � thc work fur which lhis permit is issucd (Scc. 3097. Civ. C.)
W Q Lendct's Narnc '
a � L.ender's Address
V � 1 cenify ihat f havc rcad this application and sta�c �hat thc above infortnation is
w �"" corrcct. I agrce to comply with all city and county onlinarces and state laws relating lo
O U building conswction, and hcroby authori�e reprcscnutivcs of U�is city to cmcr upnn �hc
� W abovc-mcntioncd property (or inspccuon purEwses.
a (Wc) agree to save, indcmni(y and kecp harmless the Ci�y of Cupertino against
H � liabilities, judgmcnts, costs and expenscs which may in any way accruc agtinst said City
V z in consequence o[ �c grand m�5 a���. Date lj�'— /(J' Z��
►'� APPLICANT UNDE A S AND WILL COMPLY WITH ALL NON-POINT Issued by :
SOURCEREGU . , /� ' y f
� Re-roofs '��
S' of ApplicanUConusctor Datc
� HAZARDOUS MATERIALS DISCLOSURE Type of R�of
Will the applipnt w futurc building ocwPant storc or handlc harardous matcrial
as defincd by Ilx Cupenino Municipal Codc. Chapter 9.12, and the Hcalth and Safety
caa�. ScMion 25532(a)? All roofs : hall be inspected prior to any roofing material being installed.
� Ycs Q No
�11 the applicant or fuwrc building occupant usc cyuipmen� or dcvioes which If a roof i: installed without first obtaining an inspection, I agree to remove -
cmii harardaus air contaminan�s u dcfincd by the Bay Area Air Quality Managcmeni all new m. iterials for inspection.
Districc?
❑ Ycs ❑ No
1 havc ccaci the ha�ardous ma�crials requircmcn�t unJcr Chap�cr 6.95 o(�hc Cali(or-
nia Hcalih & Safcty Codc, Scctions 25505, 25533 aru! 25534. I undcrstand �hat iCihe building
docs not curtcnUy h a icnan4 �at it is my responsibiliry to notify thc occupanc of ihc
rcyuiremcn�s wh" m t bc met prior tu issuancc ot a Ccrtifica � f Occupancya� � Signature �f Applicant Date
``� � All roof coverings to be Class "B" or better
Ownc authori�.ed agcnt Datc
f '
, ; � , CITY OF C'UPERTINO J � � � � ( �
�'��" � �`�1�� ���'��
CUPEI�TINO PERMIT APPLJ=CATION FOR1V�
r�PN # �� � � � d �� � � C� Date: � � a7
�
Building Address: �� g� ��,P I � ��'�'�
Owner's Naine: t ���� (�� Phone #: ('� �� ��I_����
`J J l,
� --- -- — — ----- --- ---- -- --- ---------___----- -------- - .
' Co7ltractor: � [��'{�� J ��� / � Phone: �'j�.���p �.�'/� �� License #: � � /� � �� i
r �-r o � � ��.
Contact: Phone: Cupertino Business License #:
J I�Co� S� �� c h�i (�C� a� g9 I-I' `�5� ��' o� 8
Building Pei Info:
Elect LS�
Job Description: ��� ��C � �(�,
l �.
Residential Commercial ❑
Cost of Project:
5 vl�
Qty. if
Applicable Fee ID Fee Descri tion Fee Group
BTEMP Te:n orary Power ELECTRICAL
EPERMITFEE Elf-ct. Permit Issuance ELECTRICAL
BUSLIC Business License BUILDING
CITY OF CUPERTINO
2 ITEMS OF 2 PERMI`[' RECEIPT OPERATOR: patg
COPY # : 1
Sec: Twp: Rng Sub: Bl] ;: Lot:
APN ......... 37!>12037.00
DATE ISSUED.......: 10,'16/2007
RECEIPT #.........: BS�)00003005
REFERENCE ID # ...: 07:_00118
SITE ADDRESS .....: 18�381 ARATA WAY
SUBDIVISION .......
CITY .............. CU]'ERTINO
IMPACT AREA .......
OWNER ............. JA(;OB SAIDIAN
ADDRESS ..........: 29:� BENJAMIN CT
CITY/STATE/ZIP ...: SATd JOSE, CA 95124
RECEIVED FROM ....: JA(;OB SAIDIAN
CONTRACTOR .......: YA(3HOUB (JACOB) SAIDIAN LIC # 29078
COMPANY ..........: AD�TANCED'DEVELOPMENT/JACOB SAI
ADDRESS ..........: 29;�3 BENJAMIN CT
CITY/STATE/ZIP ...: SP,2d JOSE, CA 95124
TELEPHONE ........: (4()8) 891
FEE ID UNIT QUANTITY ��'IOUNT 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 40.79 0.00 40.79 0.00
--�-------- ---------- ---------- ----------
TOTAL PERMIT : 102.89 0.00 102.89 0.00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 102.89 #3390
---------------
TOTAL RECEIPT : 102.89
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
103 UFER 304 ROUGH ELECTRICAL
Community Development
`� � `'-�, 10300 Torre Avenue
;� �; .
�� � ' � Cupertino CA 95014
��^� � Telephone (408) 777-3228
CITY OF Fax (408) 777-3333
�;UPEI�,TINO
Buildi�n De artment
JOB ADDRESS: /` Q g �' n � � � 1 �� PERMIT # � �� � b �, < �
1 U /'�
OWNER'S NAME: � Iac'� ,b / � D, -� PHONE # � ; � -�/� o
GENERAL CONTRACTOR: � h� � . � /7 �/� �v FAX # (. � _ � 7 c�
I am not using any subcontractors:
Si�;nature Date
Please check a licable subcontractors and com �lete the followin information:
SUBCONTRACTOR BUSIl��ESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
IIectrical
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
Tile — � �,
-- _.___._.�
�� ��� .�� �r��,� � 1,�� /� � 7
Owner/Contrac or 'gnature Date