07070214 CIT�' OF CUPERTINO � `' f' '� T
BUILDING DIVISION PERMIT �*����*-'��� y��������
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PERMIT NO.
BUIL �r�r���ES��TA WAY JACOB S.�IDIAN 07070214 .
O W NER'S NAME: PERMIT (SSUE DATE
JACOB SAIDIAN 2933 BE]1JAMIN CT 10/08/2007
� SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PHRM17' INFO
BLDG ELECT PLUMB MECH
� 0 0 0
i p p L]CENSED CONTRACI'OR'S DECLARATION JOb D2SCilptlOil
� V� I hcrcby afGcm that I am liccnscd un�icr provisions of Chaptcr 9(commencing
; Z� wi�h 5cctian 7000) of Division 3 of thc Business and Profcssiuns Codc and my licen4e is NEW 2 S `CORY 3 2 0 3 S Q FT GARAGE 4 4 0 S Q FT BA S EMENT
'<°� in full Coree and cfCec�
i�? [,icenscCiass Lic.x FINISHEI�
; f I p pa� Conuacwr
� ARCHITECI'S DECLARA7'ION ORIGINA:� CV 6 8 6 6 2 7
i�� 1 undcrstand my plans shall Ix uud az public recorcls
)yU
' u. y Liccnsed Pmfessional
� y � OWNER-BUILDER DECLARATION
1 hcrchy alTirm that 1 am cxcmpt Crom thc Contractors Liccnsc Law far thc
� p O Collawing rcason. (Sccdan 7031.5, Busincss and Profcssions Codc: Any ciry or rnunty
�,°, �i which requiccs a pc�mit to conswct, altcr, improvc, dcmalish, or repair any st�ucture
� z} priar u� i�s issuancc, alsu requims ihc applicant for such permit to filc a signcd stau�ncm
�_ � thal hc is liccnscd pursuant to lhc provisions of Uu Conuacwr's Liccnsc Law (Chap�cr 9 ; iq. Ft. Floor Area Valuation
y �� (commenciag wi�h Scction 7000) of Division 3 oC Wc Business and Professions Codc) w $ 7114 3 4
�, �.. that he is exempt Ncrefrom and t6e basis for t6e allcgcd ezemption. Any violaCion o[
Section 7031.5 by a�ry applicant for a pecmit subjccts ihe applicant to a civil pcnalty o[ Number Occupancy Type
not more �han fivc hundred dollazs (5500). 3 7 5 �- 2 � 3 ��� ,
❑ I, as owncr o( ttie property, a my employces with wages u their saic wmpensaGon,
will do �hc work, and �he swclure is no[ intended or ot[ered for salc (Sec.7044. Business Re uired Ins ections
and Professions Codc: The Conuutor's License Law docs not apply w an ow�rcr of 9 P
property who builds or improves ttiercon, and who does such work himsel[ or througd his
own emplayccs. providcd U�at such improvemen�s are not intended or otfeced Cor sale. U.
however, the building or improvemmt is sold within one yesr oC complction, tl�e ow�rcr-
builder will have ihe burden oC proving �hat he did not buiid or improvc for purpoxe of
salc.).
� 1, as awner of the property. am acclusivdy conuacting wi�h tittnsed rnnvacwrs w
conswct U�e projett (Sec. 7044. Business and ProCrssions Code:) The Coouacto�s Li-
cense Law docs no� apply �o an owner of propeny who builds or impmves ihereon. and .
who conuac�s for such pmjecis w' contractaKs) licensed pursuant w the Conuactor's
Liccnse Law.
❑ 1 am empt under Se . B dc P C fw ihis
Ownu Da1e � O , _. ._ _
ORKER'S NSATION DECLARATION
hemby alTicm under penalty o( perjury one of Ux (ollowing declara�ions:
❑ I hsve and will maintain a Certifiptc o[ Conscnt to self-insure fw Workcfs Compen-
satian, as provided for by Sectian 3700 of the Labor Code, (or the perfarmance a( the
work for which this permit is issucd.
❑ I Aavc and will maintain Worker's Compensauan Insunnce, as required by Scctian
3700 of �hc Labor Codc, Cor thc performance af �he work for w6ich tt�is pecmit is issued.
My Workels Compensauon Insurancc catrier and Poliry numbcr am:
Cartier. Poliry No.:
CERT'IFICATE OF EXEMP'fION FROM WORKERS'
COMPENSATION [NSURANCE
([]iis section necd not bc completcd if the permit is far onc hundred dallars (S1U0)
or Icss.) '
1 ccrtify thxl in thc per[ormancc of lhc work [or which �his pertnit is issucd. [ s6a11 not
employ any person in any manncr so as to bccomc subjcct to the Workcrs' Compensatian
Laws of Califomia.�D�at�,�
Applicant �°_, � ��
NOTICE TO APPLICAM: If, aftcr making ihis CeniGca�e of Ecemption, yau shoulJ
become subjcet to �hc Workcr's Compcnsation provisions oC �hc La6or Coda you muu '
� O forthwith comply with such provisions or this permit sha116c dccmcd mvokcd.
� '""' CONSTRUCTION LENDING AGENCY
(. � I hcrehy aftrm U�at thcre is a conswctinn knding agcncy for thc perCortnancc of
(Y., � ihc work for which this permit is issucd (Scc. 3097, Civ. C.)
W Q L.endcr's Namc '
� z l.cnder's Address
V � 1 certify iha� 1 have rcad ihis applieaiion and sutc U�at �hc above inConnauun is
��--� corrca I agrce �o comply wi�h all city and counry onlinances and s�ate laws rclaung to
Q U building conswction, and hcreby authori�t rcprescntativcs of ihis city to cntcr u�mn Uic
� W ahovc-mcntioncd property for inspccuon pur4wses.
a (Wc) agree �o save, indemni(y and kcep harmless ihe City of Cuperdno against
�„�"„� Uj liabilitie:, judgmcn�s, costs and expenses which may in any way accruc agains� said City ��, �
V,'� in conuquence aC thc gnnting this permi� Date [� r��
�+ APPLICAN'I' UNDERSTA S AND WILL COMPLY WITH ALL ON-POINT Issued by: �
SO CE REGULATI
(' � Re-roofs ��__.
Si Applicanl/Convactor Da�
HAZARDOUS MATER[ALS DISCLOSURE Type of R�of
Will Uic applicant or futurc building occupant starc or handte harardous matcriat
az defincd by Ne Cupenino Municipal Cadc. Chaptcr 9.12, and [he Hcal�h and SaCMy
c«� Section 25532(a)? All roofs :,hall be inspec[ed prior to any roofing material being installed.
❑ Ycs � No
Will thc applicant or fuwrc building occupant usc cyuipmcm or �icvices which If a roof i:, installed without first obtaining an inspection, I agree to remove •
emit hazardous air coniaminants ae dcfincd by thc Say Area Air Quality Managcmcnt all new m�terials for inspeczion.
asu����
Q Ycs � Nu
1 havc mad the ha�ardcws ma�crials rcquircmcnt� unckr Chap�cr 6.95 af �hc Cali[or-
nia Hcal�h & Safcry Codc, Sections 25 533 and 75534. l undcrsund ihu iC thc huilding
docs not curtently havc a�nant, ' is my rcsponsiAiliry to nail'y �hc occupanc nf Ux
rcyuircm �s which must or �o iscuance of a Ccrtifica�c o o� P�r. Signature �f Applicant Date
�� �'� All roof coverings to be Class "B" or better
Owncr thorizcd agcn� Q��