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03060179 CI'T'Y OF CUPERTINO BUILDING DIVISION PERMIT WCOW4ac CORANF,ORMATION BUILDING ADDRESS: ADAM ASKARI PERMIT NO03060179 101 'iR'S NAME: _ PERMIT ISSUE DATE ADAM ASKARI 08/08/2003 NE: SANITARY NO. CONTROL NO, ARCHiTLCTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PET LUMB MMEC11 +00 LICENSED CONTRACTOR'S DECLARATION 'H1 hereby affirm That I am henomd under provisions of Chapter 9(commencing Job Description ? with Scctum7MOof Division 3 oNhe Busimai and Profcsvinns Cala and my license is >`oy in full mreeand effect. NEW 1 STORY SINGLE FAMILY DWELLING ),y,? License Class Lie.g )Fp Date Cuooaemr LIVING SPACE 3804 SQ. FT. /Gn K'i 71 1 $Qx Z toj ARCHITECTS DECLARATION V tfm (rc I understand my plans shall w used as public records )yU o„ Licensed Professional J U L 20 2004 g OWNER-BUILDER DECLARATION <F 1 hereby affirm that I am exempt form the Contractors License Law for the 0 o following reason.(Scctmn 7031.5,Busincss and Profe doO,Code:Any city nr county _ e m which requires a Permit to eommuel,alter,improve,demolish,or repair any mructum prior,its iasmwe,also requires theappli,ml for such permil to File Mgncdsmmmem < thatImislicensedpursuanttotheprovisinmoftheCamractoriLiccnmlvw(Chapter9 Sq. Ft. Floor Area a t$fg504 (commencing with Section 7WO)is(Divkno 3 of the B usiner and Professions Cole)or that he is exempt Ncmfmm and he basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penally Of I%TMACTO O Occupancy Type ��not/more than five hundred dollars(SSW). O[I,as owner Of the pTpeny.0r my employees with wages m their sole eomI ensadmil, I a tho work.and due smuclare is not intended or offered for sale(Sec.71v,I,Business gam❑ and Professions Code:The Contractor's License Law dors not apply to an owner of 101 - FOUNDA'1' iffd Inspections progeny who builds or improves thereon,and who does such work himself or Nrough his ben employees,provided that such imprommenuam not intended or offered for sale.If. 102 — PIERS however,the building or improvement is sold within one year of completion,the owner- budder will have she burden of proving teat he did not wild or improve for pur wo,of 10 3 — UFER sale'). 104 — REBAR D 1,as owner of the progeny,am exclusively contracting wit licensed contractors IO 10 5 — ANCHOR BOLTS constmer the project(Sec.7041,Business and Professions Code:)The Conuacmr's Li. me law does not apply re an Owner or progeny who Ltild:Or Improves twreoa and 106 — SEWER & WATER who contracts for such projects with a contractor(s)licensed pursuant to the Contractors License Law. 202 — UNDERFLOOR PLUMBING ❑ I am exempt under Sec. B&PyC fort this reason 203 UNDERFLOOR MECHANICAL }446 �// _S C,& MS Date�4 off 204 — UNDERFLOOR FRAME WDRKPx'STIOND~EC�LARATION 205 - UNDERFLOOR INSULATION 1 hereby affirm under Penally ofµ:jury one of the following declarations: I wve 301 — ROUGH PLUMBING In win manminacenifiEalearcmsentmsewnsam mrworkcrscompen- cation,as provided for by Section 77W of the Lawr Code.for to pcRortnmcc of the 302 — TUB & OR SHOWER work for which this permit is issued. 303 — ROUGH MECHANICAL D I have and will maintain workers Compensation Insurance,as required by Section 3 04 — ROUGH ELECTRICAL 37W arthc Labor Cow.for the InFormance of the work for which this permit is issued. My workers compensation lasurt carrier and Policy number am: 305 — FRAME Carpo': PoOq No' 3 06 — HOLDOWNS CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE 307 — INSULATION ("Ossection need notMwmpleted iftw permit is for one hundred dollars(SIW) 308 - SHEETROCK o'less') 309 - EXTERIOR LATH I anify mat in the Iserromonce of the work for which this Permit is issued.I shall not 3 10 — INTERIOR LATH employ any person in any ma mwcoggsubje I to the Workers'Compensation Lawso(C❑ Date �� 311 - SCRATCH COAT Applicama ANT_- % -- NcomeSTOcttothC If,Compensation CesiinsofofEaempliodyouehnulJ 313 - ROOF NAIL M1ecome a comp y Tec worker's onsorp , provisions of the lawr evoke you must �Z. mrthwim comply with such provisions or this permh shall beecemed revoked. 501 - FINAL ELECTRICAL ENERGY Z' O CONSTRUCTION LENDING AGENCY 502 — FINAL PLUMBING ENERGY C > pro work Iherewh firmtthatNereisaconsox,eionlending agency lottheperformanttof 503 — FINAL MECHANICAL ENERGY permit is out(Sec.3097,Civ.C.) Q lenders Na504 — FINAL BUILDING ENERGY mc = z cndersAdaress 505 - FINAL ELECTRICAL U 0 1 cenify Nat 1 have read this application and slum Thal the above information is 506 — GAS TEST d. F" correct,1 agree to comply wish all city and county ordiromes and sum laws relating re 0U budging eonswnion.and heathy amhod.e represemaives..r Nis City In corer upon the FINAL PLUMBING C_ / a above mentioned property for lmpcetion purposes. 0 8 FIN L (We)agree to save,indemnify and keep harmless the City of Cupcnino against NN abovjabillmentidned pro ,nyfor inewedses which may in anyway accrue againstvid City e, A U z A APPLICANT or thegrantingof this permit. ^' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:5 tLG Date SOURCE REGULATIONS. _ Re-roofs 602 OOP PLYWOOD NAIL Signature of ApglicaoVC.nL1.m1 Date HAZARDOUS MATERIALS DISCLOSURE Type of RV63 — ROOF BATTENS Will the applicant or future building occupant store or handle hazardous matcnal as definetl by the Cultist Municipal code.Chapter 9.12.and the Hca b and Safety 604 — ROOF IN—PROGRESS C.SecOI3i�on 25532(a)? 5A � All roofs shall be inspected prior to any roofing material being installed. 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 it hoz odoua air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. District? OYca U1. I have read the harardaus malarials mquimments under Chaptcr 6.95 of Nc Caliror pia H.ti &Safety Codc.Sccuom25N15.25533 0025534.1 undcmland thouifthe wilding Jaen not currently have a¢pant Nat it is my responsibility in nouly Ibe occupant of the mgwmments wlucn w mpdprmissumce or.cenircat of Occupancy. Signature of Applicant Date J� w'T e�3 All roof coverings to be Class "B" or better O amhoneed agcm Datc s,S;l•� ..y'3^' fz2. 'j# K ... +' al - kT .: ....3 `..5 s^ :' y, q 2 4 J.P 'E .' .r�. m4 '. 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