The URL can be used to link to this page

050100341OCpC fZW ;g_ QFC, �4 Eaca >au a b;t �Oc SmE G CITY OF CUPERTINO '• vfA o " •*+ PERMIT C,msTsR<., INF�ORaMATIxua.DlncDlvlslon QN.••� ,x .T K = BUILDING ADDRESS: PERMIT NO10 5 010 0 3 4 10271 MENHART LN OWNER'S NAME: PERMIT ISSUE DATE BAHERI LIVING TRUST 01/06/2005 E: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH DECLARATION LICENSED CONTRd under provisions Iion7 affirm that Iamfthe Job Description p BdunderprovisionsmChador9(commencing with Section Division ] of Ne Busiau and Professinru Code. and my licenu is in fid of ec ak`k REPLACE & REPAIR GAS LINE Lorneforce Class DateClass Loc.a Dam Contra ARCHITECTS DECLARATION mbalTELTS 1 undemanJ my plans sh91 W used as public mrnrds O�0 a,-� Licensed Professional DECLARATION OWNER -BUILDER 1 Wr(Srm Nal I am exempt Tom tPr Contns License taw for tW followinguiresa(Salton 7r1]L5, Business and rode, vio reason, Co Code: Any city or courtly which li pair ms a pmmi, ri consumer. improve, demolish, ntuaum its i the aahc�pplicant fie poor m its issuance, aim myo the the applicam for such gamine hie a signed seta==e= lu ed Nal he islicensedpursuant told) previsions the CoinnctroiLiartcLaw (Chapter 8600 Sq. FL Floor Area Valuation sionf (commencing with Seaton LOBO) th Division ] of the ProfessionsAnviCMC) or Out be is exempt Nemfrom and the basis for the alleged exemption. Any violation of aged exemption. Section 7031.5 by any applicant for a Permit subjects the applicant to a civil penalty of �¢.a��,n�� eiDLLa.y` 6-bber00 Occupancy Type not mon Nan five thumbed doll.. ($SO)k p y yp ❑ I, as owner or the property, or my employees with wages as their sok compensation, will du the work, and the s Wcture is not intended or offered for ale (Sec. 7044, Business and Professions Cade: The Can=dor's Lt.. Law doe not apply to an owner of Required Inspections progeny who buildsorimproves Thereon, and who doessuch work himself orthrougb his own employ=. provided that such improvements are not intended oroRered for sus e.It, however. Ne building or improvement is sold within one year of completion, the owner builder will bases the burden of roving that he did not Wild or improve for purpose of salt.). I, as owner or the property, am exclusively contracting with licensed contractors to muntel the project (See. 7014, Business and Professions Code:)The Contraemr's Li cense law does not apply to an owner of progeny who Wilda or improves hurmon. and who contracts for such projects with a contracter(s) licensed pursuant to Ne Contraclo's License Law. ❑1 tse t/Order B& P C for this mason ��/5a. — Vlof 6 Y W RKER'S COMPENSATION D ATIO 1 herchy a=rm under penalty of redo, ane or the following dedvniom: nave and will maintain a Certificate of Crocco, to self -benne for workers Comp r. muton, as provided for by Section 37M of the tabor Code. for the parfromance of the work for which this permit is Issued. , CI 1 have and will maintain Worker's Compensation Insurance, as acquired by Section 37W of the Labor Coda. for the pie foor ma of Ne work for which On panni, is issued. My Worker's Compensation lophou a carrier and Policy number art: Cartier: Policy No.: _ CERTIFICATE OF EXEMPTION FROM WORKERS' - COMPENSATION INSURANCE (This section need not he completed if the permit is for one hundred dollars I$ Had or less.) I amity Nm in the performance of the work for which this permit is issued, l shall not employ any fesmn in any manner sen as to become subject o the Workina Compensation Laws of California. Date Applkun NOTICE TO APPLICANT: IL after making this Cendoom or Exemption, you should become subject to the Worker's Compe motion provisions of the Lahr Code, you must forthwith comply with such provisions or this farm it shall W deemed n:voked. CONSTRUCTION LENDING AGENCY I hereby affirm Nal Ike is. ..(.Lt.. lending agency for use performance of Ne work for which this permit is issued (Sec. 3097, Civ. C.) Lender's Name Underi Address I testify that I have mad this application and stain that the above inrosmation is correct. 1 agme to comply with all city and county urdinmces and sok laws relating to building conswction, and hcrcby, authorim represions i es of this city to enter upon the pro (We) agree to cast, indemnify and trop harmless dm City of Cupertino against in con equenc o the grantor iOf this Pe mitposes. liabilities, judgment, costs and expenses which may in any way acme against said City m consequence of the graining of This per=il. �T / \\J\ �� APPLI NT UNDERSTANjJS AND WILL COMPLY WITH ALL NON -POINT SOU GU / Issued by: Dat ( )IOn3.J /f' f De U4 Re -roofs K 01 ApplicanuiLornactor Dare HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicam Or future building ampanutore or handle hnAreous material as defined by the Cupertino Municipal Code. Chapter 9.13, and the Health end Safety Cod., Section 255320)? ❑Yea 'S No All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future building ecu t sae equipment Occupant q at devices whim If a roof is installed without first obtaining an inspection, I agree to remove g it Qu ict?us air contaminants as defined by Nc Bay Arca Air Quality Management T all new materials for inspection. ❑Yca II. No thow mad NehvSNnus mmcrialsoquimmenlsunder Chafer 6.95thatof Nc Calding s Safety Coe. Sessamain. am Wilding n manodunity am1355il"Y do .1 co docs rot <�rtenllY time a Tenon. Nat it is my mspomidilitY m rmdl'Y Nc occupant of tM it is my r i t e Occupant Barre whi)h niW etpormissaanaoraCcnificamoroe.pan.y. 6. (V7 Signature ofApplicant Dale All roof coverings to be Class "B" or better Own�r tar mithmixm.gcni Dale I• 1 of 1 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 37515028.00 DATE ISSUED.......: 01/06/2005 RECEIPT #.........: 28189 REFERENCE ID # ...: 05010034 SITE ADDRESS .....: 10271 MENHART LN SUBDIVISION ....... CITY CUPERTINO IMPACT AREA ....... OWNER BAHERI LIVING TRUST ADDRESS ..........: CITY/STATE/ZIP ...: CUPERTINO, CA 95014 RECEIVED FROM ....: LULA BAHERI CONTRACTOR .......: LIC # COMPANY ..........: ADDRESS ..........: CITY/STATE/ZIP .... , TELEPHONE ........: OPERATOR: suem COPY # : 3 *E ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL BENERGY PERMIT FEE 1.00 34.86 0.00 34.86 0.00 BPGAS OULETS 1.00 5.40 0.00 5.40 0.00 PPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00 BSEISMICRE VALUATION 600.00 ---------- 0.50 0.00 0.50 0.00 TOTAL PERMIT : 79.13 ---------- 0.00 ---------- ---------- 79.13 0.00 METHOD OF PAYMENT ----------------- AMOUNT NUMBER ------------ CHECK 79.13 ------------------ 3205 TOTAL RECEIPT 79.13 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 302 TUB & OR SHOWER 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING • CITY OF SJPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB AD I2 PERMIT # OWNER'S N A G / /dJ� . 1� PHONE # iqeQ ( - 2 - GENERAL CONTRACT9R FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: V,. / d X ton IL Owner/ for Signature OS' V Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum / Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting / Wallpaper Paving Plastering Plumbing 49 Roofing Septic Tank Sheet Metal E Rock V,. / d X ton IL Owner/ for Signature OS' V Date