05080051 CITYOFCUPERTINO 4w* zraE §.e�f;s '�"" ` `` ,-r
BUILDING DIVISION PERNIIT a CONTRACTOR INFORMATI 1 W.
sf43Azc &T:a w1.'T44u
BUILDING ADDRESS: BAL V S . JANDU PERMR NO.05080051
10276 ORANGE AVE
R'S NAME: PERMIT CSUEDATE
BALDEV S . JANDU 10276 ORANGE AVE 08/24/2006
PHONE: SANITARY NO. CONTROL NO.
BUILDING PERMIT INFO
ARCHITECTIENGINEER:
BLDGtt� MECH 0 Pt! 0
LICENSED CONTRACTORS DECLARATION Job Description
i u I hereby affirm that 1 m licensed under pmvidons of Chapter 9(commencing
with Section 70110)of Division 3 of de Business and Professions Code,and my licenseis
infallfonemd.rfece SFDWL-2 STORY-2 , 435 ! LIVING/GARAGE 400 '
i n Z Lkensc Class Lk.N
f Dow Contractor
p ARCHITECTS DECLARATION
3 1 understand my plans Mall be used u records
oods
n
GLicensed Professional
y� OWNER-BUILDER DECLARATION
1 hereby uEm Nat I am exempt from the Contramars License Law for the
:OC following mason.(Section 7031.5.Bush.and Pmfentons Code:Any city or county .
'O t` which reaulra a permit to conWuc4 ally,improve.consulate,or repair any swmum
prior An its ismm,,.atm refoima die applicant for such Pemlitma file a signed aatementValuation
O
that kis licensed Portman to the provisions ofthe Conutwers License Law(Chapter 9 Sq.Ft.Floor Area
IZf• (commenting with Section 7000)of Division3oflhcBusinewandProfeuimuCode)or $544542
g g l that he is exempt therefrom and Ne basis for the alleged esemption.Any violation of
Section 7031.5 by any applicant fm a permit Mbjeets the applkert to•civil penally of APN Number Occupancy Type
not mom Nan five hundred dollars(5500).
❑I,u owner of the property,or my employees with wages as tla r Win camPenestim,
will Me thework,and the structure isnotlmmmded«offered mrtale(Sec.7044.Business; Re uired Inspections
and Prornssknsdes Ince Combacmn Lkowner
anae Law does ant apply m an of q p
property who buildamimprovas thereon,and who daassmhwort himselfmthosugh his
awnemployees,provided thin such iepmvensmu art set intuWed orafrered for sals,if.
howew,the building or ImProv<manl is sold within Am year of completion.the owner,
builder MO low the burden of proving that he did Out build m improve for purpose of
akJ.
❑1,as owner of the property,am exclusively cementing with licensed conuacmn b
construct the project(See.7044,Business and Prefessome Cade:)The Comm uses Lt.
comm law does not apply W an owner or properly who builds or improv therm,and,
who concocts for such Projects with aconummr(s)licensed pursuant in the Contractors
License Law.
I am esempt under
Sec. .B A P C for this muon
r ✓eii— -;m Dam
.--. WORKfiR'�MP�NDECLAKATION
1 bemby aRuso under Penalty of perjury can,of tae following declarWmc
7311.f
aw ted will msinuin a Certifcon of Consent seself-imam(m WarkeraCompen-
,u provided for by Section 3700 of the Iabm Code,for cine performance of the
for which this Permit is Wood.
ave and will maintain Worker.compensation Insurance,as requirod by Section
the LaborCode,far the performance ofNe work forwhich this pmmlt is issued.
orkers Compensation Insurance carrier and Policy number am:
Paltry No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Crass savor need mobecompkne if lin pewit is from hundmddellass(SIM)
or legal
I cenify that in the performance of Ne work for which this Permit is issued,10311 not
employ any person in any manner an As no becomesubjecpo Ne wo'l ai Compmaulan
Laws of Califamia.Dated A / '
Applicant - --
NOTICE TO APPLICKNItlf,aftepoffiWo this Ccrtificale of Esemption,you should
become suncet to the Workers Compmeatian provisions of the labor Codc,you mot
vJO forthwith comply with each provisions'thu PenniunsW
hall be decrevoked.
Z► CONSTRUCTION LENDING AGENCY
(ti 1 hemby spim this there u a constrvNnn leading.gamey for the Performance of
((, 7 the wart for which this permit is issued(Sec.3097,Civ.G `
W Q Landers Name
LL Landers Addroa
V 0 1 certify that 1 have reed this application and sun does the above Information is
{L I cored.I agree in comply with all city and county ordinances and sate laws mining m
U building coo s..vice,and hcmbyauthorie representatives of this city to enter upon the
W ahove-mentioned property for inspection purposes.
a (We)agree to save,indemnify and keep harmless the City of Cupertino against
ti ) liabilities,judgecnts,coats and expenses which may in any way accrue against aid City
U ,Z in comequeme of the&.fn&of this remelt.
�-•� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: 62i Date
SOURCE REGU�5NS. C.
i� . G !2-"2* a Re-roofs
0e22::: �-
Slg.aw mfA,ll�,aor Dan T of Roof
HAZARDOUS MATERIALS DISCLOSURE Type
Will the applicant or future building nccupannore or handle hazardous materid -
A`
dell d by the Cupertino Municipal Code.Chapter 9.11,ad tae Health and Safety
A,Sad'15531(.)? All roofs shall be inspected prior to any roofing material being installed.
❑Yex ZINa
If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building Occupant on equipment at devices which
emit avardaus air contaeinanu As defend by Oe Bay Mea Air Quality Management all new materials for inspection.
District?
Yo Fold—
I have mal the mo ima manual.mquimmewunder Chapter 6.95of the califor
.is Hth&
ealSduyCadc,Sec ons 15505.25533 use 25534.1 understate!thus iftho thWilding
does not currently have a im.4 the,it is my re poasihility in notify the oecupant of pe
rettubommut h,sb reteademet Piofwi manCcmrnateofOccepany.. Signature of Applicant Date
Dpte All roof coverings to be Class"B"or better
Owner or mM.dea .gen,