07020061 CITE OF CUPERTINOOTRAQR IL? MA�jE�N�
BUILDING DIVISION PERMIT
PERMIT NO.
BUIL I'LG D Ess: BAINS DEVELOPMENTS 07020061
910242 N STELLING RD.
PERMIT ISSUE DATE
'ER'S NAME:
,AAHENDRA KUMAR 42285 OSGOOD RD SUITE H 02/ 7
SANITARRYYNO. CONTROL NO.
�Ptj�JNE: (510) 445-0227
BUILDING PERMIT INFO
rARCHrrECr[ENGI?NF_ER: B� E� PLUMMB MHpCLICENSED CONTRACTOR'S DECLARATION Job Description
w� y affirm that I am licensed under provisions of Chapter 9(commencing
Z 000)of Division 3 of the Business and Professions Code,and my license is ADD DRYVV ALL TO CEILING FOR LIVING RM & 3
>>H in full farce and effect. BEDROOM: .
? License Class Lic.#
• p Date Contractor
;mow
ARCHITECTS DECLARATION REPLACE DAMANGED WOOD FRAMIN
j
f�� I understand my plans shall he used as public records
)yU
'u. Licensed Professional
•C< OWNER-BUILDER DECLARATION
'} 1 hereby affirm that I am exempt from the Contractors License Law for the
<O following reason-(Section 7031.5,Business and Professions Cotte:Any city or county
<m which requires a permit to construct.alter,improve,demolish,or repair any structure
"y prior u,its issuance,also requires the applicant for such permit to file a signed statement t'q,Ft.Floor Area Valuation
-Z< that he is licensed pursuant to the provisions of the Contractors License Law(Chapter 9 t $1400
r tz (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
i that he is exempt therefrom and the basis for the alleged exemption.Any violation o[ Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 32630012 ;CT(7 Number P Y YP
not more than five hundred dollars(5500).
0 1,as owner of the property,or my employees with wages as their sale compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections
and Professions Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.IL
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
as owner of the property.am exclusively contracting with licensed contractors to
cons uct the project(Sec.7044,Business and Professions Code:)The Cntractor s Li-
who contracttLaw sfor such papply
rojects with a contractor(s)1 who
censed pursuant to the roves Contractor's
License Law. B&P C for this reason
❑I am TrT
exempt under Sec. -
W _Due
W RK C PENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
0 I have and will maintain a Certificate of Consent to self-insure for Workers Compen-
sation,as provided for by Section 3700 of the Labor Code.for the performance of the
work for which this permit is issued.
0 1 have and will maintain Worker's Compensation insurance,as required by Section
3700 of the Labor Code.for the performance of the work for which this permit is issued.
My Worker's Compensation insurance carrier and Policy number are:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or less.)
I certify that in the performance of the work for which this permit is issued,I shall not
employ any person in any manner so as to become subject to the Workers Compensation
Laws of Califoroi. atc
Applicant
NOTICE TO APP ,aNciniaking&Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
Z forthwith comply with such provisions or this permit shall be deemed revoked.
Z� CONSTRUCTION LENDING AGENCY
F.e rA I hereby affirm that there is a construction lending agency for the performance of
fYr> the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lender's Name
aLender's Address
Z
V 0 i certify that 1 have read this application and state that the above information is
correct-I agree to comply with all city and county ordinances and state laws relating to
0 V building construction,and hereby authorize representatives of this city to enter upon uhc
above-mentioned property for inspection purposes.
OWt (We)agree to save,indemnify and keep harmless the City of Cupertino against
to liabilities,judgments,costs and expenses which may in any way accrue against said City
IJ Zin consequence of the granting of this permit. Date
APPLICANT UNDERSTANDS AND WILL COMPLY WiTH ALL NON-POINT Issued b i:
SOURCE REqUL.VTIONS. 1 11
L 1 r L l Re-roofs
ti A UA �.---
Signature of Ap Datc
tCContr°ac°tor— - T of Zoof
HAZARDOUS MATERIALS DISCLOSURE Type
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
dc,Section 25532(a)? All roof;shall be inspected prior to any roofing material being installed.
C3 Yes '/0 No If a roof is installed without first obtaining an inspection,I agree to remove -
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District? n
[]Yes 1-0 No
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505.25533 and 25534.1 understated that if the building
does not currently have a tenant,that it is my responsibility to notify the occupant of the Date
rcquiremcns wh'h 4st be m t prior issuance of a Certificate of Occupancy. Signatul a of Applicant
-LIO I iq All roof coverings to be Class"B"or better
Owner or author xcd agent ate