07060047 7-7777777777--7-7
CITY OF CUPERTINO
BUILDING DIVISION PERMIT C:tl ' RAt?RIRMt4TT�N,
PERMIT NO.
BUIL(�IyG �gltES BLANEY AVE PRI YA BE ATT & RAJI B DAS 07060047
(J s PERMIT ISSUE DATE
OWNER'S NAME:
PRIYA BHATT & RAJIB DAS 06/06/2007
SANITARY NO. CONTROL NO.
,NE:
BUILDING PERMIT INFO
ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH
i p a LICENSED CONTRACTOR'S DECLARATION - Job Description
I hereby affirm that I am licensed under provisions of Chapter 9(commencing
u(=
:zw withScction7000)mfDivision3ofthcBusincssandProfcssionsCodc,andmyliccnscis KITCHEN REMODEL DEMO KITCHEN WALL NON STRUCTURAL,
I y in full force and effect. Lk* NEW LIGf:TING.
? License Class
p Date Contractor
ARCHITECTS DECLARATION
iaa
a I understand my plans shall be used as public records
�yV
U. Licensed Professional
<
OWNER-BUILDER DECLARATION
aI hereby affirm that 1 am exempt from the Contractor's License Law for the
p oa following reason.(Section 7031.5,Business and Profccsittns Code:Any city or county
which requires a permit to construct,alter,improve,demolish,or repair any structure
prior to its issuance,also requires theapplicant for such permit to file a signed statement Valuation
?< that he is licensed pursuant the provisions of the Contractor's License Law(Chapter 9 :q.Ft.Floor Area 1 O O O 0
F m (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
u�$ that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of3 6 9 2 8 0 3 f ( Number Occupancy Type
not more than five hundred dollars($500).
Q I,as owner of the property,or my employees with wages as their sole 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 docs 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.).
Dtl 1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li-
cense Law does not apply to an owner of property who builds or improves thereon,and
who contracts for su�proje7with a contractors)licensed pursuant to the Contractor's
License Law.
❑I am exe t d .B&P C for this reason
Owner Date
777 I—S COMPENSATION DECLARATION
1 hereb affirm under penalty of perjury one of the following declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's 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:
Cartier: 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 the oak for which this permit is issued,I shall not
employ any pawn in any man r r
j 9j...subject to the Workers'Compensation
Laws of Cal' i.
Applicant
NOTICE TO APPLICANT:If,aftc making is CeniCcate 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 OCONSTRUCTION LENDING AGENCY
Fr r�-� I hereby affirm that there is a construction lending agency for the performance of
the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lender's Name
2z
Lender's Address
U C I certify that I have read this application and state that the above information is
correct.I agree to comply with all city and county ordinances and slate laws relating to
Ubuilding construction,and hereby authorize representatives of this city to enter upon the
W above-mentioned property for inspection purposes.
f3. (We)agree to save,ind mnify and keep harmless the City of Cupertino against
Hliabilities,judgments,costs a penws which may in any way accrue against said City
U`Z in consequence the granti of this perm L
r-+ APPLICANT DE A DS AND LL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REG I
Re-roofs
Signature of Appli ✓Contractor ate Type of Roof
AZARDOUS MATERIALS DISCLOSURE yP
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
Code,Section 25532(a)? -1 All roofs ;hall be inspected prior to any roofing material being installed.
0 Yes )[J No
(1 If a roof i;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?
C]Yes
1 have read the hoz twSrater' requirements under Chapter 6.95 of the Califor-
niaHealth& ctyCodc, :lions 5,2S533and25534.1understandthatifthebuilding
docs not currey ran at it is my responsibility to notify the a'UP ant of the
requirements t�r to issuance of a Certificate of accu or
Signature of Applicant Date
All roof coverings to be Class"B"or better
Owner or autho -rcd agent Da