07060067 CITY OF CUPERTINO •� IRMATIQIY
BUILDING DIVISION PERMIT C�hI'�R�t1
PERMIT NO.
""DfTtTT� IORNING SPRING CT TBD TO BE DETERMINED 07060067
l l �$ PERMIT ISSUE DATE
OWNER'S NAME:
CHAUHAN, AVNISH 06/08/2007
SANITARY NO. CONTROL NO.
NE:
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
1Wz0 LICENSED CONTRACTOR'S DECLARATION Job Description
iUj p I hereby affirm that I am licensed under provisions of Chapter 9(commencing
U with Section 7000)of Division 3 of the Business and Professions Code,and my license is ADD 2 2 C VOLT AND ELECTRIC CIRCUITS TO CODE IN
H in full force and effect KITCHEI\
v�Z License Class L�#
t— Date
Contractor
� ARCHITECTS DECLARATION
i a< 1 understand my plans shall be used as public records
7W
U.y Licensed Professional
OWNER-BUILDER DECLARATION
3< 1 hereby affirm that 1 am exempt from the Contractor's License Law for the
-
'00 following mason.(Section 7031.5,Business and Professions Codc:Any city or county
(Yi which requires a permit to construct.alter,improve,demolish,or repair any structure
t'In prior to its issuance,also requires the applicant for such permit to file a signed statement $q,Ft.Floor Area Valuation
Z a that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 $6000
H$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
that he is exempt therefrom and the basis for the alleged exemption.Any violation of OCCU T e
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 6 6 5 2 0:,5 �Number Occupancy YP
not more than five hundred dollars($500).
0 1,as owner of the property,or my employees with wages as Weir sole compensation,
will do the work.and the structure is not intended oroffered forsale(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.If,
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.).
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 Contractor's
who contracts for such projects with a contractors)licem it pursue
License Law. B&P C for this mason
0 1 am exempt under Sea
Owner AVNISK LK ►IrsIPY� Date 6 2do
WORKER'S COMPENSATION 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 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.
❑I 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 am:
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 to beclm a subject to the Workers'Compensation
Laws of Caliform1 Date
Applicant
NOTICE TOA f,of mg this Ccrtilicatc of Exemption,you should
become subject to theWorker's Compensation provisions of the Labor Code,you must
0 forthwith comply with such provisions or this permit shall be deemed revoked.
z CONSTRUCTION LENDING AGENCY
Hr-. I hereby affirm that there is a construction lending agency for the performance of
.7 the work for which this permit is issued(Sec.3097,Civ.C.)
Lender's Name -
=z Lender's Address
U 0 1 certify that 1 have read this application and state that the above information is
Li~H correct.1 agree to comply with all city and county ordinances and state laws relating to
U building construction.and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
U
W (We)agree to save,indemnify and keep harmless the City of Cupertino against
0.rHy rA liabilities,judgments,costs and expenses which may in any way accroc against said City
U Z in consequence of the granting of this Permit. Date
►� N-POINT Issued l y:
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NO
SOURCE TIONS.
�� 61%)2-�-• Re-roof;
Signatu of ApplicanUCon or are Type Of Roof
HAZARDOUS MATERIALS DISCLOSURE YP
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Codc,Chapter 9.12,and the Health and Safety
Cade,Section 25532(x)? All roofs shall be inspected prior to any roofing material being installed.
0Yes If a roo r is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use eyuipmcnl o Ydcvices which all new materials for inspection.
emit hazardous air contaminants as defined by the Bay Arca Air Quality Management
District? rr
0 Yes a4o
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building
does not currently have a tenant,that it is my responsibility to notify the occupant of the Date
require rats which must be t print to issuance of a Certificate of Occupancy. Signature Of Applicant l� All roof coverings to be Class"B"or better
Ow er or authorixcd agent Dare