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BUILDING DIVISION1
PERNUT �
BUILDING ADDRESS: PERMrrNO.
10735 ORLINE CT DIPESH GUPTA 07060108
OWNER'S NAME: PERMIT `LSUEDATE
10735 ORLINE CT 06/26/2007
PHONE: - - -
SANITARY NO. CONTROL NO.
ARCHrI'ECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code, and my license is
in full force and effect.
License Class Lic. 0
Date Contractor
ARCHITECTS DECLARATION
I understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractors License Law for the
following reason. (Section 70315, Business and Professions Code: Any city or county
which requires a permit to construct, alter, improve, demolish, or repair any structure
prior to its issuance, also requires the applicant for such permit to file a signed statement
that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
(commencing with Section 70D0) 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
Section 7031.5 by any, applicant for a permit subjects the applicant in a civil penalty of
not more than five hundred dollars (S500).
❑ 1. as owner of the property. or my employers with wages as their sale compensation,
will do the work, and the structure Is not intended or offered for sale (Sec. 70", Business
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,�beve the burden or proving that he did not build or improve for purpose of
sale.)_
u owner of the property, am exclusively contracting with licensed contactors to
nswct the project (Sec. 7044, Business and Professions Code:) The Contactors Li-
cense Law does not apply to an owner of property who builds or improves themon, and
who contracts for such projects wi th a contractor(s) licensed pursuant to the Contractors
License Law.
❑ 1 am exempt u e�S , B & P C for this reason
Owner Date -�
DECLARATION
I b by alrirm umde alty of perjury one of the following declarations
❑ 1 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, ror Ore performance,of to
work for which Oris permit is Issued.
❑ 1 have and will maintain Workers Compensation Insurance, as required by Section
3700 of the Labor Code, for the performance of the work for which this permit is issued.
My Workers Compensation Insurance carrier and Policy number are:
Carrier.
Polity No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This secdon need not be completed U 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, 1 shall not
employ any person in any mann s t subject to the Workers' Compensation
Laws of cal".... .
Appfiamt
NOTICE TO APPLIQ NT: If, after making 6tccrtiricauc of Excmpdon, you should
become subject to th Worker's Compensati provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby &[farm that there is a construction lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ. C.)
Lender's Name
Lender's Address
I certify that 1 have read this application and state that the above information Is
COMM I agree to comply with all city and county ordinances and state laws relating to
building construction, and hereby authorize representatives of this city to enter upon the
above -mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
liabilides,judgmenis, costs and expenses which may in any way accrue agalast said City
in conscquerrce of the grantin of this permit.
APPLICANT UN�Q?ERST S AN WILL COMPLY WITH ALL NON -POINT
SOURCE / c _
aHAZARDVS MATERIALS DISCLOSURE '
the applicantorfuttire building occupant store or handle hazardous material
as damned by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety
Code. Section 25532(a)7
❑ Yes 1-2
Will the applicant or future bu sling occupant use equipment or devices which
emit hazardous air contaminant a CBned by the Bay Area Air Quality Management
District? ✓
❑Yes ❑No
1 have read the hazardous materials requirements under Chapter6.95 of the Califor-
nia Health & Safety Code, Sections 25505. 25533 and 25534.1 understand that if Ott building
does not currently have a tenanntthat it is my responsibility to notify the omrpant of clue
„_
Job Description
TRUSS CALCS-ORIG PERMIT #06100075 NO NEW PERMIT
Ft. Floor Area
$0
35922060:?1NNumber
Required Inspections
v
Valuation
Type
Issued by: Date �t 2
Re -roofs
Type of Roof
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
all new materials for inspection.
Signature of Applicant Date
All roof coverings to be Class "B" or better