07010003ry OF CUPERTINO
BUILDING DIVISION PE 4IT
BUILDING ADDRESS: PERMIT NO.
20905 t70LLYMAN LN -LOT 3 DIPESH GUPTA 07010003
OWNER'S NAME: PERMIT ISSUE DATE
05/02/2007
PHONE:
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
14 Z LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
z U with Section 70(10) of Division 3 of the Business and Professions Code, and my license is
in full force and effect.
nZ License Class Lic. #
-in Datc Contractor
?? ARCHITECT'S DECLARATION
I understand my plans shall be used as public records
yU
+. y Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
00 following reason. (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit to construct, alter, improve, demolish, or repair any structure
Z } prior to its issuance, also requires the applicant for such permit to file a signed statement
a that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
e (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
3 a 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 of
not more than five hundred dollars ($500).
❑ 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 forsale (Sec. 7044, Business
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. 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.).
1, as owner of the property. am exclusively contracting with licensed contractors to
construct the project (Sec. 7044, Business and Professions Cade:) The Contractor's Li-
cense Law does not apply to an owner of property who builds or improves thereon, and
who contracts for such projects with a conlractor(s) licensed pursuant to the Contractors
License
INIDECLARATION
I hereby affirm and a ty 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.
❑ 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 Workers 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 per n m any manner so as m become subjcco l e Wo ker 'Compensation
Laws of Cafitor 'a. Dat
Applicant
NOTICE TO nificate of Exemption, you should
become subject to the orker's *.tion provisions of the Labor Code, you must
z forthwith comply with sue revisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby afrm that there is a construction lending agency for the performance of
$ �✓ the work for which this permit is issued (Sec. 3097, Civ. C.)
a A Lender's Name —
i Lender's Address
® I certify that I have read this application and state that the above information is
H correct. I agree to comply with all city and county ordinances and state laws relating to
building construction, and hereby authorise representatives of this city to enter upon the
U above-mentioned property for inspection purposes.
W (We) agree to save, indemnify and keep harmless the City of Cupertino against
liabilities, judgments, costs and expenses which may in any way accrue against said City
Z in consequence of the granting of this permit.
�-" APPLICANT
Elate
HAZARDOUSrA ALSDISCLOSURE
Will the applicant or futuZi ing 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)?
[-I Yes 7 N
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
District?
[-I Yes [�fNo
1 have read the baz2rdous materials requirements under Chapter 6.95 of the Califor-
nia Health k Safety Code, Sections 25505, 25533 and 25534.1 understand that if the building
docs not cum tly have a tenant. that it is my resp ibility to notify the occupant of the
rcyuiremcnls
ancy. P
� G
Job Description
NEW SFDWL: IST FL 18431, 2ND FL 1030', GARAGE
441', COVERED PORCHES 321', UNCOVERED LANDINGS
224' -ADDRESS CHANGED FROM 10758 S STELLING R.D.
q. Ft. Floor Area
35922060
MIT
jssued by:
Re -roofs
Type of Roof
Valuation
$660362
Occupancy Type
Required Inspections
Date
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.
of Applicant
A
Date