07010005 CITY OF CUPERTINO
Cd1NktA,�T+Q � Q1TT�N,
BUILDING DIVISION PERMIT (�
PERMIT NO.
BUIL I G ESS:
�C �� JOLLYMAN LN—LOT 1 DIPESH GJPTA 07010005
PERMIT ISSUE DATE
5R'S NAME:
)IPESH GUPTA 05/02/2007
SANITARY NO. CONTROL NO.
PHONE:
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
0 0
i p z0 LICENSED CONTRACTOR'S DECLARATION Job Description
IW1 hereby affirm that I am licensed under provisions of Chapter 9(commencing
U W with$_Lion 7000)of Division 3 of the Business and Professions Code,and my license is NEW S F DW L: 1ST FL 1843 ' , 2ND FL 1030 ' , GARAGE
iz in full force License Class ndellecL Lie 441 ' , COVERED PORCHES 321 ' , UNCOVERED LANDINGS
-.C Contractor
L
Dare ARCHITECTS DECLARATION 224 '
—ADDRESS CHANGED FROM 10752 S STEELING RD.
j C< 1 understand my plans shall be used as public records
)n�•U
tL y Licensed Professional
< OWNER-BUILDER DECLARATION
I hereby affirm that t am exempt from the Contractor's License Law for the
Coo o following reason.(Section 7031.5•Business and Professions Code:Any city or county
�,0, which requites a permit to construct alter,improve,demolish,or repair any structure
prior w its issuance,also requires the applicant for such permit to file a signed statement Valuation
r4 P Ft.Floor Area
< that he is licensed pursuant to the provisions of the Contractor's license taw(Chapter 9 S q• $660362
2 P (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
1359 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 Number Occupancy Type
not more than five hundred dollars(5500). 3 5 9 2 2 0 6 1 �
❑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 does not apply to an owner of
property who builds or improves thereon,and who does such work himself or through his
own employccs,provided that such improvements are not intended or offered for sale.It.
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.).
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business and Professions Code:)The Contractor's L)-
cense Law does not apply to an owner of property who builds or improves[hereon,and.
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's
License Law.
❑lam ex e t*WKE1RK1SC0!&
B&P C lar this reason
tr Date
DECLARATION
14ercby affirm under pe of perjury one of the following declarations:
❑I Its and will maintain a Certificate of Consent to self
-insure for Workers Compen-
sation,as provided for by Section 3700 of the Labor Code,far 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 arc:
Carries- 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 i ny m9nn so to bccom u 'ct to the Wo on
Laws of California.
Applicant
NOTICE TO APPLICA .If,after in Certificate of Exemption,you should
become subject to the Worker's pe uotfp visions of the labor Code•you must
Z forthwith comply with such provisions or this permit shall be deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
[~.�►�- 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
a, Z Lcndees Address
U 0 I certify that I have read this application and state that the above information is
V." correct.I agree to comply with all city and county ordinances and state laws relating to
0Ubuilding construction,and hereby authorize representatives of this city to enter upon the
W above-mentioned property for inspection purposes.
C>~ (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
V,Z in consequence of the granting of this permit. Date
�+ APPLICANT UNDERSTANDS AND WILL Q M LY WITH ALL NON-POINT VIssued by:
SOURCE R U AI S.
OS Re-roofs
Signature of Applican onlraclor D81e T of Roof
HAZARD 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
k,G•ction 25532(a)? All roofs,hall be inspected prior to any roofing material being installed.
3Yes qNo
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?
❑Yes No
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Hcalth&Safety Code,Sections 25505,25533 and 25534.I understand that if the building
does.not currently have a tenant,that it is my res risibility to notify the occupant of the
rcyurcmcnts wh�mqtbC riorissu r�cate ora Signature �fApplicantDate
All roof coverings to be Class"B"or better
Owner or authoare