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CITY OF CUPERTINO COUILDING DIVISION PERMIO 5.]' �3
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BUILDING DDRESS: PERMIT NO.
10276 ORANGE AVE BALDEV SINGH.JANDU 07030265
OWNER'S NAME: PERMIT LSSUEDATE
10276 ORANGE AVE 05/14/2007
PHONE: SANITARY NO. CONTROL NO.
ARCHITEC IENGINEER: BUILDING PERMIT INFO I
REVISION — BATHROOM & BLDG ELECT PLUMB MECH
LICENSED CONTRACTORS DECLARATION
t hereby affirm that 1 am lieoascd under provisions of Chapter 9 (commencing
with Secdon 7000) of Division 3 of the Business and Professions Code, and my license is
in full force and effect
License Class Lic. p
Date Contractor
ARCHrrEC-rS DECLARATION
I understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the
following mason. (Section 7031.5, 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
'hat he is licensed pursuant to the provisions of the Contractors Lixnsc 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 exempdom Any violation of
Section 70313 by any applicant for a permit subjects the applicant to a civil penalty of
not more If= five hundred dollars ($M
❑ 1, as owner of the property, or my employees with wages as these sole compensation,
will do the work- and the structure is not intended or offered for sale (Sec. 7044. 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 have the burden of proving that he did not build or improve for purpose of
sale.).
�as owner of the property, am exclusively contracting with Bdrnsed contractorsto
construct the project (Sec. 7044. Business and Professions Code:) The Contractors Li -
cease Law does not apply to an owner of property who builds or improves thereon, and
who contracts for such projects with a conuactor(s) licensed pursuant to the Contractors
License Law.
Q I am exempt under Sec , B & P C for this mama
r
Owner '''- _'- i� -A '�Li - C r
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a Catificate of Consent to self -insure for Workes 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
370D 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(S1t10)
or teas.)
1 certify that in the puformance of the work for which this permit is issued. 1 shall not
employ any person in any manner so as to bSGQ^c subject to the Workers' Compensation
Laws of California T1 -
Applicant — X
PP CA : If, at& .1king this Certificate of Exemption, you should
become subject to the Workers Compensation provisions of the Labor Code. you must
forthwith comply with such provisions or this permit shall be deemed revoked:
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a comstrucUon lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ. C-)
Lender's Name
Lenders Address
I cenify that I have read this application and sate that the above information is
correct- I agree to comply with all city and county ordinamccs and sate laws relating to
building construction. and hereby authorise 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
liabilities, judgments -costs and expenses which may in any way accrue against said City
in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
SOURCE REGUL6PONS.
Sigridlim
Will the applicant or future building occupant store or handle hazardous matmial
as defined by the Cupertino Municipal Code, Chapter 9.12- and the Health and Safety
Code, Section 25532(a)?
❑ Yes [:-No
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?
DYu Q_No
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 buildinb
does not
or authorved agent Date
Sq. Ft. Floor Area
APN Number
Required Inspections
Issued by:
-roofs
Type of Roof
Valuation
Type
Date S'/ y "7
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