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06100073 .77777. CITY OF CUPERTINO BUILDING DIVISION PERMIT '� �� '' PERMIT NO. BUILD,LNl1 8nN3p@.ESSORLINE CT—LOT 4 TBD TO BE DETERMINED 06100073 l S 7 PERMTr ISSUE DATE 0111 PER'S NAME: DIPESH GUPTA 05/02/2007 SANITARY NO. CONTROL NO. PHONE: BUILDING PERMIT INFO ARCHrMLT/ENGINEER: BLDG ELECT PLUMB MECH i 00 LICENSED CONTRACTOR'S DECLARATION Job Description VI hereby affirm that I am licensed under provisions of Chapter 9(commencing Z U with Section 7000)of Division 3 of the Business and Professions Code,and my license is 2 STORY 2882 ' GARAGE 441 ' BALCONY• UNC OVERD 60 ' � ? Licenlforce se Classnd eftecL Lie# PORCH: UNCOVERED— 280 ' COVERED— 120 ' —ADDRESS E p Date Contractor ARCHITECTS DECLARATION CHANGED FROM 10758 S STELLING RD. j < I understand my plans shall be used as public records )yU U.y Licensed Professional y W OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the in o following reason.(Section 7031.5,Business and Professions Code:Any city or county <m P, which requires a permit to construct,alter,improve,demolish,or repair any structure Ll—y prior to its issuance,also requires the applicant for such permit to file a signed statement t, i< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 ,req.Ft.Floor Area $658305 Valuation ut- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or L 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 of3592 2 0 6�) �Number Occupancy Type not more than five hundred dollars($500). 0 1,as owner of the property,or my employees with wages as their sole compensation, will do he work,and the structure isnot intended oroffered 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 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.). to 1,as owner of the property,am exclusively contracting with licensed contractors to e nstruct 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 hereon,and. who contracts for such projects with a contractors)licensed pursuant to the Contractus License Law. 0 lam exemunder Sec. B&P C for n .r Date 9sloda WO ER'S COMP N 15ECLARATION I hereby affirm under penalfy of perjury one of the following declarations: 0 1 have and will maintain a Certificate of Consent to self-insure for Workers Compen- sation,as provided for by Section 3700 of he Labor Code,for the performance of the work for which this permit is issued. 0 1 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 his permit is issued. My Workers 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($100) or less.) I certify that in the performance of the work for which this permit is issued,1 shall not employ any person in any manner so as to bccom subject the Workers'Com tion Laws of California.Date ` Applicant NOTICE TO APPLICANT:If, fac aking ytis r of Exemption,you should become subject to the Worker's Compcnsa provisr ns of he Labor Code,you must Z forthwith comply with such provisions or this permit shall be deemed revoked. z OCONSTRUCTION LENDING AGENCY Fr rA I hereby affirm that there is a construction lending agency for the performance of (C > the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name jz Lender's Address U 0 1 certify that I have read this application and state that the above information is w►' correct.I agree to comply with all city and county ordinances and state laws relating to Vbuilding construction.and hereby authorise representatives of his city to enter upon the Uahovc-mcntiuncd property for inspection purposes. 114 11. (We)agree to save,indemnify and keep harmless the City of Cupertino against Hliabilities,judgments,costs and expenses which may in any way accrue against said City V Z in consequence of the granting of this permit Date ►'� APPLIC UNDER$TA DS AN WILL CO ITH ALL ON-POINT Issued by: SOURCE O S. © O Re-roofs Signature of Appli contract _ i °ate T Of R JOf HAZA OPS �4S DISCLOSURE Type Will the applicant Mire building occupant store or handle hazardous material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety .C,Section 25532(a)? All roofs:;hall be inspected prior to any roofing material being installed. 0 Yes (9 No If a roof i:;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 he Bay Area Air Quality Management all new materials for inspection. District? 0 Yes No I have read the hazardous materials requiremcns under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building docs not cu y have a tenant hat it is my ms ility to notify the=upant of the requirements 'h ` tpri issn a aCcrtirna oe Signature of Applicant Date O oCalAll roof coverings to be Class"B"or better Owner or authorized a nt - Datc