07050114L I yr �va �niat�v �-�,�7
BUILDING DIVISION i ERNUT
ENS OAK CT
A RCHT=/ENGI NEER:
z LICENSED CONTRACTOR'S DECLARATION
0
1 hereby affirm that 1 ern licensed undo provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code, and my license is
y in full force and effect -
License Class Lk. N
O Dam Contractor
ARCHITECTS DECLARATION
-' 1 understand my plans shall be used as public records
Licensed Professional
a
, a OWNER —BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the
0 following reason. (Section 7031.5, Business and Professions Code: Any city or county
which requites 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 liecrsed pursuant to the provisions of the Contractors License Law (Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
c that he is exempt therefrom and the basis for the alleged exemption. Any violation of
Section 7031.1 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars (S500). .
❑ L 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
and Professions Code: The Contractor's License Law does not apply to an owner of
ply who builds or improves thereon, and who does such war himself or through his
own employces, provided that such improvements are not intended or offered for sale. IL
howem, 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
sak.).
❑ L as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044, Business and Professfons Code:) The Cootrzcr s Lf-
eeaac Law does not apply to an owner of property who builds or improves thereon. and.
who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's
License Law.
❑ lam exe
DECLARATION
I hereby afro. under ty of perjury one of the following declarations-
1 have and writ maintain a C wate of Consent to self -insure for Worker's Compen-
sation. as provided for by Section 3700 of the Labor Cock, for the performance of the
wort 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 wort for which this permit is issued
My Worker's 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.)
1 certify that in the perfo cc of the work for which this erm'I is Issued. I shell not
employ any rson In any mAnner so as to beco j akcn' mpensadon
Laws of Calif m sic
Applicant
NOTICE
of the Labor Code, you mist
Z forthwith comply with such pro 'ons or this permit shall be deemed revoked.
.0
CONSTRUCITON LENDING AGENCY
+ ►-� 1 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.)
a Q Lender's Name
Z Lender's Address
O 1 certify that I have read this application and state that the above information is
'—r correct I agree to comply with all city and county ordinances and state laws relating to
Ubuilding construction. and hereby authorise representatives of this city to enter upon the
y Cs-1 ahove-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
y liabilities, judgments, costs and expenses which may in any way accrue against said City
z in consequence of the granting of this permit.
"-c APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
r
signmbfire &Appl tractor - c Dam
DOUS MATERIALS DISCLOSURE
Will the appli t or future building occupant store or handle ha:ardom matuiil
u dcfutcd by the Culkrdno Municipal Code. Chapter 9-12 and the Health and SafetyCode, Section 25532(a)7
❑ YesNO
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
Disuict7
❑Yes No
I 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 building
des not currently have a tenant, that It is my responsibility to notify ant osupof the
require a Cartificam of
Owner or authori7zd age t Dam
RAMACHANDRAN, VIJAX
PERMrr NO.
07050114
PERMIT MUE DATE
05/14/2007
SANITARY NO. CONTROL NO,
BUILDING PERMrr INFO
BLDG ELECT PLUMB MECH
Job Description
REMOVE EXISTING 2X4 STUD WALL IN BATHROOM.
Sq. Ft. Floor Area
34232065�� Num
Issued by:
Re -roofs
Type of Roof
$1500
Required Inspections
Valuation
Occupancy Type
Date S
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