07080194 CIT�' OF CUPERTINO ` y+ �
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BUILDING DIVISION PERMIT ������~'� �����
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PERMIT IYO.
BUIL airrr��q��.s�EDAR SPRING CT HAMMOND HOMES ENTERPRISES 07080194 .
PERMIT ISSUE DATE
NER'S NAME:
V& V DILIP 6611 JO�:N DR � 10/19/2007
SANITARY NO. CONTROI NO.
P"oNE: (408) 25`_ -9994
BUILDING PERMIT INFO
ARCHITECT/ENGiNEER: BLDG ELECT PLUMB MECH
� � � �
i p p LICENSED CONTRAGTOR'S DECLARATION JOb DeSCTlpt1011
� v p. 1 hcrcby affirm �hat I am ticen5ed undcr provisions oC Chaptcr 9(commencing
, Z� with Sccuon 7000) of Di�i�ion 3 of thc Busincss and Profcssiuns Codc. and my Iicense is ADD BATf [ROOM 2 ND F LR- 2 ND STORY WALL BE ING
>> N in full force and c[fect EXTENDEI )
j v� Z Licensc Class L�. *
: F' �� ARCHITECI'S DECLARATION TO BE FI,USH WITH 1 ST FLR-1 ST FLR REMODEL
i m ,�
a I undcrstand my plans shali be uud as pubiic rccords STRUCTUF �.AL RE - ENFORC EMENT ONLY . REROOF FOR
)yU
' u. y Licensed PruCessianal
: � e OWNER-BUILDER DECLARATION
� <� 1 hcrcby alTirm that 1 am cxcmpt Gum thc Contractor's Liccnsc Law far Uic
p O lollowing rcoson. (Scction 7031.5. Busincss and Profccsinns Codc: Any city ar rnuMy
�„° �i which requires a pcmiit to conswc4 altcr, improvc, dcmoliah, or repair any suuctucc
�'" y prior w ils issuance, also requircs the applicant for such pertni� to file a signed stamment �, Valuation
- z< that hc is liccnscd putsuant to thc provisions o! thc Contracun's Licenx Caw (Cliapux 9 �� Ft. Floor Atea � 2 O 0 O O O
x F� (commencing with Section 7000) of Division 3 of ihe Business and Professions Cade) or
��.. that he is exempl therefrom �nd We bazis for ihe allcgcd exempdoa Any violation af
Section 7031.5 by arry applicant Cor a permie subjccu ihe applicant to a civil penalty of 3 6 6 5 4 0 6 �) �� Number Oeeupaney Type
not more t han fivc hun d t c d d o l l ar s ( 5500).
❑[. as owner of ttie propecty. a my employca with wages as their solc compensation.
will do ihe wock and ihe swnuce is not intended or offered for sak (Sec.7044. Busircss Required Inspections
and Pmfessions Code: 7'he Conuactor's License Law docs not apply to an owur af
propeny who builds or improves Uureon, and who does such work himul[or througd his
own employces, providcd that such improvements are not intended or otTered Cor sala If. _
however, the building or improvement is sold within one year o[ completion, d�e ownerv
builda will have �he burden of proving ihat he did not build or impcovc for purpox of
salcJ.
1, u owner of the propeny, am uclusively contneting wilh licensed conuactors �o
constroct the projea (Sec. 7044. Business and ProCessions Code:) The Coavactor's Li-
cense Caw docs aol apply m an owner of property wha builds ot impmves Ihenon, and ,
w6o wnuacts (or such projects wi�h a conuactor(s) licensed pursuane to Uie Contnetofs
' �cense Iaw.
' am uemp nder Sec . B& P C for this rcason
�wner Dut �b � / � , _.. _
O ER'S COMPENSATION D CLARA170N
I hereby �tm nder penalry of perjary one o( �he (oltowing declarations:
❑ i hs.�e and will maintain a CeniGcme of Conscnt to self-insure (w Workers Compen-
sation, u providcd for by Scctian 3700 of the Labor Code, for the performarcc oC We
wo�lc [or whic6 Ihis pemiit is issucd.
� 1 havc and wiU maintain Workcr's Campensatian Insurance, at �equired by Scction ,
3700 0( thc Labor Cadc, Cw thc pcdormance af the work for which �his pc�mit is iswed.
My Worker's Compensadon Insurance carticr and Polity number azc:
Cartier. Policy No.:
CERTIFICATE OF EXEMP?[ON FROM WORKERS'
COMPENSATIONiNSURANCE
(This secdon necd not bc complctcd i( the permit is fw onc hundred doltus (5100)
or Icss)
I ceniC� thxt in the performance of thc work fw which ihis pertni� is issucd, I shall na
e�nploy any person in any manncr so u to beeomc mbjcct w W p���
Laws of Cali(omis.
Applicant
NOTICE TO APPLIC , af�cr making �his crtiCi tc of Excmpdan, you shou�d
become subject to �he o s Compensation provision of ihe Lalwr Code, you must
� O forthwitti comply with such provisions or this pccmit shall bc dccmcd revokcd.
CONSTRUC'IION LENDING AGENCY
(. � I heeeby aRrtn U�at there is a consuuction Icnding age�y for the performance of
(,1; � thc work for which �his permit is issucd (Scc. 3097, Civ. CJ ,
W Q Lendcr's Narnc
j � Lcnder's Address �
U 0 I certify ihat 1 havc rcad ihis application and siatc �ha� thc ahove infamatiun is
w � cortcct 1 agree to comply wi�h all city and county orttinances and sute laws relaung w
� U building conswction, and hctc6y au�hori�e represcntativcs of ihis city to cntcr u�mn Ihc
� W atrovc-mcnuoncd properly for inspccuon purposes.
a (Wc) agree to save, indcm�ify and kccp harmless the City aC Cuperuno agtinst
�� liabilitiu, judgments, cos�s and expenses which may in any way uceuc agains� said Cty f
U Z in consequence oC tAe granung of this permiG Date �� <���
� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOURCE REGULA S.
' V e J� v� Re-roofs ��--�
SignazurcofApplianUC � Z' of Roof
H 5 MATERIALS DISCLOSU YPe
Will �hc applicant or futwc building occupant storc or har�dlc hnardous matcrial
Jcfincd by We Cupenina Municipal Code. Chap�cr 9.12. and the Heal�h and SaCtty
,.«u Scction 25532(a)? ,_,/ /- All roofs >hall be inspected prior to any roofing material being installed.
❑ Ycs YJ ryO .
�11 �hc applicant or fuwrc building occupant usc equipmcnl or dcvias whie6
If a roof i; installed without first obtaining an inspection, I agree to remove
emit haiardous air contaminan�s dcGned by thc Bay Arca Air Quality Managcmcm all new m aterials for inspecrion.
Disuici?
Q Ycs Nu
( havc rcaJ the hvardcws maicrials requircmcn�s undcr Chap�cr 6.95 of �hc CaliCor-
nia Hcalih & Safcry Codc. Sccuans 25505, 25533 anJ 25534. I undcrstand U�at iCU�e buildioS
daes rwl curtcnlly havc a tcnan4 Ihat it is my responsibility W notify thc occupant �f thc
rcyuiremc which must be m t prior to issu cc o a Ccrufuatc of Ckcu a� D-7 Signature of Appl icant Date
� � All roof coverings to be Class "B" ar better
Owncr or au rin gcnt ���