05080059 BUILDING DIVISION PERMIT � CONUMT ',ORMATIO, &
BUILDING ADDRESS: BALDEV SINGH JANDU PEKMITND.05080059
10276 ORANGE AVE
O' ER'S NAME: PERWfLSUEDATE
BALDEV SINGH JANDU 10276 ORANGE
.AVF 08/24 /2006
NE: SANITARY NO. CONTROL NO.
ARCHITEC IENGINEEIt: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
O pC LICENSED CONTRACTOR'S DECLARATION lob Description
u tj I hereby afrime that 1 an Imensed under provisions of Clutter 9(commencing
with Section 7")ofDivision 3ofthe Business and Profession,Code,and my license is
in full force and effect DEMO (E) HOUSE
i�? License Class Lic.ar
F DaleTS ractor
DELL
ARCHIiELTS DECLARATION
I undersand my plans shall W used az public records
.pr^ Liccnud Pnfcssiunal
3
OWNER-BUILDER DECLARATION
CC I hereby a(Rm Nal I i. exempt from the Caroms Co License law for the /
p o following remon.(Section 703 L5.Business and ere,do mil Calc:Any city or county ,rY
which requirns a pcmil m<nnswct alcor,improve,dcmnlish,or repair any structure V
prior it)its issuance.allu mquima the applicant(Or such Permit to file a signed statement
cep thulculicensed pursuammNcprovisions ofthe ConuxmhlJccmcLaw(Chapter 9 Sq.Ft. Floor Area V _a[ion
%a• (cnmmmlcing with Section 7000)or Division 3 of the Business and Professions Code)or $4000
s $ deal he u exempt therefrom and t e bass for the alleged exemption Any violation of Y
Section 7031.5 by any applianl for a permit subjects the appliranl to a civil penally of APN Number Occupancy Type
not mom Nan lave hundred dollars(BRIO).
❑1,uowrej of tix proprary,or my uoployaa wish wagmssrhe'tr mle campewtion,
will dothewm1cmd theawcture is nmintonded or offered mrsale,(Sce.]BN.Business 35 Required Inspections
and Professions Code:The Contractor's License Law does not apply a ns an owner of q P
property who builds or i m goves thereon,and who does such work himself or through his
awnemplaycm,pr i&dOatsuchimpmm MartnotinreMcd arofferedforsaleff,
however.the huiWing or improvement is sold within..yeti of templed.,the owner
builder will have rhe thrum of proving Wal he did not Wild or improve for purpose of
sale.).
U L as caner of the property am reclusively contracting with Ecemed LanrrYloR to
construct the project(Sec.7040,Business std Profecdans Cade:)The Caauaeter's Li-
came law docs not apply to an owner of property who Wilds or improves thereon and
who contracts for sash proem with a eommuctter(s)licensed p.ohmal to We CoMm lari
License Law.
❑I am uempt under Sce .B A P C for this matron
car Dale
T WORK 3 COMPENSATION DECLARATION
I hereby aRrre under penalty of perjury can of t e following dechrufmu
❑I hem and will maims.a Cealifiam of Conserv to calf-inane fm Wmker'a Compere
sation,a provided for by Section 3700 of We LaWr Cade,for the performance of the
work for which this Permit is issued.
❑1 have and will maintain Worker's Compensation Imursnce,as required by Section
37W.(am labor Code.for On preference,of the wank for which Out pcmit s issued.
My Worker's Compensation buurmce amu and Policy number art:
Carrier: Polity No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE -
(Thu scrim need not W completed lithe Permit is for one hundred dollars(Sl W)
or loss.)
1 cerid v Wa,in the perfumance of rW work for which this Permit is issued.I shall or
employ any'pereen in any manmr an a5 ro WComc subject b IM Workers'compewrion
Lawsof California.Dam —
Applicanl v
NOTICE TO APPLICANT:If,aftiormaking this Cenifiate of mmption.you should '
become subject to the W9heri Compensation provisions of the labor Code.you most
.JO farmwith comply with such provisions or this permit shall W deaamtl revoked.
E7) CONSTRUCTION LENDING AGENCY
[—tom 1h rchyafibra Out them isacmuvuclinn lcndingagcmy,far We p efcummtcc of
(� the work for which rhe permit is issued(Sec.3097,Civ C.)
Q Lender's Nene v
,a z Lender's Address
U Q 1 cenify Wal I have read this application and sum Wal the above information is
Iy P cornet.)agree to comply with all city and county anthrones and sum laws misting to
0 building construction,and hcrebyauthenae rtprseenuivc,ofthic city to cnmrupun me S / 'r(/'\\/71fyf�(a/' //////( J
0. shrew-mcmiuncdproperty for i epences which m. �/`'-�J s-�/
(We.)agree to save,indemnify and keep humlcss We City of Cupertino against
rF+w Z inconseque consequence
orthecosuandOf this nowhich may in any way accrue against said City
Uz in consequence of me yrmung of Wu tarot,
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGU ONAC.
—4L-' // P 2- "'C 4 Re-roofs
Sigmlitre of Applic..00amrew, Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant,or future Wilding uttupmtnore orhandle hamdous material
as defined by the Cupertino Municipal Code,Chapter 9.13,and IW Health and Safety
.Scc0on 25532(.)? All roofs shall be inspected nor to an roofing material beim
C]Y. Nn P P Y g g installed.
Will the applicant or future Wildingrecupanl use equipment ofdeviecs which If a roof is installed without first obtaining an inspection,I agree to remove
emit huaaAnus air contaminants as defined by the Bay Ana Air Quality Management all new materials for inspection.
District?
❑sem 1]Nu
1 have read the haaaNrwa materials requirements under Chapter6.95 of the Califon
ria Hcalth h Safety Cadc,Scctiom 25505.25533 and 25530.1 understand thai(the building
does nal currently have a comm that II is my reapamlblllly to nadry the 0.YUPNI of the
requirements wren Wmel rwimgpmc ora certirmate or
0,'7. Signature of Applicant Date
O 6 All roof coverings to be Class "B"or better
Owner m
eulhorind agent Dam.