04060121CITY OF CUPERTINO
777
FOR'1VAT70N'�„
-
BUILDING DIVISION PERMIT
NTR"T0X1
BUILD[NO ADDRESS:
MORGADO-4 CONST.
PERMIT 1100 4060121
21951 LINDY LN
OWNER'S NAME:
PERMIT ISSUE DATE
MARK SANTORO
725 C EAST JULIAN S
2004
E:
SANITARY NO. CONTROL NO.
(408)275-0499
ARCHITECDENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
o 0 0 0
LICENSED CONTRACTOR'S DECLARATION
o
lb Description
. Nat 1 am nseunder provisions of Chapter 9 (commencing
1 hereby airItad
P
with Section plan)) ofl)"'Won 3 of the Business and Pr,fded.ps Code, and my limn. is
in fell form ..it affect.
REVISION --ROOF PLANS. /DETAILS
License elms Lie. # c.Nmr
Dow— Co
Dam
NO NEW PERMIT ISSUED/ORIG. #0310158
ARCHITECT'S DECLARATION
REVISION --#03120108/ STRUCT DET. FOR RET WALL
I understand my plans shall be used as public recoNs
Licensed Pont ..ideal
OWNER -BUILDER DECLARATION
1 hereby .(firm 1 am exempt Imre the Conlrns Lew for the
Any
0
Co : c
following on Code:Anycity as county
andve,
- S�
daons
which uiropens. a(Section]onstrBualoct. improve, demolish, or mash stuctum
requires n permit re ennaweL
fors.,
her applicant ed stationind
Met u) her cenedp.. requires theeaiidmanl for a itch uctra'IOBICaalga(Chapter9
Met he
Sq. Ft. Floor Area
Valuation
efingwitpursuantmthtprovisionaofthe eMrsinds..iictnselski(Chaper9
(commencingwith 70110) of Division3 theeged exemton. it Could) do
$107
hereSmile.
M Any
Net he is exempt therefrom and the bssLL for Ne alleged exemption. Any violation of
ro
Section 7031.5 by airy applicant for a permit subjects the applicant to a civil penally of
APN Number
Occupancy e
P Y TYP
not mots than fin hundred dollars ($500).
❑ 1, as owner of the property, or my employees with wages® their sole compensation,
Re Inspections
win do thewark,.adtheawctureisnatmmndedoroffemdforsale(Sm.7(a4,Business
and Professions Cade: The Contactors Liana Law does not apply to an owner of
aired
q P
property who builds m im proves thereon, and who does such work himself or through his
own employees, provided Nn such improvements are not intended dreamed! forsale. If.
however, Ne building or improvement is sold within one year of completion. Ne owner.
builder will have Ne burden of proving that be did not build or improve for purpose of
sad, -)
a ,-)
1, as owner of the property am exclusively contacting with licensed contractors to
wmwct Ne project (Sec. 7044, Business and Pro(essiom Code:) The Contacmr's Li
cense Law does not apply to an owner of property who builds or improve thereon. end
who conn for such ptvpcts with a contractor(aI II sed pursuam to the Conmelor'a
Lie
and axe a r5 . ,BkP for lhishat
caner Date
WORK^R5 d PENSATIONDECLARATION
1 heeby affirm under n y of perjuryone of Ne followin ttom:
haveandwillonifin nos ficamof Consentlaself-tttsum ft.'s Compen.
an, u provided fm by Sermon 3700 of the Labor Code. for the perfowma of the
work for which this pewit is issued.
❑ 1 have and will maintain Worker's Compensation Iaumnce, as required by Section
37M or the Ube, Code, for Ne perfawmce of die work for which this pewit is issued.
My Worker's Compensation Whooma 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 fm one hundred dollara(51 W)
ort e.)
I ttnify that in the perfowanc. of Ne work for which this pewit is issued. I shall nos
employ any person in any mmncr an as to become subject to the Workers' Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If. after making this Certificate of Exemption. you should
become subject in the Worker's Compensation provisions of Ne Labor Code, you must
forthwith comply with such provisions or this permit shall he deemed evoked.
CONSTRUCTION LENDING AGENCY
1 hcmby .Minn Net there is a construction Riding agency for the perfurman x ser
the work for which this pewit is issued (Sec. 3097, Ct, C.)
Lendce. Name
Lender's Address
1 certify that 1 have read this application and stem that the above information is
I agree ct comply with all city and county ordinances and stem lam relating to
buwcl.
of
builtlingnnspromathcmby anthon umoses, tiva of this city in enter upon the
ea
above-mentioned(Weare properly for inspeindemnify
t keep against
(We) acme to east, indemnify and kap humless the City of against said
liabilities, judgments, and oxpcnsuwhtchm in any way secret sgalnstaaid City
Me granting
inconsequence Ne granting of this pewit.
A NDS AND WI OMPLY WITH ALL NON -POINT
sued by: Date
UR E T
e -roofs
Type of Roof
Si 6 Applicml/Con ter Dam
H OUS MATERIALS DISCLOSURE
Il the applies future building acupmtstom or handle hevsNous material
,
u dcRned by the Crape no Municipal Code Chapter 9.12. end the Health snit Safety
code, saran xss3x(an 555���
❑Yes }g rvu
All roofs shall be inspected prior to any roofing material being installed.
If is installed first inspection,
Will the applicant arr future building occupant sac equipment or devices which
a roof without obtaining an I agree to remove
hanrdnus air contaminants u defined by the Bay Area Air Quality Management
all new materials for inspection.
rim?
10 yes )' 4u
Ihay. mad the hazardous mamriab requimme sunder Chapter 6.95 of the Califnry
IM&S adc,Smdona25505,25533w 34. l understand that if the Wilding
ors no nal .yfy'.I �m4 that it is my res ibility m nod ly Nc occupied of Ne
m mTpdormtasn amntamnro
atureOfApplicant' Date
All roof coverings to be Class "B' or better
Owner
or authorized agep Dam