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BUILDING DIVISION PERMIT
CONTkXCTQRiINFORMIiTIONN-t
BUILDING ADDRESS:
MORGADO-4 CONST.
PERMITNOO 3070016
iso M'
725 C EAST JULIAN ST..
PERMIT ISSUE DATE
PIIONE:
(408)275-0499
SANITARY O. CONTROL NO.
HITECT/ENGINEER:
BUILDI NO PERMIT INFO
BLDG EI.F.CT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
JOb Description
Unit 1 am licensed under provisions of Chapter 9 (commencing
I hereby efrom thade
p
with gCLllnn 7050) or Division 3 of IIIc BY61nC3s and ProfCASInn] eOde. and my licensei5
in full force and ffen,
Liccnec Clea, sec..
DEMO
Date Contractor
CONTRACTOR: MARGADO-4 CONST.
ARCHITECTS DECLARATION
1 undenland my plans shall be used as P.M. recid,
Licenud Promm m.1
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
following reason. (Section 703 L5, Business and Professions Com: Any city or county
which require, a Permit to construct, slmo improve. demolish, or repairanystructure
Prior In its issuance. also requires the applicant for such Permit to rile a signed statement
that he is licensed pursuant o the pnviiiinn, of the Contractor's License Law (Chapter 9
Sq. Ft. Floor Area
Valuat 000-
immune sting with Section 7") of Division 3 of the Business and Professions Code)or
that he is exempt thorefmm and Na basis for tho alleged exemption. Any violation of
,�3�� g,
3 �jj3kY'�Y ef00
Occupancy Type
Section 7031.5 by airy aPplicant for. Permit subjects the.ppficant to a civil Penalty of
not more Than five hundred dollars ($3(10).
I, u owner of the pmpeny, m my cmployors with wga u their mle compenutlon,
Required Inspections
q p
will do the work and Use swcmrt is not intended oro Bred fonalc(Sm. 7061, Business
Prof Code: The Conlnntors Lim. Law dors
and ssimis .1 apply to an owoer of
pmpeny who buildsm impornim therame, and who lou uchwork himselforthmught his
704 — DEMO
now employes, provided that such improvements ve sol intended moResed fo tele. If.
however, the building or Improvement is cold within ane year of completion, he owner.
builder will hoc the burden of proving that ho did not Wild at improve for purpose of
sale.).
1, a owner of the p.,ny, am exclusively Contracting with licensed contract. to
coawcl the pmject (Sec. 7046, Business and Professions Cade:) The Contrsetor't U.
tomo Law does not apply to an owner of property who builds or impmvs Invention. and
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who contracts for such projects with a contractors) licensed pursuant to the Contractor's
License Law.
C
❑tem exempt under Sm.,B&PCfnr this recon
D ter �t/' Data
O
WORKER'S COMPENSATION D RA N
��herchy affirm under, penalty of Perjury no aft owing declarations:
have and will maintain a Cenlficam of Conserv to self -insure ror Workers Compen.
\
as provided for by Section 37M of the labor Code. for the perfamuna of the
for which Nix Permit is issued.
❑ I bac and will maintain Worker', Compensation Insurance, as required by Section
37W of the labor Code, for the performance or the work for which this Pemsir is issued.
'
My Worker', Compensation Insurance anis and Policy number art:
Carrier: Polity No.: _
CERTIFICATE OF EXEMPTI ON FROM WORKERS'
COMPENSATION INSURANCE
(This section need nor becompletcd li the fcmtit is for one hundmE dollars (SIOr
ar lean)
I cenify that in the Performance of on, work for which his Permit is Usual, 1 shall not
employ any Person In any manner en as in become subject to the Worker{ Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If, after making this Certifies¢ of Exemption, you should
become subject to the Worker's ComPenution provisions of the labor Code, you must
forthwith comply with such provisions or Nis permit shall be deemed revnkrd.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that There is a connmetion lending agency for the Performance of
the work (or which this permit is issued (Sec, 3097, Civ. C.)
Lender's Name
_
Lender's Address
1 cenify that 1 have read this application and auto that the above information is
correct. I agree to comply with all city and county ordinances and sou laws relating to
build Ing construction. and hereby authorim representatives of this City to enter upon the
ebovomcmioned p opedy for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
liabi lids, judgments, costs and expenses which may in any way acme against mid City
,
/
In consequence or the granting of this Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
S EGG ION
Re -roofs
Type of Roof
�Ya!
Signature or ApplinntiContraclor Date
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future Wilding Occupant store or handle ha daus mal
u defined by the Cupertino Municipal Code. Chapter 9.12, and she Health and Safety
Calc, SCmian 25532(,)?
❑Yu 7(N.
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
Will the applicant Of future building accapam bit' Cgmpmcm or devices which
it haeardnus air conleminmu as &fiord by Ne Bay Arca Air Quality Management
all new materials for inspection.
or
❑Yes >' ,Iit
1 hive mad the hayardous materials requirements under Chapmrd.95 of the Califor.
tie Haldt & Safmy Guk, Sections 25505, 25533 and 25534.1 understand oral building
does mo ..fit, hove a tenant, Nat it is my responsibility to hour, to, nte omupaof the
re
ty/a which must et pilar an.nce nraceniram oraLa aney.
Signature of Applicant Date
�inee
All roof coverings to be Class "B" or better
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ser authnrivsd agent palm
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CUPERTINO
CITY OF CUPERTINO 0�3 ezo v A�
DEMO ._. T IT �l �7TA� PERMIT APPLICATION FO
II
APN #0 5-6 - �^ O -
Date: '/ P b
/
Building Address: O / 1J / L ,�, A J N I
`/� C /
Owner's Name: //Ma tl � � b
uo,
Phone #:
Contractor: orV/(
11 n 54.
License#:
Contact: ,-� it C9 r
Phone #: UO8 ^� ^ 9,N/
/ /
Applicant/ ontractor:
uildi Permit Info: U
Bld Elect Plumb Mech
esion-
Reside Commercial:
Sq.Ft. Floor Area:
3160
$/S Ft.:
q' S6U U
Architect/Engineer: o Gih /
Valuation:
Type of Construction:
Occupancy GfV-
AOp]Lcqble Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILTDNG
I I BSEISMICOM I Seismic Commercial I BUILIDNG
�_ ( l/ I BPLANCHK ' I Plan Check Fee I RT ju vw
k o 7, 5"0
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