05020173CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
x �CONTRAG"TC1R Y1V'FUeCI�T
BUILDING ADDRESS:
MOR -GADO -4 CONST.
PERMITN0.05020173
21951 LINDY LN
OWNER'S NAME:
PERMIT ISSUE DATE
MARK SANTORO
725 C EAST JULIAN ST.
12/07/2005
E:
SANITARY NO. CONTROL NO.
(408)275-0499
ARCHITECT(ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACIDIUS DECLARATION
o
IbDescri non
1 amby aRlrm than i sen licensed under provisions of Chapter 9 (commencing
P
wiN Section 7000) of Division Sof the Buarcuand ProfeulOns Code. sed my license is
in full fora and effect
REVISION --IN HOUSE ONLY
LkenseC as Lk.{ 91
NO NEW PERMIT ISSUEDI ORIG. #03010158
ARCNRELTS DECLARATION
I understand my plans shelf II reau d publiccremce ord
L/
J
Licensed Professional
OWNER -BUILDER DECLARATION
v %
1 hemhy affirm that I am exempt from die Contractors License Law far Ne
following name. (Section 703M, Business and Profeasiuns Code: My city ser county
t�
which requires a permit to cormroc4 alter, empmw, demolish. nr repair any mucture
Prior n its WbUrKe, Alan requires the Applkanl for such Permit to file a signed summon
Sq. Ft. Floor Area
Valuation
that W re licensed pursuant ratite provisions Of Ne Convectors Uccme U.(Chap=9
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that M is eampt therefrom and the basis fa than alleged outrider. My vloladon of
um er
�O �l)
Occupancy Type
Section 7031.5 by my applicant for a permit objects the applicant to a civil penalty ofp}U;y
trot mom then five hundred dollars ($300).
3 G l� .00 .
❑ I, u owner ofthe property, or my employees with wages as than sale compmadon,
Required Inspections
will do the work, and theatmnure renal intended or offered to, sae(S.C. 7044, Busitvas
and Profession Cade: The Ommo mYa Lt.. Law data nal apply m an awns, 0I
q P
property who inside or improv thereon, and who dos such work h Imalf or Uuou{h his
awn employees, pmvlded that such imprevemenu am not intended onoBesed for We. If.
however, the building or Improvement is mid within one year of completion, Ne Owner.
builder will hue the burden of paving Man he did not build w improve for purpose of
sale.).
❑ 1, as Owner of the property, am exclusively convening with licensed conlraton in
contract the project (Sec. 7044, Business and Professions Cade:) The Contravenes LL
cense law does not apply in an owner of propertywho Wilds or Improve Nemon, and
who contracts for such projects with a canna ors) licensed personal to the COOBalars
License Law.
❑ 1 am exempt under Sec. . B & P C for this reason
Owner Dau
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury aro of the following decluNons:
ave and will maintain. CeNficate of Caesars la se1(•Insum fon Workers Compen.
"'on. as provided for by Section 3700 of the labor Cede. for du performance of the
work for which this permit is issued.
❑ 1 hove and will maintain Workers Compensation Insurance, as required by Section
3700 of the labor Code, for Ne performance of the work for which this permit is Issued.
My Workers Compensation lnwrantt anter and Policy num r 49x1
Carrkr( J." 6; i Policy No.:
CERTIFICATE FROM WORKERS'
COMPENSATION INSURANCE
(This rection need not k completed if the permit IsNroo bunded dollars (SIW)
or less)
1 anify that In the performance of Ne work far which this permit Is issued. l "I not
employ Anyperson in any minor an as m kcomcobjecl to the Workers' Compenathm
LAWS of Cdifmhh. Dam '
Applicant
NOTICE TO APPLICANT: If. after making tareCeruncate of Exemption, you should
kcome subjm an Ile Workers Compensation provisions of the Leber Code. you Most
forthwith comply with such provisions or this permit "I a decmcd text
CONSTRUCTION LENDING AGENCY
1 amby aRmm Mut Nem is a construction lending agency far the pedonmaOe of
the work for which this permit Is issued (Sec. 3097. Civ. C.)
Lenders Name
lands Add=
1 certify Met 1 Nve read N4 application sort mate Nu the save Informed. Is
comm.1 agree an comply with W city and county ordinances and ants laws mladn{ In
Wilding construction. and hereby and Grim representatives of Nis city m near upon Ne
shave-mendoned progeny for inspection purposes.
(We) agree to ave. indemnify and kap hYnllea Ne City of Cupertino agdmt
liabilities, judgmenu, emu and expenses which may In my my accrue sgdnst said City
in consequence of the {ranting Of Nis permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SO CE REGULATIONS.
Re -roofs
of Roof
Type ,
.A —`- / I. —2" Oj'
SSirmature ofAppllauXontrmmr - Data
HAZARDOUS MATERIALS DISCLOSURE
Will Mm applicant or future Wilding occupant store or handle I uudous material
as finned by the Cupertino Municipal Code, Chapter 9.13. and the Health and Safety
ode, Section 15532(.)7
Y. Apo
All roofs shall be inspected prior to any roofing material being installed.
El
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building Occupant use equipment or devices which
hayardous air contaminants as der by Mte Bay Ara Air Quality Management
all new materials for inspection.
mtrin7
❑Yee KO
I haw mad the ba anha edmaterials requirements under Chapter 6.95 ostia cabror.
Hc4l @Safety Code, Secdoa 255)5.35533 and 23534.1 undcalmd that if tiro Wilding
Ln
dnot currently haw A mnam, that It is my responsibility to notify the =upset of Ne
require anuwto mus aetptiorwissuanecofaewncamOrOcapmcy.
�i3Oate
Signature of Applicant Date
c._. It -� -o r
All roof coverings to be Class "B" or better
Owner or uthadxed agent Data