06110030 CITY O['CUPERTINO + '•"- e to%� a `"'" x;c.
BUILDING DIVISION PERMIT CONTRACT 1;U-1 RMATIOON`
BUILDING ADDRESS: LANDMARK BUILDERS PERMIT NO.06110030
10965 MTRAMQNTR RD
r•' ' R'S NAME: PERMIT ISSUE DATE
LYNN & MIKI YOUNGS 17450 M
PH NE:
SANITARY NO. CONTROL NO.
(408) 779-9888
ARCHITECffENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
!oa LICENSED CONTRACTORS DECLARATION - Job Description
i C 1 haffirm
ereby Nal l am lianud under provisions of Chapter 9(commencing
with Sectim 7")of Division 3 of Um Business and Procummo Code.and my license
iu
.ten n full to=and ?'i�`l1lD REVISION: FRAMING, SHEER WALLS, S5 . 2 NEW DETAIL
aq? Uccmc Claz LW.g
-rc Dam comrswr mer tai i f5 ORIGINAL PERMIT# 05010022
ARCHITECI-SDECLARATION
i z< I understand my plans shall 4 used u public rccoNs
iy0
G�
Licensed Pmfcsaional '
OWNER-BUILDER DECLARATION
I hereby alTitm Oat I am exempt from We Convectors License Law for the
O o following mason.(Section 103 L3,formar as and Professions Cale:My city or County
Sm which mquims a parsol ran construct,altar,imP ow%demolish.to mPeol any atmcture
.¢e prior In its issuance,also requires the applicant for such permit to Glc a signed amemcm
that W is licensed pursuant nva
o the provisions of We Cocum's Llccnc Law(Chapter 9 Sq. Ft.Floor Area ValQ Q Q
(commencing with Section 7300)of Division 3o We Business and Profession Cade)m
$ Nat he or asempt W oofmm and the brodu for the alleged assumption.Any violation of
Section 7031.5 by any applicant for a permit subjects We applicant to a civil penalty of APN Number Occupancy Type
not more than five hundred dollen(s5W). 35601032 . 00
1,az owner of We Property,m my employees with wages az Weir Sole compensation,
will do We work and We awcturt is not Intended or offered for sale(Sec.7044,Businua
and Profcuian Code The Con ocures License Law don not apply m an owner of Required Inspections
properly who builds or improves W esmn,and who does soh work himself art through his
own employers,provided that such improvement are not intended coffered fm We.if,
however.We building or improvement is Sold within one year of completion,the owner-
builder will ban We Wrden of proving Na be did no Wild or improve for purpose of
SakI.
❑1,as owner of the proper.am exclusively contracting with loaned mmnnors to
construct the pmlen(Sec 7014.Bniness and Profession Code:)Tie Covoacter's U.
ane raw dors not apply to an owner of property who Wolds or improves Orman.and
who contracts for such projects with a contracur(f)licensed pursuant W We Comtracmrs
Leena law.
❑lamuemptundsrsee .Ba PCfarthis rtewn
Or Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty or perjury ore of We following declaraiaaz:
❑ I haw and will maintain a Conium of Consent to ulf-inure for Workers Compen.
scion as provided fm by Sceuon TM0 of the labor Code.far the performance of We
work for which Wis permit is issued.
have and will maintain Workers Confirmation Insurance,az myoimd by Sr,m m
37W of We labor Code.fm thr raf....ofdm wart for which this permit is Issued. '
My Workers Compenauon Insurance artiers�sW Policy number am: —A
Cartier.Sine Cerro.Ir`s,Fu policy No.: 11 1 SCI2Z—V S
CERTI— FICC OF E%221'0N FROM WO RK ERS' '
COMPENSATION INSURANCE
(ITIS a.. ad..,becomplmed if the,permit is foonc hundred duBars(SIM)
or less.)
1 ten(v that in We prufa mance of We work for which this Permit is issued.I shall not
employ any person in any mannerao az m become subject to the workers'Canpensation
Laws or California.Date
Applicant
NOTICE TO APPLICANT:If.after making Wu Cenificam of Eumprion,you should
became subject Or We Workces Compensation provision of the Labor Cade.you most
.J O foMiW wcomply with such provision or Wu permit SAO]In demand!revolted.
z CONSTRUCTION LENDING AGENCY
r
F work
which rte Naz Ummisaronlmctinnlending agenry for We pedotmamm of
�i tie work fur which Wis permit u issued(Sec.3(197,Civ.C.)
a0 Lender's Namc
� z renders Address
J Q 1 cenify Oat I have mad this application and sere Oat the above infor Om is
ly toren.1 agree to comply with all city and county ordinances and sure laws mlating to
QU building construction,and hereby aurhome mpmacnutiva of this city to enter upon the
r W atmn-mcnuumed pmpeny for inaperuon purposes.
,~y (Wc)agree to save,indemnify and keep harmless We City of Cuperono ageinsr
rq Iiabiliucsjudgmems.cosu andexpena which may in anywayaccme agairea Wd Ctry
t-1 Z ineonsequnmeorthegontingofthispermiL
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date /Z
SO�UR"�E�EG CATIONS.
'Y1lo A!Y_]A Q jn('.�.n 12-1-ocl, Re-roofs
Srinaturt V ApplianUConuactor Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will We applicam m future Wilding mcupams rte m haMk bauruom material
as definN by tiro Cupcmm Mmido Code.Chapter 9.13,aM We Health and Safety
.Section 25532(a)? No
)? All roofs shall be inspected prior to any roofing material being installed.
Fly.
If a roof is installed without first obtaining an inspection,I
Will the applicant or future building asupant taw cyuipment or devices which g agree to remove P
emir by rdnm air conuminanta u fined by We Bay Arca Air Quality Management all new materials for inspection.
Distort?
❑Ycs Nu
I haveread Jar Iuaalloux materia.requircrnentsunder Chaptar t of We Wilding
mu Neolt cu Safety haw a Smiou anti 2my snd25534.1 So molly We
Wilding
docs not currently haw a mnanr,Nat it u my rtsponibiliry m notify the a<upent mf the
reWaircmcnts hw emus,xmeIptarl raana en crmfiae of«rup ley_O� Signature of Applicant Date
.ocl A ah.,1 .agent (-JZ �n'f�"� iz All roof coverings to be Class "B"or better
0 ern aaharixd age. Dam g