05080046 CITY OF CUPERTINO s aFzt h--
f BUILDING DIVISION PERMIT CONTRACTOR INFORMATIO,,sN„ :
BUILDING ADDRESS: PINN BROTHERS CONSTRUCTIO1,91"MR"0.05080046
.10745 DR ANZA BLVD
OWNER'S NAME: PERMIT ISSUE DATE
PINN BROTHERS CONST. INC 1475 SARATOGA AVE 08/05/2005
NE: SANITARY NO. CONTROL N0.
(408) 252-9131
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
Op LICENSED CONTRACT'OR'S DECLARATION Job Description
u C I hereby affirm Inas 1 am licensed under provaim s of Chapur 9(commencing P
+=c with Section 7000)of Division 3 of Ne Busirim and Professions Code,and my license is
-� tnmItto.And affect. q / tZ TEMP POWER POLE
a,vR? License Clan Lic.N L
Dale COnlrmtor S or.
ARCHITECTS DECLA ATION
On
1 understand my plans shall k used u public records
JyU
s o G Licensed Prtsfcssional
` OWNER-BUILDER DECORATION
°�<E I hereby affirm Nn I am excmpl from Ik Cnnuncrofs UAny c Law for the
0 o following mama.(Semon 7031.5.Business and Pmfeesimu h.or Any city or county
dm" whichits motions a Permit re quires the aloe improve,demolish,Fi repair any prom rat $400
°E'^ that he its issumwursuant to Me lhovisio s or for such Permitto's censele a Law(Cha mem
-'< That he is licensed pursuant the prevision Or Nc Connector's License law(Chapter Sq.F[. Floor Area Valuation
4 (commencing wi in Section 7")of Division 3 of the Business and professions Code)or
Q Net he is exempt themfrom and Ne basis for the alleged exemption.Any violation Of
Section 7031.5 by any applicant for a permit subjects Ik applicant to a civil penalty of er Occupancy Type
......Nan five hundred dollars(5500).
0 I,as ownor of the property.Or my employees with cages u their role compensation,
will d0 Ne work and Ne awcmre is not inlendcd or ORerod for sale(Sec.7014,Business
and Professions Code:The Contractsr's License Taw does net appy m an Owner or Required Inspections
pmpeny who builds or improws Inemon,and who does such work himself Or through his
Own employrra,provided that such improwincnts art not immnded or offered forsale.If,
however,Ne building or improvement is mid within one year of completion,the owner,
builder will ban the kNcn of proving that he did not Wild or improve for purya of
sale.).
❑1,As owner of the property am exclusively Pro essiin&with )To,C conaacmrs m \ v
Li-
move
Law
Ne projon(Sec 7041.Business and Profession Codei Tkm Marano.
Li-
cent Law tines not apply n to Owner of property who builds or imProvu Thereon,and
who contacts for such pmjccts with aconuacmr(s)licensed pursuant u Ik Conuadoh
Licca Taw.
❑1 am excmpl under Sec. .B&P C for This moon
Own Dale
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury One Of the following declarations:
I ham and will maintain a Conifeau of Consent ae f-insure for WmkcesCOmpen-
I
on,u pmvidcd for by Section 37M of the labor Code,for Ne performance Of Ne
rk for which this permit is issued.
1 have and will maintain WOrkeri Compenalim Iruunnce.As,equimd by Second
00 of the tabor Cade,far the performarme of The woh for whim Nis permil is issued.
Worker's C�ompensation Innssurancee cannot and Policy n/u�mb�er are:
rtier.{� l.Q.w(I saK Polity No.:py10LLL
CERTIFICATE O�Pr10N FROM WORKERS'
COMPENSATION INSURANCE
(this section need not bo completed if the permit is fm one hundred dollars($100)
or Ica.)
1 cenifv Nat in the performance of the work for which this permit is issued,i shall not
employ any person in any manner m as to become mbjecl to The Workers Compensation
Laws Of California.Dau
Applicant
NOTICE TO APPLICANT:If,after making this CcniOcam of Exemption.you should
become subject To Ne Worker's Compensation provisions of rhe labor Code,you in=
.J O forthwith comply with such prevision or this permit shall be deemed tanked.
Z'-" CONSTRUCTION LENDING AGENCY
[—i I enmity affirm let there is a mostrtedon lending agency for Ne Performance.1
a Me work for which this permit is issued(Sec.309],Civ.C.)
Landers Name
= z Leirm,'s Address
U C) I cenify Nat 1 have mad this...limina and sou On,the above informari.is
P
correct.1 All.to comply with all city and county oNiam¢s and sou laws relating to
CU building mcorronion,and hereby authunre mpresenulisee of this city to enter upon the
r 4 ahovomcurioned property for inspection purposes.
(We)agree to ave,indemnify and keep harmless the City of Cupertino against
liabilities,judgments,costs and expenses which may in any way accme against mid City
U Z in consequence of The granting of this pemot.
FAPP (CANT U ERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date �-
R REGU ON .
....A P.M '114—�S Re-roofs
Signature of ApplicamuConuacm Dam
HAZARDOUS MR171311ALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle haarrho s material
as defined by Ne Cupertino Municipal Cade.Chapter 9.13.and The Hcalth and Safety
Code.Section 255320)vs� All roofs shall be inspected prior to an roofing material beim installed.
❑r BI Nu, P P Y g g
Will Me applicant or future building ssceupam use equipment or&Am which If a roof is installed without first obtaining an inspection,I agree to remove
it hazardous air conominants as defined by the Bay Area Air Quality Management all new materials for inspection.
soim9
O Ycsu
1 have mad the hamrtiousmamtlals requimmenu under Chapur6.95 of the Califer-
Idoes
Health hSafetyCode,Scction 25505.25533 and 25534.Itooko end that iflk building
coral.
not currently host a Nat it is my msp osihility m notify Ile occuponl of the
cots Whien sIbe IpsinrininamcenncnnificamprOccap.racy. Signature ofApplicant Date
P v I ()f5-o r-0S All roof coverings to be Class"B"or better
Owner or authorimd agcnl Dau
Community Development
10300 Torre Avenue
PTY
Cupertino CA 95014
Telephone(408) 777-3228
F Fax(408) 777-3333
�UPEI�TINO
Building De artment
JOB ADDRESS: PERMIT#
107 LIS (N 7 r(Z 74 6I vcA p b 9-0<n -t
OWNER'S NAME: ggRoTI{ SCoK57`Tfic PHONE #
GENERAL CONTRACTOR: ,c 1346S" 6,tS LCC FAX#
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
60 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
® Linoleum/ Wood
Glass/ Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
CITY OF CUPERTINO �� 6
TEMP POWER
UPERTINO PERMIT APPLICATION FORM
APN # Date:
3 a/ D -oS- O S
Buildin Ad ess: (Z
Owner's Name: vPhone #:
P;kw daoTue-4, Ca,�(s7- (/(o8) A
Contractor: Phone: License #:
Contact: / Phone: Cupertino Business License #:
Building Permit Info:
Elect
Job De cription:
Residential Commercial ❑
Cost of project: -SIS?
Qty. if
Applicable Fee ID Fee Description Fee Group
BTEMP Temporary Power ELECTRICAL
EPERMITFEE Elect. Permit Issuance ELECTRICAL
BUSLIC Business License BUILDING