05100093CITY OF CUPERTINO
IAT QN
'0"T'0
BUILDING DIVISION PERMIT
CUNT NF(?
BUILDINC ADDRESS:
PINN 'BROTHERS CONSTRUCTIO
9RMfr NO'05100093
745 N DE ANZA BLV it'101
R'S NAME:
PERMIT ISSUE DATE
BAY COLONY INVESTORS II INC1475
SARAT
PHONE:
SANITARY N0. CONTROL NO.
(408)252-9131
ARCHITECIENGINEER:
BUILDING PERMIT INP°
'
BLDO ELECT PLUMB MECH
LICENSED CONTRACT'OR'S DECLARATION
Job Description
P
I thereby affirm Nal 1 am licensed under provisions of Chapter 9 (commencing
wit Section 7Or of Division Sof doe Business and Professions Cade. and my menAx is
in fell to. Iy
5
NEW CONDO -1,209
.derrut
ucanae c Le. ar
Dau comasmar
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RCHITECI'S DECLAMATION
1 understand my plans ¢hall be used As public report,
Licensed Proicuum.al
OWNER -BUILDER DECLARATION
I hereby SITIM does I am MMPI form the CanlMMM'f UCmM Law for the
fallowing moon. (S"tiro 71D 1.5, Business and Professions Code: My city or "Only
which requima a permit to cmunowt, aluu,, improve. demolish, m ¢pair any atnWhou
,,for to its issuance, also requires to applicant forsuch permit to file stopped statement
Contractor's L.imnse Law (Chapter 9
Sq. Ft. Floor Area
Valuation
tat he is licensed pursuant to to provisions of the
(commencing wit Section 7000) M Division J of the Business and Professions Code) or
tet he o exempt dmmfrom and de basis for the alleged eumpUan. Any violation of
5 APNNVMftrUUOccupancy
Type
Section 7031.5 by any applicant for a permit smxCCtA to applicant u a civil penalty of
not mom tan five hundred dollars (5500).
❑ I. As awmer of ter property, ter my employee wit wages As deb Axis campensatim,
ns Required Inspections
9 P
will do to work and the me= is not intended oraRcrW forsals(see. 7044, Busir-..
and Pto(easions Cade: The CanUCtaYt Li"nY LJw A. Met apply b Anawrter of
property who builds or im pro.ss Lerma, aM who docs such wort hineself or trough his
own employee, provided that such impmveounu arc not intended aroRered for sale if.
however. to building or Improvement is sold wllhinom year of COMPledm. to "bar -
builder will have it. burden of proving tat he did or Wild or improve for pumbae of
tole.).
❑ 1, as owner of to property, w exdusi"ly canuaming wit licensed con nscmrs u
construct the project (Sec. 7044, Business and Prafesslom Code) The Cmuaco's Li -
"con Law does rot apply As an awmr of property who milds or improw•s teinon, and
who caopacu for such objmm wit a m ssanor(s) Reeved purawnt to the Contractor's
License Law.
lam memptundersm. ,BJtPCfmtisinamn
Dau
WORKER'S COMPENSATIONmcC RATION
1 hereby affirm under penally of perjury one of ter following declnallans:
4h "and will maintain aCardimme of Consem in self-imumtarWartrfaCompen-
sation, as provided for by Section 3700 of to Lemr Cade, IN to performance of to
w for which this permit is Issued.
yo
1 hive and will maintain Waters Compensation Insurance, As required by section
3700 of to Labor Code, for to performance of to wart for which tis permit Is Issued.
My Wor s Compa�uaautian Insurance carrier and Policy n eine o
ftrMN
Gmer Policy No
CERTIFlG'fE OF IXEMMON FROM WORKERS'
COMPENSATION INSURANCE
(Thu senlm used mtmcompeted if to permit Is (mono hundred dollen ($100)
m IM")
1 certify tat in to performance of to work for which this permit is lamed• I shall not
-
employ any person in any manner" as to become subject to tie Workers' Compensation
Laws of California. Dam
Applicant
NOTICE TO APPLICANn if. after making to Certificate of Exemption. you should
become whim in the Wortefa Compensation provisions of to Labor Code, you most
' forremb Comply wit such p"vision or this Permit shall he deemed invoked.
CONSTRUCTION LENDING AGENCY
thereby :chum tat ft. isa Commlending agency for de perfurmame of
3
' work fur which this permit o tetroti (Sm.. J091, Clv. Cd
Lenders Name
Isnders Address
I sonify that I Mw reed to applietim and sur to to amus Infomutiun is
' correct. ) agree to comply wit all city and county ordinances and sou laws blaring in
building construction, and hereby autodm mpmscnu0ve of his City to enter upon tc
far inspecuon
shove -mentioned property purposes.
(We) agree to Ove, indemnify and keep hermies dre City of Cupertino against
I Iohllitie.judgmenu so and expenseaw ich may in any way accrue against told City
In con uencc of rating of tis per t.
vim'
I Q
APPL NT UN STANDS AND ILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOU L ONS.
Re -roofs
SI"alYle olApplicanTConuescuor Dau
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
mpa ,Mom or handle hvmdam maudal
Will doe applicant m future building Merriam,
'coned by to Cupertino Municipal Cade. Chapter 9.11, and to Health and Safety
a. Section 25531(:)+
41.
All roofs shall be inspected prior to any roofing material being installed,
❑Yea
If a roof IS Installed without firs[ obtaining an inspection, I agree to remove
Will tite applicant or ruture budding assume, me equipmm, or charts, which
A.[( hrortoo air conumimnu As de0ned by the Bay Arta Air Quality Management
all new materials for inspection.
District?
❑Yea u
I have soul doe hvardnuamaur3ala requimn u on Chaps,6.95ofte Califor.
pia HAd"S etyCade, Sec 25505,25533 534.lundeoundtolftamilding
utetIInst' I. tat it u my hlllly u mtll'y 025 uxup"t or du
does Out'-
rcqulbmenr m A orheinuanb .CeniRramga"perry.
Signature of Applicant Date
D ` 0`
All roof coverings to be Class "B" or better
Owner m autamtd Amuroma