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05100094
CITY OF CUPERTINO BUILDING DIVISION PERMIT z^dl.'ONTRA..�Tn Irt>la© tlTrQN '" BUILDING ADDRESS: PINN BROTHERS CONSTRUCTIO g" "0'05100094 0745 N DE ANZA BLV # 10 'R'S NAME: PERMIT ISSUE DATE BAY COLONY INVESTORS II IN 1475 SARAT PHONE: SANITARY NO. CONTROL N0. (408) 252-9131 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLOC ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION Job Description I F�y I hemby affirm that 1 am licensed under provisions of Chapter 9(commencing ]jG with suoum 7")of Div Wan 3off Rican—and P101onamm Code,and my license is h inn in fall lame and affect7K��•� NEW CONDO-1, 209 Phil L1.2— : CLacter V:iDam ARCHITECTS DELLA ATI N 1 command my plans mall M wed as Public rams u Licensed Pmfcuioml a 0 OWNER-BUILDER in dao CATION I Wmhy.(fuse on I am eumpt from rho Conaumfa License Law far the p o fallowing moon.Permit a 7031.5,Business and w,dem ns Cade:Any city or county S$ which its i ms a peanb an cnnmme alter,improve,h permit or mash any commma,ent $259173 -iZrm prior roiu iuuance.almrequima rho applkantfar such permitrofilc asigrcdsuement Valuation C Nman at he is licensed the pmm visiooftheConnecmf'sUic.mLaw(Chapter9 Sq-Ft, FloorArea (commencing with Section 7000)ofDivision l of the Business and Professions Cade)or that M is eumpt therefrom and the bub for the Winged exemption.Any violation of Sutton 7031.5 by airy applicant for a permit subjects the applicant to a civil penalty of AP14 NVIRber Occupancy Type Out mom than Ove hundred dollars ISM ❑I,uawnerofftpmpmty,ormywploycuwim"mudmbsolceampenudon, will do Ne work,and thesuumue is not Inmnded or oQmed forsak(5..7041,Bmiuu Required Inspections and Pmfessians Cade:The Commslom w 'S License Law dam apply 0 an own-of pmpeny who Wiliam impmvrs th-.n.and whodommetswarkhlmself m through his own employees,provided That such improvements are.tinmMed Or pneas1 fm Wale It, however.the Wilding or Iminewo est is mid within am yw of completion.be Owner, builder will have the burden of proving that he did run Wild or improve for purpose of sok.). ❑1,as awn-of the property w aeluuvely cmtMing with licensed cenusmaa m .=I de pmjem(Sec.7044.Business and Professions Code:)The Cootraeen'a U- Curtis Law dean no,apply ro m owner of property who Wilds ar fmpraw Merton,and who coneracu for such pmjccm with a coma-ar(U licensed pursuant an the Comencmh License Law. lam uemptund-Sec .B&PClm Nbmscam Date WORKBRS COMPENSATION DECLARATION I hemby alRtm under penalty of perjury ore of the rallawing decbmtiam: I haw and will ummuim sCeruamid of Cement roself-inureforWmk.YsCompen- don,as provided for by Section 3700 of the Labor Cade.for W Performance of dm wo;l111 /k,for which this permit is issued. l have and will maintain Worker's Compensation loathsome,u required by Section 3700 of the Labor Code.fm The perform men,of the work for which this permit is blued My Warks Camisa on huuwm a.or and Policy K: 'w Cartier.— Policy No. CERTiFlCATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE Thuts mfm need set uncompleted If the permit is froom hundred dol an(11001 or less) I-nify that in the performance of the work for which this permh in Issued.l shall not employ any permn in my mam¢r an as ro become subject of the Worken Compensation Laws of Califomia.Dam Applicant NOTICE TO APPLICANT:If.after making this CeruOcae of Exemption,you should become subject in the Worke'3 Compensation previsions or Ne Labor Cade,you mum .J O rordtwith comply with such provisions or this permit shall be deamed revoked. Z� CONSTRUCTION LENDING AGENCY F I hereby aRrm that them!a a Construction lending agency for the performance of CL> the work for which this permit is Issued(Sec.3M,Civ.C.) [f1 A Lender's Name ' Unifies Adareu V Q 1 certify that 1 haw rad this application and sum that the shove information is i1, (~ COMM.l agree to comply with all city and county ordinances and some laws relating to pU building cooswction,and hemby authorise mpmsenwiivcs of this city to enter upon the r W alwvcmcnuuncdpm,cny fadepences uhe sou (We)agree to save,indemnify and keep harmless the City of Cupertino against tF—t faA liabilida.Judgmcnu.emu andespensesw ichmryln any way accmegWmt said City /� V Z in eomegucnee of thc gra ting of this per . Date -.n • ^ APPLICANT NDER ANDS AND LL COMPLY WITH ALL NON-POINT Issued by: SOURCER susn"04 Re-roofs �— Signature or ApplicanVCom,mmor Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant amm m handle hassf mus aimed" Rand by the Cupertino Municipal Code.Chapter 9.11.and the Health and Safety .Section25532(a)7 All roofs shall be inspected prior to any roofing material being installed. 1]Y. MoNe Will the applicant or future building Occupant use equipment or devices which If a roof is installed without firs[obtaining an inspection,I agree to remove emit hamrdaw air conumia ms as denmd by Ne Bay Area Air Quality Management all new materials for inspection. Dural ❑Yon NA. I have mad the h-ardausmaedab equimmenu under Chaperd.95 arthc Cilifor. niaHahhh Salcty Co ,Secuom75505, 533andM534.Iunimmand ThatirthebuilEing Jars not ally h a mans Nash b y nesponsibuity m wdfy the occupant of Tm rtyuim mWmetpnan auwec ort ceranae of Occupancy. Signature of Applicant Date $w1l'ae All roof coverings to be Class"B"or better Owner or auNerind agent Dau