05100095 CITY OF CUPERTINOzswm:x,+�w*a<:r,4ai..r
BUILDING DIVISION PERMIT "C.6't'rRdTO'RaINk'ORMAT`IE .I
BUILDING ADDRESS: s FINN BROTHERS CONSTRUCTIO §`RM1TND.05100095
'LD745 N DE ANZA BLV if 105
'R'S NAME: PERMIT ISSUE DATE
BAY COLONY INVESTORS II INC1475 SARATQGA AV 021.=Z.2006
PHONE: SANITARY NO. CONTROL NO.
(408) 252-9131
ARCHITIiCT/ENGINEER: BUILDING PERMIT INFC0
BLDG ELECT PLUMB MECH
l
8 LICENSED LICENSED CONTRACTOR'S DECLARATION lob Description
i I hereby afOrm dos I and limaae i under provision of Chapter 9(commcncing
with Section 70110)of Drvlelan 3 oflhe Box.and ProfeasWtn Cade,and my If==is
j�„
in fall L NEW CONDO-1, 194
i b Llane�Clasa-�—Lie.• I
i pDam Q-gaB_wL...._ 7ELTs DECr JWRM 1"4814 rF1
TION V
i 7W7W� I�uMTcnfia�nd my plana�Caha111Ue uuJ n public rtcnrJs
°Q LicsnscJ Pmfmsianal
]] OWNER-BUILDER DECLARATION
I hereby.(Siem that 11. exempt rate the Canlramo o :Any c taw for du
U o following reason.(Section 7031.5.Btulmas and Pmfeadom Cole:Any city as aunty
e a r which da issuance.
•permit w CnnmacL dao.improve,demolish.ri sepsis any ummure $255957
J¢i prior Witscensed e.ahu requires theappBcant fortieth Con Penni'Widusecrile a iaw summers Valuation
n5C
that heiscingwiitpursuant WtheofDprovisions oofthe eBuinWhliverIJW(Chapter9 Sq.Ft.Floor Area
2 (commencing with Section 70D0)nf DivHion3af the Business and Professions Cmle)ur
'� that he is exempt themfrom and the basis far the alleged exemption.My violation of
SeNan 7031.5 by any applicant for a pemalt aubjeeu the applicant to a civil penalty of r Occupancy Type
tet team than flue hundred dollars MOM.
❑I,asownerofahaproperty.mmyemploye"wW wamutheirm1 eamPemdon,
willdo thcwork.and theumclureumt mundW oaRerW rosam(Sa.RNR,Bad—•.
Required Inspections
and Profession Code:The Cm
anuWA.tean
r's Lt.raw dt apply m Owner Or q P
pmpeny who hu dda an impmvea thereon,and who don such wok hu moll m through his
ownemPloyen,provided thatsuch impmsemmAmts are an,intended oaRered for ate If.
however,the building ar improvement is sold within Amu year of eemplmide.the oweer-
builder will have the border of proving that he did tet build ar improve for pulp=of
sale.).
❑1,as Avner of the property am exclusively contracting with licemed antrmton W
construct the pmjem(Sec.7014,Business and Pmmfsion Cade:)The cmurnetnr's Lt.
cave law does not apply W an owner of Property who huilds or impmves demon,and.
who contracts for such projects with a contnclor(U licensed pursuant W the Contractor',
License Law.
I ser exempt under Sec B A P C for this mason
Data
WORKERS COMPENSATION DECLARATION
' 1 hereby alrnm uMer penalty of pedary And of the folWwing declaraflone
ai have and will maintain.CeniBau of Consent W sdf-insure for WarkefaCompen-
Minn,As pmvided fes,by Section 3700 of the labor Cade,far the performance of the
wort/r,for which Nu Permit is issued.
�I have and will maintain Worker's Compensation Insurance,as,regaled by Section
37W of the Labor Code,for tM performance of the work for which this permit b funded.
My WarkeM1 QMpersation Insurance tinier and Policy
Cartier:
Policy
CERTIFlCATE P EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
C1'his seniors need notbecompkmd lithe Permit a foam hurdarddailars(5100)
or less.)
1 certify that in the perfarmana of the work for which this Parfait is issued,("I net
employ any person in any murder an An W beams subject u the Warken'ComPemation
levo Of California Dam
Applicant
NOTICE TO APPLICANT:14 after making thin Cenificate of Exemption,you should
become subject W the Worker's Compenm0an provisions of the labor Cede,you must
'70 rorthwith amply with such provisions o this permit shall be deemed munked.
'Z'^ CONSTRUCTION LENDING AGENCY
E-i I hereby aRmm that then is a atutructinm lending agency for the Performance of
6L' > the wok far which this permit is issued(Sec.3097,Civ.C.)
�~n. lendces Name '
.7.Z lender's Addtcas
U O I eerily that I have lead this application aha sou than the above Infurmaliun is
U. 6-� corset.I agree to comply with all city and county ordinances and sou laws relating W
QU building construction,and hereby authmim mpmsenutiWS Or this City to enter upon the
r GLI above mentioned property for inspection Purposes.
6. (We)agree to save,indemnify and keep harmless the City of Cupertino against
.Fs fA IiabmEa
caPeasmw Ich may In any way seems against old City
of this Per IDS AND\ LL COMPLY WITH ALL NON-POINT Issued by: Date 641"Ok
Re-roofs ��—
SignuurtofAPplican,'Contractor DauT e Of Roof
HAZARDOUS MATERIALS DISCLOSURE Type
Will Oe ap,limil or future building uccupantatom o handle haddell m'wrial
Rexed by the Cupertino Muni iPat Cade.Chapter 9.11,and the Health and Safely
.Section 15532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes o
Will the applicant or future building Occupant use equipment a devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as deflosd by the Bay Area Air Qudity Management all new materials for inspection.
Diatrictl
❑Yes WK
1 have real the hazardous materials mquiadmms under Chapter 6,95 of the Caliror-
nlaHeaW@SafelCndcSatian25 5.25533 uW25534.1undcnunddtuifthebuilding
dos atmm hem•tcnank Net i,my respomlMlity W iwtify IM oecvpant of the
mqt to I cheaunt he meted aaeecariccrrtnmarrxapaney. Signature of Applicant Date
jq'I1-04 All roof coverings to be Class"B"or better
O)�ronutharfmd agate Dam'