05100096 CITY OF CUPERTINO y �mSj> wv$gaa n
BUILDING DIVISION PERMIT q?CpNTRACTQRINF(> TION
22
BUILDING ADDRESS: PINN BROTHERS CONSTRUCTIO SRERMI "051O0096
R'S AME: - PERMITISUEDATE
BAY COLONY INVEST II IN 1475 SARATOGA AVE OR/17/2006
PHONE: SANITARY NO. CONTROL NO.
(408) 252-9131
ARCHRECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�oo LICENSED CONTRACTOR'S DECLARATION lob Description
idC I wreby affirm that I am licensed under provisions of Chapter 9(commencing
with Section 7M)of DlvWon 3 of NO Business;and Professions Code,and my licence h
I"fall taro.end effect. NEW CONDO-1, 518
ve los Lk.N
J DaLkemContruwr '
ARCHrrEC`rS DECLA ON
i I..&.nd my plans Nall he used u public records
i
r cLicensed Professional
y� OWNER-BUILDER DECLARATION
Contractor's
I hereby affirm that 11. exempt from We Cssimas is c:A License Lew for the
a O which re maw n.(Section]03L5,Business and ve,dcouu Code:Any city of county
S$ which requires n permit e."re carmtaL eller.nt form do permit t Il repair any asumuro $325413 n
•z> prormits iuwncc.alsu requires the applicant formals permit to Ole aaigncd sammcm
Net he is licensed pursuant m the provisions of the Contractor's Liccom Law(Chapter 9 Sq.Ft. Flo�Area Valuation
SFTs (commencing with Section 7000)of Division 3 arias Business and Profusions Cnds)at
— Nal M is exempt therefrom and the but,for the alleged eumption.Any violation of
Section 7071.5 by any applicant for a permit subjects the applicant to a civil penalty of r Occupancy Type
not mare dun Bw hundred dollar(35W).
❑1,u awmr of the pmlxrtY•or my wPbYm with wages u dre'v mle compenaUen,
will do the work.and the museum,6 rot Nmndd oraRcmd formic(See 7044,But. Required Inspections
and Profession Cod&'The Conitserardose Out License Law doout apply m an Owner of 9 P
property who builds orimprom d etmn,and whodoessuchworkhimselfor through his
ownempioyees,attended that such Improvements are not intended aronered for sale.If.
however,the building or Improvement Is old within one year o(«mptetion,the Owner.
builder will have the burden of proving that he did not build or Improve for purpose of
sale.).
01.u Owmr of the Property am a mawly comermt with I:...,ed comments,to
cmutnel the project(Sec.saw.Business and RO(esaam Cade:)The Cestraemra u-
«nse law does not apply In an owner of property who builds or improve Nemon,and
who contracts for such pmjems with a comommons)licensed pursuant to the Connector,
License law.
I oro uempaada sec. ,B At P C for Nu moan
Data
Mir WORKERS COMPENSATION DECLARATION
/1 hereby aRmn under penalty of pe0ury one of the following declauloes:
11-w and will maintain aCeNfimm of Consent to self-insae for Workcra Compost-
'd.,
u provided for by Section 3700 of the labor Code.for the performance of tie
7for which this permit is issued.
haw and will maintain Workers Compensation Insurance,as required by Section
3700 of the labor Code,for the pmfarm ent of Ne wait for which this Permit is e
issu .
My Workers ompensame,Insurance unix and Polity Q
Grtier. Pollry No.: w —`
CERTIFICATE F EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(Dtisaction sed notbccwnpkted if the .I%is(Or.hundred Bogan CHOU)
nr leu)
1 certify Net in the performance of tie worge for which this Permit is issued 1 alull not
employ any person in any manner an u to become subject to the Worlmof Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Cenificam of Exemption,you should
became subject to the Worker's Compensation provisions of Ne labor Code,you most
OZ forthwith=reply with such Provisions or this Permit shall w dmmd mwked.
zCONSTRUCTION LENDING AGENCY
(~ 1heeby anlres that these its construction lending agency for the performance of
rl 7 the work for which this permit is issued(See.3097,Civ.C.)
W Lenders Name —
] z Lenlse.Addmcs
U0 I reentry that I have mad this application w use this the.hove information Ise
F correct.1 agree to comply with all city and county onlinarcts and sok laws elating to
OU building construction,and hereby authorsre epmscnmives of this city to enter upon the
W above-mentioned property for inspection purposes.
gy (We)agree to save,indemnify and keep harmlcu the City of Cupertino against
n„r N liabilities,Judgments, sts mdespem0 Id It may to any wysamc against aid City
U 7, in to
or
nGng of Nis per cit.
^ LI A UND STANDS AND ILL COMPLY WITH AL1 NON-POINT Issued by: Date _ 2 .p C
sauR R 4.11 Re-roofs
Signature ofApplicam/Con ramor Dateof Roof
HAZARDOUS MATERIALS DISCLOSURE Typo
Will the a Cupertino
ter foam wal C g e.Chapter
ht atom ter handle hauNou Safety ety
0md by the Cupertino Municipal Code.Chapmr 9.12.and the H«IN and safety
e.sedon 25532(x)] All roofs shall be inspected prior to any roofing material being installed.
0Yes
Will the applicant or fugue building occupant use equipment or dcvicea which If a roof is installed without first obtaining an inspection,I agree to remove
emit honsdnes air contaminants as dcOnsd by the Bay Ana Air Quality Management all new materials for inspection.
Dietrich
OYca WIr
I have real the haaard.eventual,requimmentsund nChapur3.95 of the Califon
nie oat safety a@.senions23SOs.2ss7 am25sx.luderstsne tha0d,e wining
Jas of eml� w•tenanh dol h h my npomihililY m notify the accupanl of Ne
req mm h' muawmmpaormisu «aracen0«mora panty. Signature of Applicant Date
All roof coverings to be Class "B"or better
Owar a wmorimd qem Dam'