05100097 CITY OF CUPERTINO -�€ rp.*� P�x'�T17,777777777,777-777777
BUILDING DIVISION PERMIT
BUILDING ADDRPSS: a PINN BROTHERS CONSTRUCTIOD gRMITNG.05100097
�IQ745 N DE ANZA RLY Ji 102
FERMTTL6UEDATE
R'S NAME:
BAY COLONY INVESTORS II IN 1475 SARAT
PHONE: SANITARY NO. CONTROL NO.
(408) 252-9131
ABUILDING PERMIT INFO
RCHITECT/ENGINEER:
BLODG EO PLUME MECH
O
loo LICENSED CONTRACTOR'S DECLARATION - lob Description
a I honesty affirm that 1 am licerucd under armistices of Chapter 9(commencing P
with Scalae 70M)o(Divtslan 3 of the Business and Profession Code,and my license is
.zo infull fame aadaffect. 41L -act kz- NEW CONDO-1, 178
z Liccnw lac Lic.x
Data
On
V a s `r�ARCHITECTS DECLA N
1 mWemtand my plans shall he used as public mcards,
5y0
2p� Licensed Professional
OWNER-BUILDER DECLARATION
I herby affirm that I am exempt from the Contractor's License Low for the
oO following reason.Section 7031.5,Business and Professions Code:Any city or county
which acquires a Permit to rnregme4 ober,Imprve,(bounties,nr nomm any structure $252527
1•i H� prior W its Wgumse,also requima de,applicant for such permit in file a signed statoment Valuation
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that he is licensed puauent r the prviaiav of the Contractor's License law(Chapter 9 Sq.Ft.Floor Area
$ (eammcacmgwith Sccaon7000)of Division7nf the Business and Profession.Code)or
5 — that he is attempt thcrefxem and the basis for the alleged esempdon.My vloladen of
Section 7031.5 by any applicant far a permit subjects the applicant M a civil penalty of F Occupancy Type
not more than five hundred dollars ISM
❑I,U owner of the pmperty,or my amployme with wages as their sale mmpentadon,
will do the work.and the structure is not intended or offered for ask(See.7044,Busin.e. Required Inspections
and Professions Cade:The Contractor's License Law does not apply W an owner of 9 P
property who builds or im provas 0tmem,and who does amh wart himaalf or through his
ownemployees.prvided that such improvements art not intended mo@red feature.if.
however,the building or improvement it sold within aro year of completion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
ole.).
❑1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Businm and Professions Cade:)The Camamer'a U-
cove law dace not apply W an nwner of property who builds of imprwy Woman.and,
who contacts far such ism jeeta with a contrxclons)licensed pursuant to the Cormlctars
License Law.
I ten eaempt under See ,B&P C for thio nacre
Data
WORKER'S COMPENSATION DECLARATION
I herby union under penalty of perjury ace a(the fallowing declarmumo:
3f1 have Camiguin will momman a Camiimof Coventm self-Wum far WorkeesCompen-
,.arm,a provided for by Section 3700 of the labor Code.for the performance of dm
workr which this permit is issued.
1 have end will maintain Workers Comperuion Issuance,as required by Section
3700 of the Labor Cade,far the performance of the work for which this permit is issued.
My wmlme`ycamppgmtinulnns�urance Claim and Policy m
Gaffer.
CERTIFICATE
Polity FROM
ro1�
CERTIFICATE OF COMPENSATION
PROM WORKERS'
COMPENSATION INSURANCE
Crisis section need not W completed If the permit is figure hundred dollars(Ilan)
or lass)
1 mnify that in the performance of the work for which this permit is Issued.I shall not ,
employ any person in any mann rm as as become subject to the Workers'Compensa im
Laws of Cali(amia.Data
APPlimnt
NOTICE TO APPLICANT:If.aMr making this Certificate of assumption,you should
become Maisel to the Workers Compensation provisions of We Labor Code,you most
CC)O forthwith comply with each provisions or this permit shall be doomed mvnked.
z CONSTRUCTION LENDING AGENCY
[-r I anarchy union that there is a construction lending agency for the performance of
a the work ror which this permit is issued(Sac.3097,Cih,C.)
W Q t.enne Name
z Lender's Add.
U Q 1 comfy that 1 have road this application and suss Nu We above uformaliun is
k+F
--------I agree r comply with all city and county ordinances andstate laws relating W
0 U building cmgmaion,and hereby authorim aprewnutivcs of this city to cnurupnn the
>" W shave-mentioned property for inspection purposes.
6t (We)agree to save,indemnify and keep homeless the City of Cupertino against
,E"s Cn liabilhi ,Iodgmcn mumdexpensns hich may in my way acme agaivlaeid City
U az-" APP ICA nceUN RSTAof NDS Athis
ND ILL COMPLY WITH ALL NON-POINT Issued by: Date -CL
SOU CE S
9-IT-OG Re-roofs
Signature ofApplica WCanuacmr Date Type of Roof
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building mcupenuWm orhandlc hapudous material
Ikerined by the Cupertino Municipal Cade.Chapter 9.12,and the Health and Safety
We,Section 35533(a)? �R/ All roofs shall be inspected prior to any roofing material being installed.
C]Yu
Will the applicant or future building occupant use equipment or device which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air contsminants a food by Ne Bay Area Air Quality Menagemem all new materials for inspection.
District?
❑Ym
4&0
materials requirements under Chapter 6.95 or the Cali(or.
3f5 ,35533m,125530.1undcraundthatifJu building
that is mympomibllityWnodfythemcup.Lofthe
Pan anceof C fmuwgafOccupamy. Signature of Applicant Date
r te//-'06 All roof coverings to be Class"Bo or better
Owner or euWorizcd ager Data'