05100098 CITY OFCUPERTINO yak q
BUILDING DIVISION COl`fTRAC, R�I1�EQRMATI�N
tSink.e s,Y"R"Y. �'i.. "4".`•z m'a1'htY�'s#
BUILDING ADDRESS: FINN BROTHERS CONSTRUCTIO 9"M"''05100098
0745 N DE ANZA BI-V it 109
R'S NAME: PERMIT Le6DEDATE
BAY COLONY INVESTORS II IN 1475 SARATOQA AVE
PHONE: SANITARY NO. CONTROL NO.
(408) 252-9131
ARCHITEC VENGINEER: BUILDING PERMIT INFO
BLDOQ ELECTO PLUMB MECHO
pop LICENSED CONTRACTOR'S DECLARATION Job Description
i 1 hereby affirm that 1 am licensed Color provisions of Chapter 9(commencing
with Section 70()0)of Division Sof No Businea ad Pmfeasium Code,and my Ileo—ie
in full room and ef(ec NEW CONDO-1, 178
;tR_ LimvcCls�Lm.a 'j�L� �'2.
)Fq Da1c f�—g�II�Con DECL_�JARY_ Jd
447 O r r `e ARCHITECTS DECLA�A710�N "
I undenund my plans atoll be used u public records -
i
•c Licensed Pmfnsianal
y Oat I too em,t from
DECLARATION
)0 1 mahy.(Tian on 11. uempt from NC CCntrecoYm :Any c Law for the
i 3 O whicfolloh ng las a. otter,t 7 o ar Business and om.dem N Cade:Any city as county
tura
I$(< which requiRts a pmnit m convect,alter,improv.demolish,or repair any suuctum $252527
-ire me,he 4ts umeneoalotequiam p.i,mb&.f Me snehpctorsU lea Law Culrmcm
Mormencing itpuwml70(10)provisionofof mBuataAlJmnechaw(Ganter9 Sq.Ft. Floor Area Valuation
9 dommemitawishmatron,and of Divisionr of doneegelnCompieess and r.My mCade)m
that io m 31.5 b any
and a buts for mha subject,
Me eumptioa Any l penaan of
Salton them by CryapplicantfaapmmitsabjcctsNeapplicantto•dvJpeneltYof r Occupancy Type
M,mart Nan Rw hmWRe dollar(&100).
❑I,n owner ofthe property,or my employees with wages as their sale Compestion.
will do thewok and lheanYClYR is lml NRadedaraRCRd rormle(See.7044,BYVM3] Required Inspections
and Prefouians Code:The Comesur's License Law dam not apply N an owner of q P
pmpeny who builds or improves Nercon,and sato does sec h work Imbeciles through his
awn employer,provided Nn such Imprommrnls art bol intended or Cuff"foredo If.
however.the building or improvemtnt is old within one year of completion.the Comer.
Witter
mer-
builder wait hate 0n burden of proving that he did set Wild or Improve for pwpme of
sale.).
❑L as awns of the prapeny.am exclusively commit,with licensed ronhactms m
construct the project.(See.7044,Business and Profcarons Code:)The Canuacor's U-
Co.law docs nut apply he an owner of property who build.or imine.Norton,and,
who contracts for such projects with a commemr(s)licensed pursuant on the GnOamor's
License law.
1 am emmps under S.C. .B&P C for this Ram.
Data
WORKERS COMPENSATION DECLARATION
J I he eby affirm ulcer pcnslty of pejury mat the fallowing deebmaanc
1 have and will maintain a CeniBcste of Consent to self-Insure for Wwmces Compcn-
sallan,n provided fm by Section 5700 of the labra Cade,for Na performance of Ne
wa her
which Nu permit is imued.
I have and will maintain Worker's Compensation Insurance,u mmluimd by Sector
57M of Na labor Cade.far Ne performance of done time f r which Nis permit is lame.
My Works scan Insurance artier and polity&nk
Grtier. Polity No.
CERTIFICATE OF EKEMPTION FROM WORKERS
COMPENSATION INSURANCE
(Tbu ocuor;need nal he completed If Ne permit Is froom hundred dolls($100)
or Ices)
1 certify that In the performance of tho work far which this permit is issued.I shall net
employ any person in any mMnerso as m become subject to the Worken'Compe auth n
Laws of California Dam
Applicant
NOTICE TO APPLICANT:If,after making this CeniRmte of Exemption.you should
become subject o the Workefs Compematon provisions of Ne Lobar Code you mud;
.J O forthwith Comply with such provisions or Npermit
is dull be doomed revoked.
zti CONSTRUCTION LENDING AGENCY
Fr I hereby affirm that More Is a contraction lending agency far the performance of
CL 7 dm work for which this Parrott is inned(Sac.3W7.Cl,,Q
ALender's Name
M z Lender's Add.
U O 1 turfy that I hate read this application and mute that do oboe information Is
(;F come,.I harm in comply with Lit City and county aNlnNmm and sort laws relating to
0U building construction,and hereby mmo6n mpnshMwa of this city to enter upon am
4sl •Imvarotatiunca property for impecaon purposes
fi (We)same to saw:,indemnify and keep homeless gra City of Cupertino against
vy lA liebilitim.judgmonWc mdvpcnscs hichmeymanywayaccrocsgalnstsaid City
APPLI NT UND TANDS AmNads Or ILL COMPLY WITH ALL NON-POINT Issued by: Date �` (� �U l
SOUR R U NS. F-17-0(p 17—OG
Re-roofs
Signature of ApplimnUCantroor Dam Type of Roof
HAZARDOUS MATERIALS DISCLOSURE
Will theapplicantor future Willingrampantsore2,maa hmalthamateria)
Road by the Cupertino Municipal Cade.Chapter 9.12,and rte Health and Safety
Section 25552(a)7 All roofs shall be inspected prior to any roofing material being installed.
[:]Y.
Will Na applicant or future building occupant eco equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
Dludct7
❑sem u
I hew mad the haysldous mamriamrequimments under Chapmrd.95 of the Cali(or•
nu N&SafmyCode,Sttvom M505,25 55 and 2UI4.l unknmnd lhuifdn Wilding
J urond w a tenant Nu It u n RsponlMlky m Mary the occupant of the
m me n t mmttoMet Our onia Rof.Coumm�af eaPmRy. Signature of Applicant Date
tlpt1'C 6 All roof coverings to be Class"B"or better
Owner of authorized agent Dam