05100101 CITY OF CUPERTINO
BUILDING DIVISION PERMIT
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BUILDINGADDRESS: FINN BROTHERS CONSTRUCTIO "'T"x'05100101
RNAME.N DR ANZA 51-V If 112 PERMIT STE
UE DA
BAY COLONY INVESTORS II INC1475 SARA
PHONE: SANITARY NO. CONTROL NO.
(408) 252-9131
ARCHITECVENGINEER: BUILDINO PERMIT INFO
BLDG ELECT PLUMB MECH
O
lop LICENSED CONTRACTOR'S DECLARATION Job Description
ibs 1 thereby afflrm that 1 am licensed under provisions of Chapter 9(commencing
with Section 70fa0 of Division 3 afthe Budneu and Profrssioa Code.and my license u
j „ in full force auF, nd effect. �7� NEW CONDO-1, 178
,)a= Licease laus� .seg
ISCLA
F Dau�Jw x. wL Cmnmseur
QQ ar9ARCHTIECTS__ ON
I2 1 understand my plans shall he used as public seeold,
s uds6
•c Licensed professional
OWNER-BUIIDER DECLARATION
1 hereby fi rm that I am exempt from she ConeracmYs License Law for the
•n o following lesson.(Section 7031.5,Business and Pmfessiom Code:Any city of county
129
29 which requires a permit to cosmic,allot,improve,demolLsh,or repair any structure $252S27
priortoitsissuance,WinimiumartMapplicantforsuchPermism6leasignedstatemcm Valuation
: C Nat he is llccmd Pulliam m the previsions of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area
1 (commencing with Suction 7000)of Division 3 of the Business and Profesniors Code).1
that he b exempt therefrom and the bub for Ne alleged eaempslon.Any violation of
Secdon 7031.5 by airy applicant fa a pontis Ubjecu me applicant m a civil pemhY 01 r Occupancy Type
nos more Nan live hundred dollars(MI
❑L"owner of the poputy.or my employees with wages as their sale compensation.
wiudotirewotkandthesuss .ice etre- dQl QfTmAfmraale(Sec.7 ,B"— Required Inspections
and Profession Cave:The Cmnsnemea Liceue I.w door ret apply m an owner of q P
property who bu ilds or improves thereon.and wou does suc h work himself or thmugh his
man employees.provided tho inch improvements art tens intended ornffuM for Ne If.
howtver,Our Wilding or improvement Is sold within one year of completion.the owner-
builder M0 have she burden of plowing mu Ite did ret Wild m improve for purpose of
sale.).
❑1.as towner of the property are uclumvely contored.,with licensed cum acme m
consumer the project(Sec.7044.Business and Profesaioru Cade:)The Cwmaemes U'
corm law does not apply in an menu of prepeny who Wilds or Improves thereon,and,
who convects for such projects with a mummulds)licensed pursuant m Our Commences
Lkeme Law.
I am exempt under Sce. ,B&P C far this..on
Date
WORKER'S COMPENSATION DECLARATION
�1 hereby affbrn under penalty W perjury rete of me following declarations:
�I ham and will maintain a CudOesu of Consent to self-imum for WmkeesCompm-
asims,a Provided fer by Section 3700 of the Labor Code.for me performance of the
worlt.fxhieh this Permit b iaued.
I harave aM will maintain Wormer Compevatimm Iuurawt,u resulted by Section
3700 of Ne Labor Code,for be performanw of me welt for which mb Permit elloved.
My Wertres mpeY tiotn lance carrier and Polity um a
Cartier: w1 I�!I Polity No. - r11�ll
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thbsemlon wed wtbecompleted if the fermis b foomm hundred dollars($100)
or less.)
1 certify that In to Performance of me work for which this permit Is issued,1 shall not
employ any pence In any mannerm as to become subject to ma Wmrken'Compensation
Laws of California.Dau
Applicant
NOTICE TO APPLICANT:If,after making this Collimate of Exemption,you shwW
become abject to me Workees Compenndon provisions of me labor Code,you mus
OZ immidh comply with such provision or this permit a hall be deemed rermkcd.
-O CONSTRUCTION LENDING AGENCY
t-t Ihereby&M.that ftba wnsruednn lesongagenry,for ftPerfarmarvsof
D:> the work for which this permit Is issued(Sen.3097,Civ.C.)
W Q Lende'sName
.a7 Lr
z mses Address
U 0 1 certify that 1 have mad this applicadon and sum that me above information is
t4.F coram.I agree to comply with all city and county ordinances and sou Ian relating to
0 U building constonion,and hereby aushorim representatives of this city to enter upon the
W above-Men ioned property for inspection proposes.
(W me 0see,indemnify a keep h.1.me City of Cupertino against
nF.t h liebilitie udg enn.c and expense hick may in any.4,seems against old City
In conA
f the ling of this pe it.
�--� APPL ANT D TANDS AN ILL COMPLY WITH ALL NON-POINT Issued by: Date
SOU
ER U NS,
'1w0ll' Re-roofs
Signmum of ApplicarKmamacur Onto
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Ne Culmoser fMorcbuilding arupapt ahem handle hmardoamaterial
Bred by the Cupertino Meniri 1 Code.Chapter 9.11.and the HpIN and Safety
.Section 25532()7 All roofs shall be inspected prior to any roofing material being installed.
❑Yu Ne
If a roof is installed without first obtaining an inspection,]agree to remove
Will the applicant or future building oceuptmuse equipmentordevices which
emit haum oa air contaminants as dcOwd by the Bay Area Air Quality Management all new materials for inspection.
Diatrict1
❑Yes u
I love mad she heardous materials requirements under Chapter 6.95 of du Califory
nice Hcalm afmy Cm c6=23505,255 arW25534.1urnmusandmatifine Wilding
docs not tly haw a mk mat Is to m respomi llity m notify me acupans of me
myelic hi cmeipdorions cenfaCeniOuuofp"cupawy,_ Signature of Applicant Date
O-f x10 All roof coverings to be Class"B"or better
Owner or authorized agent Date