05100102 CITY OF CUPERTINO
BUILDING DIVISION PERMIT I�I:4xI2A.C1'aR�7NP`U �'1T;I'.
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BUILDING ADDRESS: FINN BROTHERS CONSTRUCTIO SERMIT"x05100102
0745 N DE ANZA 31-V it 113
R'S NAME: PERMIT ISSUE DATE
BAY COLONY INVESTORS II IN 1475 SARAT
PHONE: SANITARY NO. CONTROL NO.
(406) 252-9131
ARCHITECT/ENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
0 0
imI
9 LICENSED CONTRACTOR'S DECLARATION lob Description
ibI hereby affirm that I an licensed under provisions Of Chapter 9(com icuing
,da Section 7000)of Division 3 of the Business and Proression Cade,and my license is
!p nfmlmmoanderfecl. J! X112,.- NEW CONDO-1, 460
1 yJ Z License�'us Lic R
q Dae anlyA.1�_Cont.lo, �g��
Iq�. a —A7rCHf1ECrS OECLAR OR
i Z 1 uMcntend my plans$hall he used u public records
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1p
Licensed Professional
OWNER-BUILDER DECLARATION
m I Mrehy$(Tum an I am exempt from the Cantrns Cc :Any c Law for me
ay
p O following reuan.(Session 7(D 1.5,Business ted Pm(ecriuu Cale:Any city ey s caunry
S9which mtsisuapremiereuiresthLalar.Improve:,hpermittorrepaireduomataricams $312980
-iy
poor mits issuance.alw require Jte applicant forsuch permitmfik$signed sWemenl Valuation
< WommencaveJpurwmlaM)aDiviamofNeConuaclmaiPrsciaw(Chapin9 Sq.Ft.Floor Area
f�$ (cammcndng with Section 7000)dOivisian7of lite Busitmssarm Profession Codc)w
Nat he is exempt theofrom and the basis for dm alleged a Pdou MY vtilsder of
Secdon 7031.5 by my appliunl fm a permit maim me applicant m a civil penalty of Ir Occupancy Type
not more Nan five hundred dollars($500).
wil❑L o the wa of l d property.m my uapmyers ervided of upland
age u mev role eampewdon,
ad mesion,,ands; he Corerxccbm License
Law
fa Out apply 0In Own"Broacca
Required Inspections
and property
whoProfession,Code:The annlrcmh Ld who Law don res apply b rd owner is q p
propertywholoulpro orimprovuthimpr,and who doessuchwarehimtelf a mrougb his
however.
the building
thin s such Improvements art Imt ea:afonded re offered the Owner-
however,me building u improvement b mid within oro Year of c prove for
me ease of
Owner-
builder will nave the burden of proving mel he did nal Wild m improve far puryote of
tele.).
❑1,as owner of the property,an exclusively contracting with licensed contrxemn in
construct me project(Sec.7(94,Business and Profusion Cade:)The Contractor's Li-
..Ilse law doer natality man owner of property woo builds or improves thereon.rod,
who contracts for such projects with a conwase ar($)licensed pumunt to Lha Coronaries
License law.
1 am exempt under sec .B g:P C fm mice masa"
Dam
WORKER'S COMPENSATION DECLARATION
/i aemby affiren under penalty of perjury ane of the following declaa nsome
I have o tel will malma,a Certificate of Consent in self-insure fm WarkeY+Compen-
sWon,u provided fm by Section 7700 of the Labor Cade.fm me perfarm ace of the
or which this permit is issued
have and will maintain Worker's CmnpenWon Insurmce,M required by Section
3700 of this Labor Cade.for me performance of the work for which this permit u Issued.
My War ompemunsu
tion Irance eller ad Policy a fart: .0L.
-�Q
Cartier: Policy Na `f
CERTIFICATE OF EXEMM09 FROM WORKERS'
COMPENSATION INSURANCE
(Thlasection heed smile completed Vine permit le foram hundred dallus Wind)
or iese)
L certify that In the part..into of the work for which this permit is issued.1 aha11 nal -
employ any poison In any mannans as at become subject to the,Worker'Compensation
Laws or Calimmts.Dau
APplicmt
NOTICE TO APPLICANT:If.after making this CerlRum of Exemption,you should
became subject in the Worke's Cmnpcnandmn provisions of the LAbm Cade.You must
O faMwim comply with such provisions m this MMIL shall be mumad rel
veed.
Z► CONSTRUCTION LENDING AGENCY
(••' Iherehy.M.that mere iso conuucMn loading agency for the performance.(
a> cite work for which this permd is aimed(Sec.7077,Civ.C.)
Wy Q Lender's Name '
0.Z lenders Mdreas
U0 I certify that 1 have re>d this application and sum du the shave information is
V, F corm".I agree in comply with all city and county ontmatee and sum lava missing to
O U building construction,and hereby sudericempmsenutives of this city to enmr upon the
Isl above-mentionrA property for inspection purposs.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
C.,
imbiliticajudgmenW eLAD
nsuJLL
mayinmyvnyaccmcgaWsmid City
U in cc ice of thes
'-" APP UNDND COMPLY WITH ALL NON-POINT Issued by: Date
50 CE
Re-roofs
SiSkAT.al'Applicam/Canusemr Dem
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIII the applicant or future building meeupmutaro or handle haurdons mamrial
Med by the Cupertino Main I Code.Chapter 9.13,and me Health and Safely
Section 75572(a77 All roofs shall be inspected prior to any roofing material being installed.
❑Ye u
If a roof is installed without first obtaining an inspection,I agree to remove
WIII dm appli:am or furore Wilding occupant us emotional or device which
emit huudnu air communisu as rind by the Bay Ama Air Quality Managcmenl all new materials for inspection.
Diubt7
❑Yes Nu
Ihavereadthelia. A mamriLLr OxI ffenu under Chapusd.95ofthe Califor•
nu Fiul SafclyCode,. 'an 25505,ss.. . 25574.1 undcommdmnifine Wilding
doer c n0y Msec rot.Jus It b my epamibilily te really the oxupmt of me
reyui m h'h emetpriormiss aoIaCiant'" Occupancy. Signature of Applicant Date
All roof coverings to be Class"B" or better
Ow er .roti gent Dam