05100105 CITY OF CUPERTINO '�_ :cap : «'*,�idc; °' ' "
BUILDING DIVISION PERMIT `CJ�O= ivTRtItCTQRINFRMA 'ION
BUILDING ADDRESS: s PINN BROTHERS CONSTRUCTIO Tam"°'05100105
R'S NAME: PERMIT ISSUE DATE
BAY COLONY INVEaTORS 11 Ll 7 1475
CO
SANRARY NO. NTROL NO.
PHONE;
408) 252-913
ARCHIIECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECTPLUMB MECH
Z
Op LICENSED CONTRACTOR'S DECLARATION lob Description
ti I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing
with Section 70100 of Division 3 of the Business and Profeasiunr Code.and my license is
I.full romeaMefrect 35Zq�t NEW CONDO-1, 178
t�? Liccwc Class Lim.N
Da.6' isL Com"'m Ili ff e. �' e
q�q T ARCHITECTS DEC RA SbIP p
2 1 undersand my plans shall he used as public records
ti
SCC' Licensed Professional
OWNER-BUILDER DECLARATION
)a Z I hereby affirm on I amexempt from be Cssums o License Law for the
e o O fallowing roasm.(Section 713 I.S.Business and Improve,
ocr um Cad:Any city s manly
$ which tequima s e.aim re enm Ile alwc imprew,d Permit
i or repair any atrodure
prior m Pss issuance.also requires the applicant forsuh pcnnit w tilt aaigned staumanl Valuation
-�� dot he u licensed pursuant dte provisions of the Conuacur's Uccnsc❑w(Chapter 9 Sq-Ft, Floor Area
i� m oncoming with Seclimn7000)o(Divtsimn 3ofthe Busimmmnd Prormbno Code)ar
$ Net he u exempt tWd m scullion basis for the alleged esemp0oo.Any violstion of
Section 7031_3 by"applicant for a permit subjects the applicant to A civil penalty of r 0 Occupancy Type
not mom don It.hundred dolan($M
D I.as owner of that property,or my employees with wages as th.4 sole cmmpensetion,
will do the work and thesouclure Is trot intended or offered for sake(Sec.7014.Budneas Required Inspections
and Preform Code:The Commune'Lienee Law does rot apply u an owner of q P
property who buildsorimpmves maroon,and whmdoeaawhwork himself or through his
awnemployew.Provided that such improvements aw not Intended oroffered forsale.If.
however the building m improwment is=to withino s year o(enmPletion.the Owner.
builder will haw the burden of proving that he did Out Wild or Improv for purpose of
"lc.).
D 1,u owner of the Property ser exclosiwly mnuaning with licensed mmrmorm in
mwuuct the project(See.7014.Business and Pmfestlmts Cade:)the Commences U. .
cense law does rot apply a an maser W Property who builds;or improves meteor.and,
who contracts for such projects with a conmcur(s)licensed pursuant to the Commences
Licess.law.
I am..emit under Sec. .B&P C fw Nis mason
Dace
WORKER'S COMPENSATION DECLARATION
1 hereby o ire under penalty of perjury One mf me following dcommtimnc
QI h.w and wf main was CutiOmu of Come,to self-insure for Worme.Canpen-
soon.n provided for by Section 3700 of the Labor Code,for the perfmrma,e of the
wocar which ibis permit is issued.
1 haw end will maintain Workees Compensation Insurance.as required by Section
37W mf the Labor Code,for tha performance of the work for which this permit is Issued.
My Wark�m�jn-.aado�nn wllo�uunnm carrier and Policy u
Carrier. T RNB�►ia4�1 Polley No. ^O
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
f rho section need rot be cam pleed time permit a forane Wnshed Mian(S 100)
or less.)
1 certify dost in the performance of de work for which this permit is blued,l shell not
employ any Person in any memerso as m become subject to tie Workers'Compensation
Laws of California.Dau
Applicant
NOTICE TO APPLICANT:If,4fur making this CmnOcau or Exemption,you should
became subject in the Woher's Compensation provtsims of the lobar Cede,you most
.,O forthwith comply with such provisions or this permit shall W deemed revoked.
�0 CONSTRUCTION LENDING AGENCY
(r I hereby same that mem is a construction lending agency for to Performance of
ce 7 the work im which this permit Is issued(Sec.7097.Civ.C.)
W�Q Lendme.Name
7.Z landau Address
U O 1 certify mat I have read this application and sum that the above Information is
fY fes^ correct.l agree to comply with all city and county ordinances and sum laws misting to
Dr, building construction,and hereby authorim rtmosenali-I Of this city m enter upon the
W ahove-rommioncd property for inspection purposes.
(We)ague to ave,indemnify and keep harmless the City of Cupertino against
rFi y liabilities,judgmenb.c andeopenseawhich ay in any way acme againstasid City ''rr
C)z in co meq ufthe ng of this Permit
^" APPLIC UND NDS AND WIL COMPLY WITH ALL NON-POINT Issued by: Date
SOUR R U
Re-roofs
Signamt of ApplicasZonTractor DowOf Roof
HAZARDOUS MATERIALS DISCLOSURE Type
Will the appikmt or future building meupowtmum or handle haardous material
fined by the Cupenim Municipal Cod.Chapter 9.12.and the Holm and Safely .
Section 25332(a)7 �i/o All roofs shall be inspected prior to any roofing material being installed.
DYes
Will me applicant or future Wilding occupant eastequipment or device which If a roof is installed without first obtaining an inspection,I agree to remove
emit hmardow air cmntsminsnto u fined by de Bay Arta Air Quality Management all new materials for inspection.
District]
Dyer u
Ihammadlhehojrusmamrialarequir enuunder .Chipur6.95ofde Califor.
no
Flcnith Cad23JU3,2357J d25334.1umlcnundthmifthc Wilding
rims not c h w that It u my ponobility m notify the occupant of the
nu k e,pdorwissua,afaCcrygRate roemp,rw'. Signature of Applicant Date
Owner orauthorimda ant Dae All roof coverings to be Class"B"or better