05100106 CITY OF CUPERTINO �. ^� �`'' '`" ��"'°"' �'• '""
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BUILDING DIVISION PERMIT CONTRA, ',,,R INP'U121Ve�'TI( 1V .
BUILDING ADDRESS: t FINN BROTHERS CONSTRUCTIO 'IMrt"x'05100106
R'S NAME: PERMIT ISSUE DATE
BAY COLONY INVES 475 SARATOGA ANTE
PHONE: SANRA0.Y N0. CONTROL NO.
408) 252-913
ABUILDING PERMITINr-0
RCNITECfyENGINEER:
BLDG ELECT PLO MEOCH
oppp LICENSED CONTRACTOR'S DECLARATION Job Description
V bI hereby affirm that 1 am licensed under provisions of Chapter 9(commencing
with Section 70ra)af Division 3ofthe Business and Pmfeaiuro Code,and my license
! y in full farts and affect. Zq l'a. NEW CONDO-1, 272
r w�z Lice. Ire Lic.s
Vis• Dem
Contraction Milli `
ARCHTfECTS DECLARATION
1 urtdersmna my plans Mall be used as public records
tyU
SCC' Licensed Professional
u,3 OWNER-BUILDER DECLARATION
ConTION
I a I I herehy.(Sero than I am mmpt Wm the Csshoms o License law forme
.p O following reason.(Section 7031 .Business and Rvfcssi rr Cole:MY city or minty
1$
which rtaulros•permit re eines dic eller.impmae.dcermit ri rile a sig ed romeone menian
•a:i prior m its issuance.Aso2226711
Asian
dm applicant f Contractor's
icanceLawJnakmcnr Valuation
C matheItlicensedpursuantmthepon ionsefJseCanuacmr'sLicemelaw(Clade)m Sq.Ft,Floor Area
`�g (canmcminlwith Scctian7a00)of Divuim3oftha BuslnmaM fmiom Cade)or
.• mat be is exempt therefrom and dm basis for the alleged emmpdam My violation of
Semon 70314 by any applicant fa a permit subjects the applus nl m•civil penally of r 0 Occupancy TYPe
not mom Nm few hundred dollars($300I.
❑1,a water of the property,army employees with wall a Weir solccompemadon.
will do Neworli Na swctum Is mtimended or offered fomate(Sec.70".Business Required Inspections
and Preis alum Code:The Contractor's License Law dol mi apply m an owner of q P
property who bulldsorlmprones Luerso n,and whodmsuchworlehimselfm through bis
ownemployecs,provided that such improwmenu as notheended m offered forsake.11.
however,the building or Improwmem Is sold within am year o(complman.the owear-
builder will 1mw she burden of proving that he did wt build or improw for purpose of
ate I.
❑1,As owner of the Imparts,am exclusively contracting with licensed centramn m
mm sect me pmkm(Sec 70".Business and Profmimu Code:)The Casualties U. -
came law does not apply m an owns of property who build,of improm thereon.and,
who contracts for,ach projects with a cenuacmr(,)licensed pursuant in the Comni
Lana.law.
❑I am mempt m ign sec. .B k P C far this moo.
Data
WORKERS COMPENSATION DECLARATION
1 hereby atom under penalty of perjury aro of the following declarWam
M I haw and will maintain a CudOnm ofComenl m self-Imumfor Workers COrmam-
sallon,u provided fa by Section 37M of the Labor Code,for me Performance of me
wo rwsuch this permit is issued.
1 hew end will maintain Worker's Compensation Insurance,u m9ulmd by Secdm
37M of the labor Code,fa the performance of the wank for which this permit la issued.
My Warks m ensutlon Insurance artier aM Policy n he
Caerer•._,�Policy Na.:.l>L<.B1t3.aueL�
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(thisaction need not he completed if the permit Is Formic hundred doors($100)
or Inas)
1 certify that in me performance of de work fa which this Permit is blued,I shall not
employ any person in my mannerso a At became subject to the Worl iCompensation
Laws of California.Dale
Applicant
NOTICE TO APPLICANT.If,Our mutant this Certificate of Exemption,you should
become subject m the Workers Compensation provuio a of me LAW,Code.You muse
z forthwith comply with such pmvinons or this permit shall be rimmed revoked.
z CONSTRUCTION LENDING AGENCY
[•n4 Ihemby.M.des,dumb.comlmcJon leading.mlar me ped.rmance of .
G'> We week fur which this permit is issued(See.3097,Civ,C.)
ALeorkes Name
z lender',Addrm
U 0 1 certify Wal I haw read this application and sum mat the show Information is
D. P comet.I agree to comply with all city and county ordinances and sum laws relating to
DU building construction,and hereby authorim representatives of this city to enter upon the
r W above-mentioned properly far inspection Purposes.
0. (WT.)agree to sew,indemnify and keep harmless the City of Cupertino Against
V) limilides,judgmcnm,coats and num which may. my way accom against said City /
fJ z in cc car
the/rerun of is permit.
.. APPLICA U ER A D ANO WILL CO PLY WITH ALL NON-POINT Issued by: Date
SOURCE OU S -
�1� Re-roofs
Signuurta limucanranor Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applkent or future building aampant sera or handle hemardoos material
fired by the Cupertino Munin� 1 Cade.t]upser 9.11 and d¢Hnlm all Safely
Same.35532(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yos
Will the applicant or future building aavpant sea cduipment or dcvim which If a roof is installed without first obtaining an inspection,I agree to remove
canis hvardnm air c..=me Or defined by the Bay Arta Air Quality All...I all new materials for inspection.
Dlmrict7
❑Yos u
I ham mad the herod molest bmyuircmems under Chapuer6.9fofine Califor.
ni.;��. 25533 srld1533 .Iundefsmndthmlrthc building
JamU s my mrpensihilily m rwul'y the mcupant of Nc
'asuwaaf.C.rufc, rOceupaney. Signature of Applicant Date
own r.,authorised..;Our Dam All roof coverings to be Class"B" or better