05100109 CITY OF CUPERTINOo-
BUILDING DIVISION PERMITCUI�ITRACTOR�INFORMWTI N`Ni
rA,x, nr. 0wa. Ta s-
BUILDING ADDRESS: , PINN BROTHERS CONSTRUCTIONS PERMIT NO'05100109
10745 N DE ANZA
R'S NAME: PERMIT IESUHDATE
BAY COLONY INVESTORS II IN 1475 SAFATOaA AVE
SANITARY N0, CONTROL NO.
PHONE:
(408) 252-9131
BUILDING PERMIT INPO
ARCHITECTIENOINEER:
BLDG3
EO PLUMB MEOCH
tett LICENSED CONTRACTOR'S DECLARATION lob Description
U I hereby affl.that l are limnsd under provitlom of Chapter 9(rommcncing
with Section 7")ofDi,i i..3 oft the Business and Professions Cade.aha my license u
. � inarBforce andeflect. ^. �y NEW CONDO-1, 193
'!a Z Lieenx lacy Le.ig
aybat Dnu Contractor
44 ARCHITECTS DECLARATION G
i 2� I undununJ my plain shill he meJ as public rcenrJs
)�
.0 Licensed Profeml
ions
OWNER-BUILDER DECLARATION
I c Z I hereby.(Tien on I I.S.esempl from the Canu s Co Liana Law for the
-0 0 which g moxa.permit
t n6l ,Alo.a and Profcuiam coda:nay city ar roomy $255743
5$fLi which inquires a permit ac vires the
altar.impmw,dPermit,ore a s11 mYig ed ttunum
•Zj, priarinits iuusncc,iluant1, athaapplicant
nscifwfmchparmr'succo Lacdstatamam Valuation
that
hatslkanseJpunumlxtheprovisiomaftheConuaclmeLicCnxhaw(Chapkr9 Sq.Ft.Floor Area
a�Sfeommcncing with section 7000).(Divi,ian 3 of the Business it Pralwahms Cada)ter
that he is ecompl themfrom and the basis far the alleged esemption Any vkdaian of
Section 7031.5 by any applicant for.permit subjocu six applicant m a civil penalty of r V V Occupancy Type
Out ream than five hundred dollars(SSW).
I,uownerofukptoprty,mmyemployeaswlthmrAu etmkeomPu Ow.
will do thework.md de,Imctuin tsnmintendead or offered mm.k(S.C.70".Business Required Inspections
and Podasaom Cade:Tim Commitments License Law does out apply M an Owner of q p
property who build,orimproves thereemand whodoessuchwark himmlfser Waugh his
ownemployees,provided thatsueh improvements am not iaknded.oRered forsale.IL
however,the building m Improwm.tt is sold within one your of eompletan.the ownu-
builder will haw dw bunko Of pmA.g that ha did nal Wild or orprom a far pulpae of
ask.).
❑1.as awmr of tha property,am exclusively conmcdn{with Ilcensel.wnuanon in
romtruct inn p ojea(see.You.easiness and Profession Cade:)The Continence-u-
cense Law dans out apply in an own.of p epeny who builds or improwu dmmon,and.
who contracts for such projects with a contnnons)licamed pursuant in site Cantr.cmYs
License law.
❑ I ore uempl under See ,B d P C for this mason
Data
WORKERS COMPENSATION DECLARATION
1 bemby a0bm under penalty of perjury oto of the following deelsommer
haw and will mainuin a Certificate of Consent in self-imam far Workers Compen-
sation,as provided far by Ueda.3700 Of the labor Cade,for the part---of de
oro r which this permit is Weed.
I have and will maintain Wmimes Compensation Insumna,u required by Senior
3700.1'the labor Cade,far de part=..of Je workf whWithispermhtsiasued.
My,
y Wor Ilan haarrm arra.and Policy
tinier. 1 /T S Pa11ry No
CERTIFICATEOFEXEbIMONFR WORKERS'
COMPENSATION INSURANCE
(Ihuxnion need int he completed true pered,is narrow hundred dollen($1001
or lure.)
I ec ufy that in the performance of Iha work for which this permh Is Wand,I shill not
employ any permn in my mmmrm as m became subject in the worker'Companastion
Laws of California.Data
Apidicanl
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should
baome subject in the Worker's Compensation prov4ions of the Labor Cade,you must
.J O forthwith comply with such provisiam m this Permit be deemed revoked.
z^ CONSTRUCTION LENDING AGENCY
f••' Ihereby affirm lha,then is a eousraninr lending agency for the performance of
a> the wart for which this prssnh is blued(Sec.3097,Cw.C.)
W 0 Lenders Names
0. Lenders Adder..
U Q 1 anify that 1 hive read this application and sum that Nes ahem Informauun is
W
Comet.I.gree to comply with all city and county ordinances and state laws relating to
�U building conswclian,and hereby authorize represenutivca of this city to CRIT upon the
W above mentioned property for inspection purposes.
OL (We),gine to asw,indemnify and kce harmless the City of CYPadlaa against
vF-,VI for"IU"'bd{menus uandexperuos whi mryin my vay.mue a{ilml said City
U Z in co or this Zing of this penmi
t••t
LI A UND ANDS AND WI COMPLY WITH ALL NON-POINT Issued by: Date
SOU ER NS.
94 2,11-11 Re-roofs /Lf
Si{nilux ofAppa aRDO
HAZAARDOUS MATERIALS DISCLODam SURE Type of Roof
Willy Une Cupertino
future Wildingoccupantrmreorand Hard anmaterial
de0rcd by the Cupemw Muni' 1 Cade.Chapter 9.12,and the HCilth and Safety ,
Section 255324)7 All roofs shall be inspected prior to any roofing material being installed.
1]Y. Na
Will the applicant or future building=open,use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hmudous air contaminan III III by the Bay Amo Air Quality Management all new materials for inspection.
D slric@
❑Yes, Nu
wA
s moon,, uiremcau under Chapter G95 of the Califor.
nia th .25505. 33 ad 255X 1 mldesiand this lithe building
it t e 4 Nm ll Y y teapo ndbility in newly the 0.Yupanl Of the
req. m t prior fa CcrtOakgaeupency. Signature of Applicant Date
111P6d ,te_ All roof coverings to be Class nB"or better
Owner.outhariyaagent