05100111 CITY OF CUPERTINO
BUILDING DIVISION PERMIT C01�IT12AT'QI2, I,I�FUM� 'Z �''•
BUILDING ADDRESS: s PINN BROTHERS CONSTRUCTIO pC0.M1TNo.05100111
10745 N DE r�PERMIT WAM DAM
R'S NAME:
BAY COLONY INVESTORS II IN 1475 SAATOnA AVE
PHONE: SANITARY NO. 7 CONTROL NO.
(408) 252-9131
BUILDING PERMIT INFO
ARCHITECT/ENGINEER:
Elm Eta
PLUMB
t�
83 LICENSED CONTRACTOR'S DECLARATION Job Description
i V 1 hereby affirm that 1 at licensed under provisions Of Chapter 9(commencing
;¢9 with Section 7")of Division 3af the Busir«•••sed Prolenduts Code.and my license is
=y m full forte ad effect. 3529 Z NEW CONDO-1, 178
z Lkaucchis�L�—Lica
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_48to V� ARCHI EC'CSDEC
m 1 understand my phos shall W used as public records
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1wl; Licensed Professional
y� OWNER-BUILDER DECLARATION
I hereby from that I at exempt from the Contractor's License Law for the
:O o fallowing memo.(Section 7031.5,Business and Professions Code:Any city or county
�s� which mqulru a pored m cmmin,after.improve.demullsh.or repair any structure
-iy priaruitsissuance,also mqules me applicant for such permit to Ole atigneJ suement Valuation
C
that he is Ilcenand pursuant in the previsions of the Conuxur's License law(Chaper 9 Sq.Ft. Floor Area
2 $ mommmsingwiM Section 7000)of Division 3 o the Bmlmeamd Pmicesam Code)or
9 ..
malice Ia exempt therefrom and the basis for the alleged exemption.Any violadon of
Section 703 1.5 by my applicant for a person subjects the apPlicans to a civil penalty of Occupancy Type
net more than fin hundred dallue(5500).
❑I.uawner of me gofserty,ormy wploycea with wgeau the4 mlecompenssdon,
wdldothework.and mestmcture unotinume dora(rased Tartare(See.7041,Business Required Inspections
and pmfeW.m Cade:The Cro mclor's Lieatse Law does m1 apply m an ownu of
pmputy who builds o4aprowtitman,ad who doessuch wank himselformmugh his
awnemplayetes,provided that such impronmau art not imeMd oroRerd(an hit If.
however,Ilse Wildngar improvement is mid within ane year of coapletim.the owner-
builder wild tun the burden of proving that he did at bulb m Impron(or Purpose of
sale.).
❑I,an owner of the property.Me aceirm sly eonuacti q,with licensed common u
construct the project(Sec.TA,1,Business an Pmlesslom Code:)The Coommeasr's Li.
CO.law does nal apply man owner of property who builds ar Improves thereon,Md.
who concocts for such projects with amnsremr(U licensed pursuant as the ConmacmYs
Lictme law.
❑lam exempt under Sea .B a P C for this Mason
r Dau
WORKERS COMPENSATION DECLARATION
/I hereby affirm under penalty of perjury nm of the fallowing dummeatam:
I hasand will madman a Cerdiiam of comem in elf-Insure for Worker's Complex,
udon.u provided for by Section 3700 Of the labor Code.far that Perla mama of the
wodg fdI which this pant,is issued.
I Eon ad will malnmlrx Warkefs Campeuatian Insunnm,as scyWreO by SeNa
3700 of me kjDor Cadt for the perfoman.alms wort ,which Nu Permit u issued.
My Works m
ore otirri
on luunxxre caer a,policy rk
Cartier: Policy N -
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
QmaseNnn need nothe completd if the Permit Is fortune hundred clothes(5100)
or less.)
I certify that In the perlomanee of the work for which this permit U issued,l$hall not
employ any person In any matter u No bane subject is the WorkersCompensation
Laws of California.Due
Applicul
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Wanker's Compenutian provisions of the Lahor Cads you am
.J QM
fawith suc
comply with h provisions or this pant shall be deemed revoked.
Z► CONSTRUCTION LENDING AGENCY
[—t I hereby$Mho mu then is a construct lending agency for that perfommen of
Pf:> the work for which this panel,is issued(Sec.3097,CN.C.)
W�0 Ladeh Namc
z Laticra Address
()O 1 certify that I ban read this applicant,sed sum mu the shoo information is
It, F^' correct.1 agree to comply with all city and county ordinates and state laws relining to
� j building construction,and hereby amthoire representatives of this city to corer Upon the
W ahun-men Toned Property for inspection puriwres.
(We)agree to un,indemnify ad keep hamlets the City of Cupertino against
i(aq liehit 0es,judg emu,casts and expenses which may In my way accrue against old City
V vL inconega o cFFFtF����mnlAln this pcOR ��L
^ APPLICA U SAND WILL C )PLY WITH ALL NON-POINT Issued by: Date if—
so
f- �1
soURCE EGU y
(I-& Re-roofs
SignuSppacat/Canlre tW D°mof Roof
HAZARDOUS MATERIALS DISCLOSURE Type
Will the applicant or future building eccupalmre or handle haardau maelial
defined by the Cupmino Municipal Code.Chapter 9.13.ad the Health ad Safety
Scedon 25532(x)7 �7vJ All roofs shall be inspected prior to any roofing material being installed.
Yu
If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or furore building occupant um equipment or Jevima which
emit heardnus aircanutrammu dcrined by the Bay Amo Air Quality Managemem all new materials for inspection.
District?
❑Yes u
IMdardou rom"iab nimmenu unJer Gapmr6.97 of the Califonn33ad 21534.1 unJeramd thattite building
a cone..mat I u y rmpouih1111Y la nNl'y the cecupat of me
mebcnefPon, o(aC eofOcapancy. Signature of Applicant Date
11 �� All roof coverings to be Class"B"or better
Owner or amhorixed gcmt Gam