05100112 CITY OF CUPEsRTINOvqur,� m
TiCTORIsU_ R.9aAfI
BUILDING DIVISION PERMIT �� +Ft MN
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BUILDING ADDRESS: PINN BROTHERS CONSTRUCTIO rb""0'05100112
7NAME: PERMIT ISSUE DATE
BAY COLONY INVESTOR IN 1475 S
PHONE: SANITARY NO. CONTROL NO.
(408) 252-9131
ARCHITECT(ENGINEER: BOPERMIT INFO
8ELECT
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loo
LICENSED CONTRACTOR'S DECLARATION Job Description
i�Z+ I hereby AM.that I me licensed uMar pmviYons of Chapter 9(mmwsing
t< with Section 7000)of Division 3 of tha Business tad FIVIOSS n Cade.and my lloease is
,oNh mmnmwanderre NEW CONDO-1, 178
tnZ Lucem lana�Llc.N
mr
Date—944-0 6_ARC NI'fELTS DEC LAA ION G
i 1 understand my plan sha11 be used as public moods
sal
.o
Licensed Professional
x OWNER-BUILDER DECLARATION
ON
I i i I hereby mose n(Bnn othat I 1. attempt from Nc sCContractors :Any c Law for No
.p o following mason Permian 7 onstru t.alter. and w.de Professions Calc:Any shy or county
$ which mquims a permit reconstruct.alar,improsu h Perlin ofrepair
asir any struunumum
•Zi pdormita iasuancc,ahu requires the applicant for sch Permit tilt aalgneJ suomant
i G Thu heulicensedpursuanttotheprovisionsoftheContractoriLicettmIAw(Chapmr9 Sq.Ft. Floor Area Valuation
S $ (commencing with Section 7000)of Dividan 3 of the Business and Professinm Cole)or
— that he is exempt themfmm and Ne basis for Nc alleged esempdm.Any violation of
Section 7031.7 by arty applicant far a permit Subjects the IPplicanl lo a civil penalty of r Occupancy Type
not mom Nan five hundred dollars(51110).
01,asownerofthepmpcny.ormywploycmwithwgesuOchslee Pemd0n,
will do Liework,and theawctum B OutintandeE or offered mask(Sec.71144.E.M. Required Inspections
and Pm(esriam Code:The Contractos rLlecom Law decal ant apply 0 an owner of 9 P
properly who buil"m ire proves thereon,and who deaf Such work hitmelf w through his
own employers,provided thatsuch bo mm unu am not unanded wo@red for Sale If.
howem,IMWildingwimpmwe tusldwhhinaneymo(mmpletis,theowner-
W ilder will bee Ne burden of proving that he did rot Wild m imProw(w Purpose of
talc.).
❑1,n owner of the property ant exclusively contracting with licensed commem's le
comment the pmkct(Sec.7044.Business and PmfeWom Cade:)The CsnaeNYs Li-
m.taw dena oat apply an an owner of property wM builds or improves Hewn,and
who c..=U for such pmjecu with a mntractor(0 licensed purmsm to the CDmmmw'a
License Law.
❑ I em exempt under See .B A P C for this rea en
r Dam
WORKER'S COMPENSATION DECLARATION
hereby affirm under penalty a(perjury one of the following declaration:
I ham.m will maintain aCeNncem o(Cameni to SelFimum far Workefa Compen-
mmim. provided for by Section 1700 of the Labor Code,for the performance of the
wo
r which Nis permil'u isued
EI Mve and will mamuie Werimes Compenatis Insurance,as teyvi¢d by section
1700af NoV Code,forme perfarmanceof Newmtf which this permit u USOOL
My Warless a penudan c easier and Policy
Carver: r S Policy No.
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
MIS Section need smite completed if Ne permit is farone hundred dollars($100)
or Ices)
1 cenlfy that in the performance of Ne work for which this Permit is issued.I Shall not
employ any Pena.in any manners as m become Subject m Ne Wwket'Cwnpemmlon
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:IL alter making this Certificate of EcemPdon,you should
became subject to the Worker's Componasdon Provisions of Ne lab,Cede,you must
Q faMwith comply with Such provision,this permit sl dl bmvoke
e deemed red.
z► CONSTRUCTION LENDING AGENCY
�F/ I hereby alarm Nu there is a mnumctinn lending agency for the performs¢ f
o
yl � the work for which this Permit Is Issued(sec.3097,Civ.L'.)
i n~. Lender's Name '
.'7 Z Lenders Address
U O I cutify that 1 have mad this application and num dw the W.Information is
P correct.I agree to comply with dl city and county onlinancm and State laws mlating to
OU building construction.and hereby authorim repmaenmives of this city to enter upon the
W aImr.-Oncnfuncd properly for inspection purposes.
(We).,me to ave.indemnify and keep harmess them
lCity of Coconino-gas
ti y IiabilidN05P
which sy in any way secw against tato City
Uz in noperm it. 'a
^" D WI COMPLY WITH ALL NON-POINT Issued by: Date G
-l7"" Re-roofs
Signature of AppliandConuxmr Dau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding uccupantamm or handle hazardous mamrid
defined by Ne Cupertino Monte I Cade.Chaplet 9.1x,and the Health and Safety
.
Sect 35532(1)9
All roofs shall be inspected prior to any roofing material being installed.
❑ver u
wn Nc.ppfieanm or stare tiding emupam tax cquiPmenl w Jevkes which If a roof is installed without first obtaining an inspection,I agree to remove
emit h mmame,air cmtaminnta 0ned by th B y Area Air Quality Management all new materials for inspection.
D urint
❑Yes Nu
Ihavcmal Nehwardnusmato I yuI mcnuunderC1wpmr6.97ofNeCalifar-
.14Hcalp Sala dc,Scctiwux7707, 31 and x5734.1 uulorstand NU lfthe building
Joes [c nl rho a arsons Nu It is y responsibility m notify the occupant of the
m�lr�m uz be wt nnrttiroa
=of.certe of Ocspaney.
tl f'TSignature of Applicant Date
g
Owncro mthamrdagem W"' 6+--• D,m�S All roof coverin s to be Class"B"or better