05100113 CITY OFCUPERTINO "�' "'"�
BUILDING DIVISION PE MIT .CONTRAq,,,P,(1R'INFORMA.TF4, N"
s zk„+& ,.
BUILDING ADDRESS: PINN BROTHERS CONSTRUCTIO PERMIT"x.05100113
0745 S
R'S NAME: PERMIT ISSUE DATE
BAY COLONY INVESTORS II IN 1475 S
PHONE: SANITARY NO. CONTROL NO.
(408) 252-9131
ARCHM=ENGINEER: BUILDING PERMIT INFO
BLDG ELECT' PLUMB MECH
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ipp LICENSED CONTRACTOR'S DECLARATION Job Description
1 hertbf affirm u d I am licensed under provisions of Chapter 9(Mmmeacing
.Sj with Section 70M of Division 7 of the Business enol profemmum Cade.and my liceme is
m in runrt
foe tenderfeet. 35sAy NEW CONDO-1, 460
h Z Liansc�Iass Lic.
Dam Yrl ef�wL —camreclor C
ARCHfTECI'S OECD
i i understand my pines"I he used as Public records
s
•c�,S Labeled Pmfusiraml
3 Oat I am exempt
from
mDECLARATION
0 1 brthy.(Res on I a1.,Busin from dm Contractor's Co License Lbw for ac
po followingreason• Uraftt 7031.5,Business and Improve.
dernm Code:Any City or county
iso! which requima issuance.permit re enmum4 per,improve,ae ermit t nr e a sig any suunum
_¢i thin he islensedpumant to the the applicant roe much permit m Bleuigne(ChaPtem Valuation
thathamming itpSesuantto0MofDislomofthen,Buanmrsluemelaw(Chapmr9 Sq.Ft. Floor Area
(commenting with Section700Mand ft basis f 3 of the alleged
W Pseon.My
Cade)or
.• Net io u exempt1.5 btherefrom and tax lour.for be Ms de, exempnm.Any Wolman of
Section7031.5by hunreddollas(aperchmblma the Applicant toacivil penalty of r 0 Occupancy Type
not mom Than five hundred dollen(53001.
❑I,ummratth pmpMy.mmyemploycmwithw Mwa irmlecompensadon,
will olo thcwrk.and aeswctum la not amndedmaRcrtdfm We(Sa.]Oaa,Bush.••
Required Inspections
and Profesdom Coag:The Communes License raw dam oat apply m an convert Of q P
properly,who build,or i mpeoses tlarmn,andante doe,such work hima4f e,through his
we employees,pre lded mat such improvements tae ant intended or offered fat le IL
however,the building or improvement is sold within One year of completian,me Oval
builder will have she burden of proving Nal he did not build or Improve(m Purpose of
able).
1.as Owner of Or properly,me ealusively"emaating with Iimmed cents m to
mmuuct the project(See.7044.Business aha Proreaaiam Cade:)The Commences U-
come law does oat apply m an owmr of properly who Bibb or improves thertoq and.
who contracts for such projects with a mnuanm(a)licensed puremm M the Commences
License raw.
1 am accept unaee Sec .B At P C for Nie moon
er Dam
WORKER'S COMPENSATION DECLARATION
/ 1 lovely aRim under penally of perjury one of the(allowing deshma am:
3 h,ve and will maintain a Comfiwm of Consent to self-hum.fm WarkCe3 Coal
mum.,Or provided for by Section 37M of Ne labor Code.for the NVIaman¢Of the
wo or which this KKR is useed.
1 hes and will maintain Worker's Compenenian?mum=,as,mounted by Section
37M or the labor Code.for On performame of the work fo hich this permit is issued.
My Works an Imuran,warier and Policy
Geier. (I Z*W5 policy Na: �I
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section recd mtbcomplemd If the permit is forone hundred dollen(Slip)
at Ices.)
1 unify met in Ne Performance of the work for which this pemit is Wood,I shall ml
employ any person in my mannerI as In become Subtl rotate Workers Campematim
Laws of Caliromia Dam
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should
become subject 0 the Worker.Compensation provisions of the labor Cade,you must
.J O forthwith comply with such provisions or this permit shall be deemed mwked.
Z CONSTRUCTION LENDING AGENCY
(� I hereby affirm that boort u a mmuoction lending agency for the Perrormemc of
rt> the wort(m which this permit is immd(Sec.3097,Ci,C.)
Wry~n. Utudels Name '
.7 z Lcndefs Addrem
U Q 1 certify that I have mad this application and sum that the,hove infomWun la
Ly F~•' COMM.I UMC to comply with all city and county ordinances and State laws mining to
OU Wilding convection,and bemby auaorire mpmsenutives of On city to MUM upon as
ction
,A ,bve.menuunemenseny for
bad c.e.,whichpurposes
(We)agree m eve,indemnify and keep brimless the City of Capcnino against
titi liabilities.judgments.casts end eapenxs which may in any way aceeuc against said City
in conm�Ulll
er t.APPLICD N LL COMPLYWITN AIL NON•POINr Issued by: Date 1( i
k-11-" Re-roofs
Sigmtumof PPRAr anuamor Dau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will dre applicant or(u tum building Occupant start of handle hauammus material
defined by the Cupertino Muni al Code.Chapter 9.13,and the Health and Safety
Section 35533(a)? All roofs shall be inspected prior to any roofing material being installed.
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If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or fumes ise ldtng Occupant ucquipmenl or device;which
emh haraednm it, mm deflated by the Bay Area Air Quality Management all new materials for inspection.
District?
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I have mad the hvardous Us mriele yvimrmnts under ChePmr6.95ofdu Gllfon
Mia Heal Safety Sabom25303. 3llind233H.luricmmdthuifLh bilding
"Can e dy It for m,met It y rapamihllity m notily the occupant or the
mqui me sthemet print mom OfaceetifmamofOccupancy. Signature of Applicant Date
All roof coverings to be Class"B"or better
Owner or an norized,gem Dam