05100114 CITY OFCUPERTINO
BUILDING DIVISION
PER 1�'.CUNTRA.C,`l'OR�7 `� M�' jON -
BUILDING ADDRESS: x PINN BROTHERS CONSTRUCTIO SRERmrr No.05100114
10745 N DE ANZA BLV
PERMIT asue DATE
.R'S NAME:
BAY COLONY INVESTORS II INC1475 SARATOG
PHONE: SANITARY NO. CONTROL NO.
(408) 252-9131
BUILDING PERMIT INFO
ARCHrfEC1yENGiNEER: BLDG ELECT IE PLUMB to
MECH
l� L�
op LICENSED CONTRACTOR'S DECLARATION lob Description
b r- 1 botany sRrm Thu I am licensed under provisions of ampul 9(wmereacins
wishSecdon70110)of Division3ofthe Busiuuand Professium Codc-a myliam'u
in full farce and effect ����_10" NEW CONDO-1, 178
(4Z Liccn Clus�_Lk.N
F Dem Comrwl'I
ARCHITECTS DECLA�ATIIIR� P`y"B/w—`a' )Lie
i 1 understand my plansshall be used as public mcmde
iyU
.p Licevcd Professional
OWNER-BUILDER fr DECLARATION
I hotly.11fifirmsec the 11. exempt from the CssionC's License Law for Be
oo followingmoon.(Scoden1031.1Busiauand vc Profession Cad':Any city or county
e$ which requiresnBeastreeorestheellenimPww,hpemitimrepsigeduwnum 252527
tat Wal tensed meon,soda,thovisios of the for achpermilo Tima.ig.(Ch.p oro Valuation
(commencing
licensed pursuwl m00)o(Diucnsa of
Business
sand Prulaw((Captm9 Sq.Ft. Floor Area
SSB that he .atereitheectim 7000)of basis nuc of theopeinm andon.Any
Cude)or
mnof
— Net io u aumpl therefrom and the bur it bi sloped t ed exemant to Any violaden of
Section than by veemapplicantfar.permswbjee,NeapplicentIreacivilpensltYof Occupancy Type
hat mom then five handled dollus/S300),
0 1,u owner of Bk pmpcny,w my employees with wages u then cle=Penwthon,
will do the work.and the saaluta 4 namendedaraQered include(Sec.7044,Business Required Inspections
and Profession,Code:The Conuumr's Liaise Law docs at apply b an owner of q P
property who buildsorimprovesthercen,and who doessuch work hirmelforthroug),his
ownemployecs,provided then such improvements sm not intended aroRered for We IC
however,the building or Improvement r old within am year of omPledmn.Ino owner-
builder wEE haw de burden of proving But he did not build or improve for purpose of
0 1.as ower of the propmy.am'aluuwly aonuacdn6 with Earned canmennma o
construct die pricks(Sec.7044,Ballow and Professiav Code:)The Camcmes U'
came Law does lot apply to an owner of property who builds or improve thason,and,
who canna,for such projects with a comramr(s)licensed pursuant to the Cmnlrumm's
License Law.
Of
oro exempt under See ,B B:P C for this moon
er Da,
WORKER'S COMPENSATION DECLARATION
II hemby effluent,Mer penury o(perJury nuc of me folbwin6 declarations:
re and wB munuin a Ceniemm of Covent m wlr-alum rm Woe eesCompen-
sadon,as provided for by Section 3700 of Be labor Cade,for the performance of One
xro A which Nu permit"oad.
I law eM will munuin WorkNs Compensation lommna,u required by Stevan
00 of the labor Code,far the performance of Ne work for which this Peonk a luued.
My Wory���a�j�.v�e. to. artier end Policy
f AfNB�t Poli
Cartier. N NI
AM
PE SATIONINSURAN ORKERS'
COMPENSATION INSURANCE '
(Dir section need Out as completed If the permit is forma hundred dollan($IIX)
or less.)
I¢miry BOB in the performaae of Be work for which this Food,is iuved,l still not
employ any Barco in my mwarso as as become subject m the WaftW Compemation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you mould
become subject as the workms Compenw4on provisions of the LeW,Code,you most
,J O forthwith comply with such provisions or this Permit shall Its damnw
nd aked.
„Z,tCONSTRUCTION LENDING AGENCY
0
f'+ Thereby affirm Buttthem 1,a comtruclinn lending agency for the Performance of
a > Ne work for which this permit Is issued(Sec.3097,Civ,C.)
GLmdar's Name
Z Under i Addreis
U Q I amity,that I haw mad dds application and stem that tic above Information is
F~- torte¢I agree On comply with all city and county Ordinances and sat,laws totaling le
� Wilding construction,and hereby auNon m aprecnmives of Nis city to enter upon the
,�-^U above-mentioned proPeny for impcmon pugu
es.
(WO)spree m sew,indemnify and kap harmless Be City of Cupertino against
nFi h limilitia judgmenu,cm d cepenau which may in my wry we=against mid City _
U Z in caurgwpat of the 6 m B of Blia permit.
a-' APPLI%UNDEDS AND WIL COMPLY WITH ALL NON-POINT Issued by: Date - /7—t/so - S ` Re-roofsatpr Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will ded applicant or future building acupantuam or handle hazardous material
Odefined by the Cupertino Municipal Code.Chapter 9.13,and the Hcuth and Safety
Secdan 35532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Ycs o
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emll hazardnm ter mnuminwu aydcrad by me Bay Amo Air Quality Management all new materials for inspection.
Diwict7 gN/
OYO. o
1 woos Be hunrdnusmaorulem ulrcm'nu underChap,rd.93 of the Califon
Oil He ayCode,SxBmu335U5.33 7aM73534.l.n&.dthulftho Wilding
docs t c n y by enen4 Net Il b maponsihility o adfy the axupent or the
rcga m' k atxmmpriarto or.eemrlsye-or(a;�y Signature of Applicant Date
¢oaf . All roof coverings to be Class"B"or better
Owner ar.atharim'd.,cutDam