05100115 CITY OF CUPERTINO ;--- ffr'�tvkr' `'""'' ''` '
BUILDING DIVISION PER IVIIT = COI�ITRACTQRINFORMATION ;
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BUILDING ADDRESS: s PINN BROTHERS CONSTRUCTIO 9RM"'05100115
10745 N DE MZA BLY ft
FERMUISUEDATE
R'S NAME:
BAY COLONY INVESTORS T1 IN 1475 SARATOGA A17
PHONE: SANITARY NO. CONTROL NO.
(408) 252-9131
ARCHRECr/PNGINEER: BUILDING PERMIT INFO
BLDGO ELECr l� PLUMS MFCH
O l�
too LICENSED CONTRACTOR'S DECLARATION IOb Description 1 bercby affirm
Nn I em licensed under provision of Chapter 9(commencing
i� with Secifer lM)ofDivkion 7 ofthe Bualness and Notional..Cole,end my license is
.�„ mfullforceandcffeem. (y NEW CONDO-1, 460
n�Z Liceue❑eat Lle.a
h, Dam CasTOE L L
gg ARC all W use DECIA A
�q 1 undcnnnJ my plans shall he used as public records
°QUI Licensed Professional
OWNER-BUILDER DECLARATION
p I hereby alrvm that 1 am except form the Contractors ucCose Law for We
1
:cc following reason.(Section 7071.5,Business and Profession Code:Any city or County
i9 e which requires s permit m common,alter,improve,demolish,or repair any swnure
Zen priaroits issurimmalsorequir.theapplicant(orsuchmarilmfile,asignedsutemenlValuation
That be is licensed purauanuo We pmvialouaf Jim Contrxork License taw(Chapter 9 Sq.Ft.Floor Area
3�g (Commcncingwilh ccUon70th)MDivuion7nfftSualnessmdP rminnaCMc)o
thx be is exmpt Werefram and We bull fo the alleged exmptian.My violation of
Section 7OU by a"applicant for a permit subjects the applicant in a civil penalty 01 r u Occupancy Type
not mart tun Eve hundred dollars($5007.
❑Lasowneroftil pro perty,ummyotinte bewithweepuall((See
Business
will do Wewons ands: he Contla ties Lndcdor Law
Mied sim,apply 10",Business Re aired Inspections
and Pm(whin u Code:The oonuamon.and
whoic.Law don nal apply ro rt ourcurough is q P
of
Property whin h.Ildamimprove th Improvements
andwho doe satechwarthimselforWmueb his
howe er.the
or i that oven Imps mid wit ax Inti inundN moRertd for de 9-
however.
,
bowev.,We building or improvementismid within orc>ev of improw for the owner
builder will have the bodes of proving Motion did not Wile o impose(o puryox of
tele.).
❑1,an owner of the property am ruminatively conaacline with licensed Common to
Chutmct We project(Sec.7044.Buslnets and Prollea ams Cade:)77n Constrictors W- -
cenx law it.not apply in C own.of property who balks or improves amount.m4,
who Comments for such projects with a cenuxur(s)licensed puonsood m the Crimnnors
License law.
❑lam uemplunder See ,B&PC(o Wlsoason
r Data
WORKER'S COMPENSATION DECLARATION
/ 1 herby unno under penalty of perjury ane of the following dttlWioca:
[�1 msec and will maintain aCeNBmu of CanxntmxlGinsum fo WartrrsCmnpem -
wian.u provided(at by Section 7700 Of We labor Cadc,lar We perfarmance of We
wo for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,u required by Section
7700 of We labor Code,for We performance of We work for which Win permit is Issued.
My' one eualinnaksurance easier and Paltry -�w
Carrie. w ( Polity No
CERT( CATEOFEXEMPIION FR WORKER5
COMPENSATION INSURANCE
COW,secoon need wt be camplaed ifue permit Is f.one hundred MIM(5100)
ar less.)
I xnih that in the performance of We work far which rills permit I$issued,l Wall not
employ any person in my manneran as in bmmme subject in We Woraus Compensation
Laws of California.Dale
Appliont
NOTICE TO APPLICANT:If,after making this Certificate of Eaemption.You should
become aubjoet in the Workers Compensation provisions of the labra Code,you most
vJ z fortawith comply with such provisions or Nis permit shall be deemed rewked.
zi0 CONSTRUCTION LENDING AGENCY
[..t 1hereby&Mmthat More is a tmnuomin lending agency for We Performance of
ai h7 We work fur which this permit Is issued(Sec.7091,Civ.C.)
W Q Lenders Nunc
z Iandcrs Add.
U 0 1 certify that 1 have mad this application and sou Wm We shove information is
Ir.F corm.l acme in comply with N city and county ooinanc.and mm caws mating in
DU Wilding construction,and hereby authorise mpresenmiva of Wis City to enter upon the
W aiwvehmentioned mpersN
fee purposes.
(We)agree m ave,indemnify and keep humless We City of Cupertino against
yIiebili0u.judgmenutlgmenu,costs and expenses which may In any way acrneageimt aid City
U`z in conuq of We{n 'D o(Wis permit.
^" APPLIC�N ER fDS AND WILL OMPLY WITH ALL NON POINT Issued by: Date o
SOURC L N . �1+'7�
Q Re-roofs
HAZARDOUS
Sienuu pBeacmr Date
HAZARDOUS MATERIALS DISCLOSURE or URE Type of Roof
Will to applicentar(atom b IlOIng nccupmltlore or handle huardous material
defined by the Cupertino Muni
pal Code.Chapter 9.12,and We Health and Safety
SeNnn 255724)T All roofs shall be inspected prior to any roofing material being installed.
Oyu No
Will the applicant m future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hmaonns air contartma�f/gl denied by We Bay Ana Air Quality Management all new materials for inspection.
Dimict7
QYos Nu
I hitist the haaadtsu mamriau uiremcrns WrierCMpmr6.95of We Califon
iia Hol S tyc 'nu 23505, 77 am123534.I unMnundlMifmc WiiJine
Want nal ly 0 ant.that it b r.pamihilllY m notify We occuput of We
requir nu I W elpdorW ofaCamfficracofamapmcY. Signature of Applicant Date
dMT� All roof coverings to be Class"B"or better
OwnerorauWorcredagenl T' Date'