05100116 CITY OF CUPERTINO
BUILDING DIVISION PERMIT topI�ITRAC""T,,OIi.,,INI'', MN
BUILDING ADDRESS: x FINN BROTHERS CONSTRUCTIO &RMITNO'05100116
10745 N DE ANZA RLV it 214 PERMIT tsueDATE
R'S NAME:
BAY COLONY INVESTORS II INC1475 SARAT
SANITARY NO. CONTROL NO.
PHONE:
(408) 252-9131
BUILDING PERMIT INFO
ARCHITECr/ENGINEER:
HLODO EO PLO MEOCH
ip6 LICENSED CONTRACTOR'S DECLARATION Job Description
i u1 Washy affim that 1 am li amed under pmvWom of Chapur 9(mmmcmcing
Am Section 70lk6 of Division Sof the Budr.and profeatum Code.and my license us
H in full ranee and affect ALL
4 i y NEW CONDO-1, 178
$? Licence as�ay —Lis.M
Dam VTi=eY COnitnemr
ARCHITECTS DEC RATION
J 1 undersand my plansshall he used a public records
i 1y
G Licensed Professional
Oat I AM MPt l an be RATION
COMAACM
�<C
I hereby.(0m that 11. exempt Wm the Cssions Co license Law for the
p O following rima..permit
t 7101.3,construct.alums and ere.de um Ca dc:Any city s rounty
f$ whim its i s u a e.ai re resthealms imprnt fora,h remit t rile Or repair any auedum
zi pdarmiu issuance.aim requires
the applicant Me Conpemi0oicense ned Law
Valuation
p Thal he is licensed pursuant to tise provision of the Contractor's Licence law(Chapmr 9 Sq.F[. Floor Area
2 (commencing with Section 700(1)of Division 3 of the Business and Pmfesdam Code)an
9
that M ts mampt LWmfmm and the bad,fos the alleged exemption.Any viola on of
Section 7071.5 by any applicant fan a permit wribl"the applicant an a civil penalty of r Occupancy Type
not more Nan five hundred dollars(5500).
❑1.m owms of the psopeny,a my employees with wages u thea wleewnpenation,
will do the work.and Ne,wclure u notmousled ar offered forsam(Sec.7014.Business Required Inspections
And Professions Gude:The ConVKbYa Lt..Law does not apply An an Owns Of
Property who build,Or Improves thereon,erd who does such amt himself w through his
ownemploy.,provided Jan such improvements am trot intended Oroffered fmala ff.
however,the Wildingar improvement is gold within one year Of complcd°n.the Manor-
builder will haw the Wall of proving that As did not build or improve for purpose of
ule3.
❑I,As Owner of the prepeny,am mclmively contracting with licensed co"uamom m
conetmct the project(Sac.7614.Business and ProfegdOm Cade:)The Commutes Li.
came Law door ml apply man owner of property be builds or improves them°.,And
who concocts for such projects with a conuxtor(O licensed pursuant to the Conmetw's
Licence Law.
❑Inna.pt under See ,B h PC for this rmwn
Dam
WORKER'S COMPENSATION DECLARATION
I hereby afftm under pemity Of pedt ry ane Of the fallowing declara'see
001 have and will mainuin a Cerdfmm O(C°menus alf-insum for Workers Compon-
anta".As provided for by Sectio"7700 of the labor Cade.for the performance of the
7which this permit is utmed.
w uW will mainuin Worley,Compensation lawman,as myulrm by Section
7700 of the lathe,Code,fa Ne performance of the work for which this permit is issued.
My Weft!i��"o�m�p�emad�an lgymr.artier and Policy a �I
Carticr. �/�Y��w S Polley No
CERTIFICATE OF EXEMFITON FROM WORKERS
COMPENSATION INSURANCE
(this semilas aced ret te oompkmd if the permit is foram buMrtddolisn(5100)
or lass)
I anify dust to the performance of that watt for which this permit is issued,1 shall not
employ any pawn in any mannerw As m become subject to the Workers'Compensatian
Laws of CafKMAW Dam
Applies.,
NOTICE TO APPLICANT:If.after making tab Cenificam of Exemption,you should
become wbjat to the Worker's Compensation provisions of the Later Code.you mot
�O forthwith comply with such provisions a this permits hall be damW revoked.
Z C13 CONSTRUCTION LENDING AGENCY
[.., Iberahy AM.that there is•mmatmedn rending aCO.,for Jon puff...of
ai > the work for which this permit Is issued(Ser.3097,Civ.C.)
W Q Lender's Nunc
7 z Lenders Addnua
U O 1 certify that I have mad this Application end sum ma the above information in
W P corms.I agree m comply with all city and county ordinances and sum laws relating to
0 U Wilding construction,and hereby au,mrim mpmmnutiw or this city to enter opus the
W above-mentioned pmputy for inspection purposes.
gy (We)agree to save,indemnify and keep harmless the City of C.ImNno against
lumilitim,Judg .coats and.Not.which y In any way acento against aid City
t)z in e.=,.Jll d oft gran) of this remit.
sr APPLICA UN S�k Ds AND WILL OMPLY WITH ALL NON-POINT Issued by: Date
SOURCT 'GU 0 6 `��
O 1 Re-roofs
signanm,° pf can °"Cr DamOf Roof
HAZARDOUS MATERIALS DISCLOSURE Type
Will the applicant or future building occupantsmm Or handle incautious mamdat
de0ned by the Cullum.MZPAI Code.Chapter 9.13,and the Health and Safety
Section 255324)? No All roofs shall be inspected prior to any roofing material being installed.
Eves RNa
Will the applicant or(uure Wilding aaupmt use cquipmant ser deal.which If a roof is installed without first obtaining an inspection,I agree to remove
°mil hurardno airc.=inan Ormd by the Bay Ams Air Quality Management all new materials for inspection.
District?
DYos Na
I have mad the haardnusmamdalsm uimmenis un der Chapmrh.95oftheCalifor-
niaHca afctyC edosu 253115.33 3and25534.lundctsdthairthe building
J.n c ntiY ho a nmL that his -Misibilily m netify the occupant of the
maul nu cin melpiarmi anceence eamarOccupamay. Signature of Applicant Date
` 1-04 All roof coverings to be Class"B"or better
Owner ser wthomcd, cn1 Dam