05100117 CITY OF CUPERTINO ':+a.#ini -"
BUILDING DIVISION PERMIT a COrITR�"T RST Q�M��I( N
BUILDING ADDRESS: v PINN BROTHERS CONSTRUCTIO r""°05100117
10745 N D PERMIT ISSUE DAIS
R'S NAME:
BAY COLONY INVESTORS II IN 1475 S
PHONE: SANITARY NO,
CONTROL NO.
(408) 252-9131
BUILDING PERMIT INFO
ARCHIIBCT/ENGINEER: BLDG ELECT PLUMB MECH
op LICENSED CONTRACTOR'S DECLARATION Job Description
V FI hereby affirm that 1 am licensed under provisions of Chapter 9(commencing
u� with Section 70Mq of Divides3o(Na Business and Profasalom Code.and my license is
win full forte and eff.L e NEW CONDO-1, 178
,4z License Class La.N 35'Ytf,�-
F O
DOW Cantfamar
7W ARCHf1ECpS DEC Orr rA
i I unlanund my It.mail be used As Public rtcmda
tdU
G
to Licensed Pmfeuionel
'y1 OWNER-BUILDER DECLARATION
1 hereby a1Bnn that 1uempt from Ne,Conuano/s License Law for Ne
.O O following mason.(Section 71131.1.1 Business and Improve.
de um Calc:Any city or roomy
f$ which requires a Permit re ennswea aAmr.pplicant
improve,de ermit i or rePmr any ummer,
pdormim issuance.also requires the apPlicanl fonuch Permit in fila aaigned mumment Valuation
VSqthat he islieensedpursuanttothe provislonsofthe Comu
ncr'sU.c seiaw,chapmn9
.Ft. Floor Area
(commending with Sccdm 7000)of Division 3 a(the BYLnesisod Pmfcsslana Cade
j of
`< Nn he la exempt therefrom end the buss for oe alk,cd examption.Any violadan a(
Section 7031.5 by any applicant fu a aucB subjects the AppUeent to a civil penalty of r Occupancy Type
Out roam than five hundred dollars(S50)).
❑Las owner oftbe property.army creployeawilh waguu Neo ala compensaUan,
will do thewark,end Neauctum hnotinmeded or oriented fofsak(Su.70".Busiwe Required Inspections
and Prefessiom Code:The Contractor's Lkeme Law does rot apply to an owner of q p
pmpeny who buildsorimprovem ounces,and whodoessuchwark Mmselfor Waugh his
awn employco.provided that such improvements am sat mankind worriment forsake.If.
however.the building in improvement is said within one yea a(compledon.the Owner.
bunion,wit low the burden of proving that he did net Wild m improve for purpose of
❑1,As owner of she Property.Am exclusively contracting with IIansW muWasme to
consmmt IN project(Sec.70x4.Business road Professions Colo:)The Cmmcaor's U- .
cemu Law doss hot Apply to an owner of property who Wilds or improve Noreen,and
who contracts for such projects with a contramr(s)Barred pursuant to Ute Contractors
Leena law.
❑l on exempt undo See B 4 P C forthis moon
Date
WORKER'S COMPENSATION DECLARATION
I hemby affirm under penalty of perjury aro of the following d XAmdJOns
I hew and will maintain a CuraiOcamof Comm in self-immure(m Warkr's Comen.
mien,as provided fm by Seedon 3700 of the Lahor Code.for Ne performance of dee
or which this permit k issued.
w
';!'have and will maintain Wakar's Compensation Inarace,As required by Section
3700 of the Labor Code,for the performance at the wmkf which one permit is issued.
My Work;r nsetia Soares artier And Policy
Carrier:_Po1iry No
CERTIFlGTE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(Thu inion mud atbecompleled ifft permit is foram huMrtd dollars($100)
or less)
I certify Non in Ne perfomtanee of the work far which on,penult Is usual,I mail not
employ any person in any manner an As m become abject to the Worken'Compensation
Laws of Califomia.Date
Applicant
NOTICE TO APPLICANT:IL oiler making this Certificate,of Exemption,you should
become subject to the Woher's CorepeueUan provisions of W labor Cade,you must
'J- Z forthwith comply with such proui
vnns Or NU Mall all M domed mwi ed.
Z^ CONSTRUCTION LENDING AGENCY
l.r 1 hereby aRhm Nat Nero Us commands.Indio,.,nc,for Ne perfmoomeeof
C$> the work for which this Permit m island(Sec.3097.Civ.C.)
W�~n. Londer'a Name
06 z Lmilu's Addmo
U O 1 certify that I haw read this application and sum Nu the shove infmmatiun is
W H torten.I agree to comply with all city and county ordinances and mute laws relating m
rJU building
We)A, toane,Inde nifyauthd rtpf harmless;one
this
ofymenmrup g.the
[i] about-mentomcd property for inspection porNsee.
(We,)a ime to save,indemnify tad p harmless Ne,City o(Cupenino egeinst
yIiebiliUu.ju menu.com and upensu we hmayk ay wry acme egelnst said City
fJ'Z in co of the Ung of this Paan
APPLI NT ND ANDS AND COMPLY WITH ALL NON-POINT Issued by: Date
SOUR RE U S.
Re-roofs
Signmure arApplicint'Ohmarlar Dam Type Roof
HAZARDOUS MATERIALS DISCLOSURE +yp
Will W Applicant or future Wilding Occupant store car handle heurdau material
defined by IN,CupeninO Muni al Code.Chapter 9.12.and the Health And Safety
.Sccdan 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
0 C4.
Will the appli car In,.in QQKyyyffflfllding accvpan ossa equipment or deviea which If a roof is installed without first obtaining an inspection,I agree to remove
mit nuaNnns air eanumia. d by Um Bay Area Air Quality Management all new materials for inspection.
DIWIct7
❑Yes Nu
I hew mol the has rd mriala quiremena under Chapun6.95of Ne Califm.
antic yAsaretyco .!Z'U'1255115,2 33od25534.1undcrsund Nuifhc building
dors atq t n0y ha a mnane Nm It is y reapomlhlliiy w naUly 0e,occupant of Ne
my mord �r c Ree metplarto of.Camino, �c myo� Signature of Applicant Date
o ariyc agent a I Data All roof coverings to be Class "B"or better