05100118 CITY OF CUPERTINOBUILDING DIVISION PERMITCQNTRA•G1'aRI1�IL`�RMA"I'rf�T
BUILDING ADDRESS: v FINN BROTHERS CONSTRUCTIO gRMrr"°'05100118
10745 N DE ANZA RLY A 717 PERMIT ISSUE DATE
A'S NAME:
BAY COLONY INVESTORS 11 N 1475 SARATOGA AVE
SANITARY NO. CONTROL NO.
PHONE:
(408) 252-9131
BUILDING PERMIT INFO
ARCHITECTIFNGINEER:
BLDG ELECT PLUMB MECH
pp LICENSED CONTRACTOR'S DECLARATION Job Description
i U 1 hammy arftrm that 1 am licensed under previsions of Chapmr 9(commencing
wht Section7000)afDivieio 7of the BuslneuaM Pro(cuiam Cade,and mylieenseu
t In mO fo..md ertee I's, NEW CONDO-1, 272
n Z Licenwe�C,�las�s� �
Lt.a
F
Dow_ywA_�a��Gonlraelar opt c
Iu �e Mand 1�// ARCHRECTS OEC 1
1 understand my plans shall M uM u Public reenrsin
IyU
Licensed Profrssianm
OWNER-exempt RDECe Conu ON
I 1 hereby.(Sure on I am exempt from the ContramCal License law for the -
p O which re won.permit
o]m IA,Business and Improve.
deauu b--e:Any City or county
S$
which h,issuance,
n Feast w ronWueL applicant W, prosu demolish,sirt in e a sig any swnum
-Z< pdormitscensedero ,Inde thovisisofor Conametch o"License neJnatemem Valuation
O
than heisIlee witpursuantmsitprovisionsofor BeBuumfrIxenselaw(CMPter9 Sq.F[. Floor Area
1 (commencing with theal Busmen andon.Any
Cadoof
$ that he in eumpt thme(rom and the buts for the alleged esemption.Any vlontion of
Section 7031.5 by any applicant for a permit objects the applicant •civil Penalty of r Occupancy Type
not ream than five hundred dollars(MS
01,uownerofftpmpeny,ormywployerwithwagsuLitholem Peuadan,
will W Newark,and the swnuR ts not imm.ded m affemd pursue(sea 7W.Business Required Inspections
and ProfeniON COCIL The GOmnebrs LfCrt4 Law dreg net apply in an ownU of
property who huildsmimprosudRreon,and whodorsechwork himRlforNrough his
own amplayen,provided that each improvements am not intended reoffered for We.If.
however,the building or improvement Is Gold whamone year of completion.the owner.
builder will have don burden of proving that ata did nm build or improve for purpose of
ul.j.
Q I,u Comer or the property,am relatively contracting with Barred ennuanors In
mrstroct the project.(Sec.7014.Business and Professions Code:)Tim CommcmYs Li.
cc•..law does not apply m an owner of progeny who builds or improves thereon.and.
who common for such pmjccn with a connacor(s)licensed purwant un the Conusemfr
License law.
❑I am sompt under See .B k P C fathu recon
Data
WORKERS COMPENSATION DECLAa TION
1 hereby atfas under penalty of perjury one of the fallowing declmatiou:
1 ham and will mvnmin.Certificate of Cement to self-Imu ,for WorkeraCompen-
ntion provided fm by Section 7]00 of Ne Labor Code,Its Na perfa m men or the
ova Cr which this permit is Wued.
I have and will maintain Worker',Compensation luuroce,as m4viRd by Section
7700 of the Lobar Code,fm the performance of she wart for which this permit as Issued.
My WorkeplCtsm,carsadan Mwnnce carrier and Poly No.:
Cartier. —Policy FROM
CERTIFlG OFEI(EMNINN FROM WORKERS
' COMPENSATION INSURANCE '
(Thin section need notbe completed If the remit in Forane hundred dollen(SIM)
sir tau.)
1 cenify that In Ot performance of the work for which this permit Is issued,I Nall not
employ any Pemon in any mortar an as,to became object m the Worker'Compensation
Laws of California.Dat
Applicant
NOTICE TO APPLICANT:IL after making Nis Certificate of Exemption,you should
became obj=an the WOrke s Compensation provisions of the LAW Cade-you man
O forthwith camply with such provisions or this Permit shall be deemed revoked.
z.~N.. CONSTRUCTION LENDING AGENCY
E.+ I hereby a from that them is.eonstrue0nn lending agency for the Performance of
cal s7 the work far which Lids permit is Wood(Sec.7097,Civ.C.)
tL1~n.
Undoes Nout
.a7. z lnndees Add..
I,7 Q 1 carefy that 1 have Rad this application and sure No the above informal..is
lt.(•' correct.l agree to comply with all city and county ordinancesend stat leers mlatingto
0 V building construction.and hereby authorise repmeenmivu or this city to enter Upon the
r fed .love-menti...d propery for iupccdan purposes.
(~LL (We)agree m save,indemnify and keep harmless the City of Cupertino against
rat Iiablliuu,j rents,eons and esperues which May.so-Y.yacrntagaiutsaid City
U z in eonseq r fI g ng of thio permit.
�'+ APPLIC NT E NDS AND WILL CO PLY WITH ALL NON-POINT Issued by: Date
SOURC RE S.
Re-roofs
Sig as fApplicanUConncmr Dote Type of Roof
HAZARDOUS MATERIALS DISCLOSURE app
Will the applicant Or future building accupantuom arhande haurdous material
defined by the Cupcake Muniei 1 Code,Chapter 9.11,red the Health and Safety
.Section 15571(107 All roofs shall be inspected prior to any roofing material being installed.
❑Yr e
If a roof is installed without first obtaining an inspection,I agree to remove
Will Jt applicant oil future building aceupam ase equipment or devices which
cosh hacardnus air commourat u fined by one,Bay Area Air Quality Management all new materials for inspection.
Dianct7
❑Yr
I W,mad the tor, materlob myvim n under Chapter 6.95 afthe Califar.
ria He Safety Caa►sttdou 8303,13577 and 334.I understand thuifthe building
Jart cu ad h a ammo.that it is my ms ly m notify the a cupant of the
"ul men h W Ipnor to i �
s t a Certificate pupancy. Date
�n� D -13—Or Signature of Applicant_ All roof coverings to be Class"B" or better
Owner w autn0antd agent Dat