05100119 CITY OF CUPERTINO
BUILDING DIVISION PERMIT €.1, i'.CtA.GC'(�'R�xURM, TIUN�
BUILDING ADDRESS: FINN BROTHERS CONSTRUCTIOxmIT NU.05100119
10745 N DE AN
R'S NAME: PERMIT 650E DATE
BAY COLONY INVESTORS II IN 1475 SARATOC�'A AVE
SANITARY NO. CONTROL NO.
PHONE:
(408) 252-9131
BUILDING PERMIT INFO
ARCHITECTYENGINEER:
BLODG EO PLUMB MEOCH
Ipij LICENSEDCONRUCTOR'S DECLARATION Job Description
1 hereby afBrm that 1 me licensed under provisions of Chapmr 9(commencing
with Section 7000)of Division 3 of the Business and Professions Code.end my license is
j y in full(area and affect 1e 11. NEW CONDO-1, 755
t z License Lic.x
t D Data Canlracur •v�n�L�..iet�e
ARCHITECTS DEC
i C 1 mltlenunJ my phos shall W used n
pub]c records
IyU
Licensed Pramasioaal
S OWNER-BUILDER DECLARATION
I hemby a1Rrm that 1 am eamil from the Conuacurea License Law for the
o O following mason.(Section 7031.5.Business and Professions Cade:Any city ar manly
3 a which ae,eirea a permit to construct.alter,narrow,demolish,or repair any measure
ze prior m its issuance.siuu mquims the applicam forsuch Permit rile asignsd sulement
Ft. Floor Area Valuation
that he is lleemed pan ucot m the provisions of the Connector's License Law(Chapter 9 Sq.
2�D (commencing with Section 7000)of Division 3ofdtaBusiness and ProfessionsCode)or
13. that he Is exempt therefrom and the bash far Ne alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicanl in a civil penalty of r Occupancy Type
not mart Nan five hundred dollars(SM
1,as owner cribs property,or my employees with wages as their solecompentardon,
will do Iheworir,and the suucturt is tmtimmnded ar offered foamm(Sec.Tim.Business Required Inspections'
and PmfcWom Cade:The Contnctm's License Law don act apply to an owner of
property who buildsorimprawa themon,and whoduessuchwmkhlmaelfor Waugh his
own employee,provided that such improvements me notinnMed oro@red(orale.If,
however,the building or Improvement is sold within arc year of cemplction,the owner-
builder w1U have the burden of proving that m did not build or improve fa Purpose of
sale.).
❑1,in ower of the property,am eaclusivcly contracting with tiecame mnuactan to
construct the project(Sec.7014.Business and profemians Cade:)Tlm Connector's Li.
came Law dors not apply to an Owner of property who Wilds or improves themon,and
who conuaces for such proieets with a cannacter(s)licensed pursuant to site Contractors
License Law.
❑I am exempt under Sec. ,B d P C for this moon
Data
WORKERS COMPENSATION DECLARATION
I hereby&Man under penally of Perjury am of the following declarations:
1 ham and will maintain aCer iri om of Convent la self-imam far WmkerS ComKao-
seuo ,m provided for by Section 3700 of Ne labor Cade,for due Pertarmmm of dm
w far which this permit is issued.
1 have and will maintain Worker's Compemadon Insurance,a sequircd by Section
3700 of the Lobar Code.far the performance of the woh forwhich Nis permit is iasmd.
My WofgyrtaSom emuionp renes terrier andalicyyty�c a
Carrier. ;jj;i c Poli N�{M1{y1..J�
ER IFICATE OF EXEMPTION FRO ORKE 1S
COMPENSATION INSURANCE
(ibis aeclion need not W completed If the penult is foram hundred dollars($100)
or less)
1 certify dont In the performance of the work for which this permit is tweed,l shall not
employ any person in any mannerso m to become subject to the Workers'Compensation
Laws of Califomia.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Eaemption,you should
become subject 0 the Worker's Compensation provisions of the Labor Cade,you must
Z fanhwith comply with such provisions or this permit shall be accrued rtwkod.
zO CONSTRUCTION LENDING AGENCY
WP'r+ I hereby affirm that them iso construction lending agency for the performance of
> the work for which this permit is Wood(Sec.3097,Civ.C.)
W Q Lender's Namc
z 'sander's Add.
U Q I certify Nn I have mad this application and sm s that me above information is
U. F cortccl.1 agree to comply with all city and county ordinances and sum laws mlaing to
veS
CJ building co)agree to ane,Inde ni ty aid kepr arroloss the City city uPenu upon the
�a
Omc-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
F rA liabilities,udgmanu,euoaandeapemnwhich ay inanywaY accrue agsinnuid Clly
U z In con oflheg ung of this permit Date
APPLI A E ANDS AND WIL COMPLY WITH ALL NON-POINT Issued by:
SOUR R Ns.
4ra1 'dit Re-roofs
Signor of pjplicmffifftnnracOr Dam of Roof
HAZARDOUS MATERIALS DISCLOSURE Type
Will the applicant or future building Occupant slam or handle harndom material
defined by the Cupenho Municipal Code,Chapter 9.13.and the Health and Safety
,Section 255324)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yn
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 '
Omit hvartmes air conumimne u deBmd by the Bay Area Air Quality Management all new materials for inspection.
D urict7,
❑Yrs u
I hew mad the hvardaus materials mquir menuundcr Chap arli.95 of the Califaa
nix Heal Safely Cod Smuons 25505,2553 d 8534.1uWesand thus irda Wilding
data c tl haves unent mat It h mY sponsihilily to notify ton occupant n(me
royui me sthemet poor inism fCOAOe, af0emparmySignature of Applicant
Date
owner ar.amarizm �7-0� All roof coverings to be Class"B"or better
xacnt