05100121 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CUf7Cl2ATOit TI�'FOIiMATIJIV ''
BUILDING ADDRESS: a PINN BROTHERS CONSTRUCTIO g-"""0.05100121
10745 N DE ANZA B
R'S NAME: PERMIT ISSUE DATE
BAY COLONY INVESTORS II INP 1475 SARATOQA AV 08Z12120015;
PHONE: SANITARY NO. CONTROL NO.
(408) 252-9131
BUILDING PERMIT INFO
ARCHITECTIENGINEER:
BLDGO ELECT lm PO MECH
oil LICENSED CONTRACTOR'S DECLARATION Job Description
V F 1 hereby affirm That 1 w licensed under provisions of Chapter 9(Commencing
`uf with Section 7M)of Div Wan 3 of the Beading and prafestlum Code,and my license is
! F
in full NEW CONDO-1, 348
t 8 z Wcenm Ice Lm.gIL
L
O Dam Conlnmor
l � ARCHITECTS DE LLA I ,
i < I utWmunJ my plana shell he used as public records
iy
c Licensed Professional
Oat I am exempt
fieDECLARATION
ncu,
1 hereby.(Oren that 11. eusin from the Conan s C a Chat:
License Law for the
p o following reams.(Section 1031.5.Business and Professions Calc:Any city or manly
S$ which requires a pcmdl re comom,afar,improve,demolish,ore asir any eeme.1 7
thathits cense pursuntto am the applicant parsucove,Co rermitma.signed smemnnt Valuation
Ihathcancing with
t7 the provisions oftheConusinces Liam rselaw(CNper9 Sq.Ft. Floor Area
`�$ (c romancing with Section 7")of DivkionJaf the BusineuaM Profeginns Code)Co
..
the he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.1 by my applicant far a Permit subjects the applicant,to a civil penalty of r Occupancy Type
nut more dun five hummed dollua(SSW).
0 1,a owmr of the pmpwy.m my employm withwagn u drb mleemnpewdon,
wBl do thewrk andtMswnurebmlinended ora@red forgak/sec.70M,Businm
Required Inspections
and Profession Cade:Tie Conuscmr's Lk a=lawm eam dt apply an in.of q P
property who buiids m improve themon,and who dm such mark himself m thrmgh his
owncmploym,provided that such Improvements K ret inmeded moRered formic.If.
however,the building or improvement is mid within am year of completion.the ownm-
buildec will ban the burden of proving that he did not build m improve for purpose of
gain.)
0 1.as awter of the property,me exclusively contracting with licensed conoanors to
common,the pmject(Sec.7064,Basin.and Profudons Code:)The Cantncmr's Li-
Came law dm not apply in an owner of propeM1y,who builds or improves,thereon,and.
who contracts for such projects with a conuactone licensed personator the ConumtoYs
Lien.Law.
0 I ore exempt under S.C. B g:P C far this rage"
Dau
WORKER'S COMPENSATION DECLARATION
/ 1 hereby affirm under penalty of perjury am of the following declarations:
I ban and will connote.a CutiOae of Consent to self-inure for Workers Campcn-
.am,as provided fm by Section 3700 of the labor Code,ren the parfarm.of the
w or which this permit 0 ksuN.
1 have and will Creole.Workers Oompensatkn Insurance,as required by Semon .
3700 of the labra Code.for Ne pedmmana of the wart for which this permit is issued.
My War ompeuadon trmatrmct arricr and Policy u v I
ql
Carder. Policy N .
13
CERTIFICATE OF EXEMPTION HI MWORKPJIs
COMPENSATION INSURANCE
mis inion need Out becompleted if the Permit is fmone hundred dollars($100)
or less.)
1 certify then in on performance of thc..,it for which Nis permit is lattice.I shell n01
employ any Person in my manners as in become subject in the Warton Compensation
Laws of California.Dale
Applicant
NOTICE TO APPLICANT.If,after making this Certifiam of Exemption,you should
become subject or the Wotkers Campemmion provisions of the labor Code,you most
.7. forthwith Comply with such provisions or this Permit shall M demand
revoked.
„z„r~N., CONSTRUCTION LENDING AGENCY
H I hereby e1Brm that them la a conmructlan lending agency far the perfurmanm of
GE> the work fur which this Permit is W and(Sec.3097,Civ.C.)
aA Lenders Name
CI Landers Addmu
U Q 1 certify that I have mad this application and sum the the above Information is
H tore,
.l agree m comply with all city and county ordinances and soon laws relating to
by
ns
y to color upco the
pU buildin(We) Sc,w and Mmemnify d keep
hansinsa to Nis ofCupcino genu .
}'U ab.n-numitmod property for inspection purposes.
(We)agree m ave,indemnify and keep harming the City of a agerino against
vF.t h
liabilities, enWc, nperun which easy any vay accrue agalnstgaid Ci,y
()z 'nearing rte a the i of thin permit.
APPLIC NT D ( DS AND WILL C Lv WITH ALL NON-POINT Issued by: Date
SOURCEREG { all-0�
{ Re-roofs
Signature ApplionuCanummr Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Wall do applhem or furore building aceupmismre orhmdle Intramural material
defined by the C.
andno Monici al Code,Chapter 9.11,and the Health and Safety
Se
Cyn a a 1553x(.)+ All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future banding=UPam man equipment or device which If a roof is installed without first obtaining an inspection,I agree to remove
emit hagrdous air conWningu 0ned by the Bay Arca Air Quality Mmm gement all new materials for inspection.
District?
CYcs Nu
M&49
amrlelsuquiumc T.I,` Chep 1r 1.1oftheCahfor-
ndeHa35505,x5533 amt 3J4.Iwdcmund thuifthebuilding
s, hat I,k my repo ibliky mratifythececupantofthedo, igtiga rdncatcV ap�tcy.e` Signature Of Applicant Date
owner or authodudagcnt `j I IDa,c All roof coverings to be Class"B"or better