05100122 CITY OF CUPERTINO , .
BUILDING DIVISION PERMIT C(� V' YtA1Y ',MTZ ! f °
BUILDING ADDRESS: s PINN BROTHERS CONSTRUCTIOI f 05100122
10745E.
0 7 4 5N DE ANZA FILM It 224 PERMIT ISSUE DATE
BR'S NAME:
BAY COLONY INVESTOR IN 1475 SA
PHONE: SANITARY N0. CONTROL NO.
(408) 252-9131
ABUILDING PERMIT INFO
RCHITECT/ENGINEER:
BLDG ELECT PLUMB MIECH
oopp LICENSED CONTRACTOR'S DECLARATION lob Description
V LsI hereby affirm that I am licensed under previsions of Clupter 9(commencing
IMwith Secuon70(IU)af0ivUion3of Ne Bminmod Pmfesdam Cade,and mylimnscis
F in full Carte and effect NEW CONDO-1, 193
i v�Z License lea Lk.0
iF Dam Comrator
ARCHITECT'S DECLAA 11 Z
i I understand my plans shall be used as puhlic records
is
Licensed Professional
g Oat I am exempt B se due C ATION
nsomm
I hereby cano .mom that 11. .Busin from ted Consomme,Code:
:A License Law far the
:00 following moon.(Suction 7031.5.Bairns and Profession Cade:Any city or county
3$E which require a permit w ennsWCL eller,improce,demolish,or repair MY alrucum
priorm Its issuance,also requires the applicant for such permit to rile a signed sukm a, Valuation
Ithat he is licensed pursuant to dmpmvisiomofthe Comment's Ljcenmlaw(Chapter 9Floor Area
I (commencing with Section7f1B0)of Di vision 3 of the Business and Prafaaions Cade)or
— that he in exempt dmm(rom and the hats per the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally Of p 0 Occupancy Type
nut mom than I..hundred dollars(5500).
❑1,as owner of the property,or my employees with wagon as their mlecompensedon,
will do the work.and the srecume 4 an,intended or offered for Mas 7014,Business ns Required Inspections
and Pmfesdom Cad,:The Contractor's Liceme Law don not apply m an own"of 9 P
property who builds a impeowa dmrcon,and who donsueheank himselforthrough his
own employru,provided that such improvements ane not Intended or offered for sale.if.
however.the led Id!ng or improvemenl'ts aced within on You of completion,tlm Owner'
Wilder will have the burden of Craving that he did ant build a impreve fa purpom of
sale.).
❑I,as owner of the propenY,am exclusively contracting with licensed Contractors to
construct the project(Sec 7044,Emma.and Rofndom Code:)The Contractor's U.
Come law does not apply to an owner of property wed Wilds or)mprovel,Neman,and
who contrxts for such projects with a contsadan(O IIConsed pursuant to the Contractor's
Lkeme law.
❑Ism exempt umbel Sec. ,B&.P C for this mann
Dau
WORKER'S COMPENSATION DECLARATION
hereby air..order penalty u(perjury am of the following dnlamtkm:
ave and will murrain a CeniOak of Continuum self-insum for Worker's Campen.
saiaa, provided fa by Section 3700 of the labor Cod.,far Ibe pelf"mance of Ne
ark r which Nis permit is tssuetl.
itw have and will maintain Workers Compensation Insurance,a required by Sceron
3700 of th,labor Code,far the perforimam of the work for which Nis pemdt Is laved.
My W.6 m ematiatyho.rance ami"arm Policy u wa m
Cartier. (T[7 PalicyN I=�3�—
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
India section need not be completed If the permit is foram handout dollars(SIM)
or lcaa)
1 comfy Nat in to performance of the work for which this perms is island,I shall not
employ any Parana in any mannerm as m become subject m the Waskeoi Compensation
Laws of California.Dat,
Applicant
NOTICE TO APPLICANT.If,afar making this Certificates of Exemption,you should
become subject to the Worker's Compemedon provisions of the later Cade.you amt
.J z forthwith comply with such provismus or this permit shall be deemed revoked.
ZCONSTRUCTION LENDING AGENCY
'[•r Iherehy.M.that ft.lea construction lending&gamy for the performance of
LYi 7 tie work for which titts permit ts issued(Sec.3097.Civ.C.)
W�Q Lendoes Nam, '
] z Lender's Address
fJ
(DI unify dial T have rod this application and sum but the above information is
D. Fcomet.I agree an comply with all city and county ordinances and state laws relating to
CJ building Construction,and hereby authorim mpmarmadvea of this city to enter upon the
E ahovc-mentiumd pmpersy for inspection purposes.
.
f•a (We)agree to save,indemnify and kap harmless the City a(Cupertino against
In IiabiUtin,judgments.com,and expenses which may in anyway&come againslsaid City
fJ`z in conugm of Ne jn8 of this perm.L
t'^ APP Oes NDE NDS AND WIL COMPLY WITH ALL NON-POINT Issued by: Date
SOUR S.
e-1 "04 Re-roofs
SignmumofACm can ontrmmr Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or marc Wilding acuper amm"handle haandom meed.]
definrA by 0m Cupertino Municipal Cade,Chapter 9.13.and the Health and Safety
.Section 25532(41lAll roofs shall be inspected prior to any roofing material being installed.
❑Yrs
Will the applicant or future Wilding occupant um.yuipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit haardnm air contaminants a derimd by tis Bay Ams Air Quality Management all new materials for inspection.
District?
❑Yu z
1 have mv1 dm hexardmst materials requirements,under Chapter 6.95 of the Califar.
ria Hcol &Safety ,Secdans 15505.3 33 and 8534.1 mahmend that if the building
docs oily a a anent.gat II u y respomihility m notily the acupanI of the
m u' m ah' t bemet norm' anal ofaCcn�mo .n anar. Signature of Applicant Date
All roof coverings to be Class"B"or better
Owner art authoriyad.gem Dau' ,