05100123 CITY OF CUPERTINO ' '
BUILDING DIVISION PERNIIT i`CONTRAC'TORTINF'ORMATI(, ,,
a 7s*,rka): °aa� aSt c..ri ..v "
BUILDING ADDRESS: PINN BROTHERS CONSTRUCTIO rm""'05100123
10745 N DE
R'S NAME: PERMIT ISSUE DATE
BAY COLONY INVESTORS II IN 1475 SARATOGA AVE
PHONE: SANITARY NO. CONTROL NO.
(408) 252-9131
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MMH
00 LICENSED CONTRACTORS DECLARATION lob Description
uF 1 theMilken tha
thereby Milken 1 as,do nscd under pmvisimls of Chaplu 9(mmmeaing
u� with Section]Up)of Division 3oflhe BusircvaM Professions Cade.aM my ficence is
in full to=anderfecL 3 ti �_ 46 CONDOS-PLAN CK PURPOSE ONLY
tR 3 Liu w
D..7*Tj, fcanlacmr�gfM t CLOSE OUT WHEN APPROVED-ISSUE THE 46 INDIVIDUAL
1 �CTSDEC I I PERMITS WHEN READY
i @ 1 understand my plana shall he used u public¢ceras
id
,Q Licensed Pmfcssional
OWNER-BUILDER DECLARATION
<i I hCMby.Rina that 11. ,Business
Truro J n Cortins e"SCo License Law for the
s O o fallowing mesa.Permit
i 7031.5,Blnilns and Profwiuns Cade:My oily seer aumy
5$I°i which inquires a permit m ennetrwt.slate.improve,dem.lkb,or mp.ir any s4wtum
z'�•
prior w its issuance.dpree rt to the mavisi ns of the Contra tail m Tile a.signedLa (Chaps em Valuation
C Nat toitsccnxJpmsuantbNetheapioeatJrsuch ermriluxnelaw(CNper9 Sq-Ft. Floor Area
25 (commencing with Section 7000)ofDivision l of she BumnwsadPrufesdoesCade)or $259173
that he Is eaempl the arm n and the basis for the alleged esempJm.My violation at
Securer 7091.5 by any applicant for a permit subjects the applicant m a ctwl penalty of APN Number Occupancy Type
nm more Nan 11.hundred dollen($SW).
❑1,as mwner of one property,or my employees with wag.as their sok eampewdan,
wiaduth.wurk.$namestmnumisnmimmwed.r.11kedrars.le(sec.704.Bue.aa Required Inspections
and Profershms Code:The C.nmctor's License Law does n.1 apply m an owner of 9
Property who builds or improves Nemon,and who does such work himself or through his
own employees,provided that such improvements are amimm�dN ser offered forssle.It.
however,the buildingar improvement is sold within am year of completion,the awar-
builder will have de bard.of proving that he did not biro m Improve far purpose of
isle.).
1.as owner or the properly,Sm aselusinly contracting with licensed Cantrumni in
cn.wct the project(Sec.]014.Business and Profesd.ns tr Cade:)The Cm3 Li-
CertainLaw dees oat apply m an owns of property who bulhls or impure.thcman.and,
whocantncn for Such pmjcm with a conuacmr(s)licensed passuant in use Continence,
Lhemen Law.
❑taro exempt under Sec .B&r P C for Nis moon
r Dam
WORKER'S COMPENSATION DECLARATION
/ 1 hereby affirm under penalty of perjury Met Of the following declvulo.:
1 Its.and will rot ins in a Certificate of Consent to self-Ilium for Worker'sCompen-
sstion,u pyov)detl for Ey Section 3709 of the lahm Code.ter the penormance of Ne
vat or which this permit is owned.
I have and will malm,ln Workers Compecoadon bueuce,u Deland by Semon
)709 of th.Labour Code,for the performance of the work ser which this permit is lewd.
MYWarl.rr.'rompewuon huuruce ami¢and Polity u '
Grtier. IIS Policy No
A '
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
moisuctiw wed tetbecomplem i lions permit is fm.a hundred dollars(SIM)
M less.)
I cenify,that In the performance of the work for which this permit is issued.I shall not
employ any pinion in any mannerso as in become subject to the Workers'Compensalion
Laws of California.Data
Applicant
NOTICE TO APPLICANT:IL afcr making this Cenifcam of Exemption,you should
become subject in the Wahms Compensation previsions at the IAbW Code.you am
Oknowith eomplY with each Provisions or this permit Ghali he damW msvked.
z.~N.. CONSTRUCTION LENDING AGENCY
(ti IhemhyaMmWt ft.is a connrwtinn lending agency Tanis permrmance of
ai> It work for which lids permit is bawd(Sm.7097,On.C.)
aW Q Lender's Namc
nti. z Landers Mdmw .
U O I cenlfy that I have mad this application and nam that the above Infammlon Is
r4.P come,.l tgme in comply with all city and county ordinances and rum laws relating to
0U building construction,and hcmby amhorim represenmtiwS of this city to enter upon the
G31 shove-manli.nad property for iuspecdon purposes.
(We)agree to save,indemnify and kap harmiw the City of Cupertino against
y lubilidu,juil;Ckus,costs it tape.which may in any way acme$&,last said City
U z n ren sof tic ung ofib is perms
v-. 'AlPLI A UND ANDS AND W L COMPLY WITH ALL NON-POINT Issued by: Date
SOUR 0. NS.
9'11'04 Re-roofs
Sigemm of ApplianUConuacter Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupantstnm.r handle haz4rdaw mamnal
defined by Ibu Cupertino Mumm d Code.Chapter 9.13.and de Health and Safety
Section 35332(.)7 All roofs shall be inspected prior to any roofing material being installed.
[:I yes
WIII 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
emlt h.rardaus air contininanu fad by Ne B.y Area Air Quality Management all new materials for inspection.
Dis ncR
❑Yes Nu
I haw rtW the hazardous materials mquiremcw unity Chaptcr1W ofthe Califon
niaH.lth@ yCodc,Senia.23505.25577 USN.lundeysmnd Jw Kthr building
dasnotc m naw uL Jim ltu myre ulhilitymn.tifY�•aupant of Je
require sew n mil narmiartr .eenirmampwmy:� Signature of Applicant Date
Owner ser authorized agent Dam All roof coverings to be Class"B"or better