05100124 CITY OF CUPERTINO
BUILDING DIVISIONPERMIT CONTkA.CTOR INF'UTtMATION
BUILDING ADDRESS: a PINN BROTHERS CONSTRUCTIO rMITND'05100124
10745 N DE ANZA BLV 4 303
PERMIT ISSUE DATE
orR'S NAME:
BAY COLONY INVESTORS II INC1475 SARATOG
SANITARY NO. CONTROL NO.
PHONE:'
(408) 252-9131
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: ELECT
BLDG O PLUMBQ MECH
Op LICENSED CONTRACTOR'S DECLARATION 70b Description
U F 1 bcreby affirm Wm
t 1 am licensed miler provisions of Chapter 9(commencing
zj u� with Section 7000)ofDivkian 3 o(Oo Regimented Profeedum Cude.andmyliarecis
n in full farce and affect 34540 1 L NEW CONDO-1, 209
n License Clw Lk.N
�= Dem �m�"t
� COntrmmr L
STT—6 ;ARCHITECTS DECLAR
i C 1 understand my plans shall he used as public reenrJr
i�
GLicensed Professional
y OWNER-BUILDER DECLARATION
ContrON
t I herehy_Rete Net 11. ucmpt from IPr f o thacmra License law for the
fiZ
0 o fallowing moon.(Section 703 1.5.Business and Re,damor .Calc:Any city Of county $259173,7 3
129 which in Issu a permit w eon;wot.a@r,improve,h Permit
t or repair any tatemure
zi priormits Issuance.alw require tM applicant tforhe Conpermi'mmnso signed statement Valuation
-Um that he is licensed pursuantmtimpmvisionsnftimContractur'aldcenalaw(Chepter9 Sq.Ft.Floor Area
(commencing with Section 7000)of Division 7Or Wa Businesaand Professions Coda car
3 g Net he I,exempt therefrom and the bub for the alleged exemption.Any violation of
Section 707 LS by any applicant for a permit subjects the applkmt m a civil penally of r Occupancy Type
oat more than 0w hundred dollars(5500).
I.uowner_(the Napefry.ormy employees with wagvatheir wk compensation.
will an,the wart-and thertrumun is not Intended of offend Certain(Sec.70th.Business Required Inspections
and Profession Cade:The Canuonofs Lkevn Law dors nut apply m an o-xrcr of
pmpeny,whobuildsor Improve;to m en,and who duetsuchwork himselformmugn his
ownemployev,provided thsuch Improvements am not intended oronemd for aleif.
however,in.building or impmwment is mid within aro year of compictum.the owner-
builder will have she burden of proving that he did am build or improve for purpose of
salad.
I,as awher of the property.am"elusively contracting with licensed anuscmn in
construct the project(Sec.7044.Business and Professions Cade)The ConmKtX';U-
cove law dam not apply in an owner of property who builds or Improves thenen,and
who contracts for such projects with a"a uecmr(q licensed Puduam no the Contractors
License law.
❑IamexempluMor See ,BkPCforthbreaan
Data
WORKER'S COMPENSATION DECLARATION
1 hereby ahem under penury of perjury,ane of the following decladlmoic
1 ham and will maintain a CCrtlBee a of Covent0 self-inmm far Worker"Cooper'
sedan u pmvided for by Section 7700 of the labor Code,for Jap performance of the
for which this permit is Wood.
w I have and will maidtsin Wallach Compaystian I a.as required by Secuon
7700 of the Labor Code.for the performance of the wwhich this Permit u Wued.
M Works alimWn artier and Poi' �a4
Cartier. Pollry 7
CERTIFICATE OF EXEMP ION FROM WORKERS'
COMPENSATION INSURANCE
mAsseetion heed nut he completed If the permit is Inane hundred dolbn($1001
or lass)
I ecnify that in the performance of Ne work for which this permit is issued,l shall Out
employ any person in my manner an a to become subject to the Worked Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:IL after making the Certificate of Exemption,you should
become subject he the Worker's Compensation provisions of the labor Code,you muss
Z far with amply with such provisions or this permit shall he eamed mooted.
ZOO CONSTRUCTION LENDING AGENCY
E~ 1 hereby alarm that then Is a construction lending agency for thc performmuce of
gY> the work for which this Permit b Wucd(Sec.7097.Civ.C.)
W QLenders None,
0 z lander',Address
U Q 1 certify that I have mad this application and sum that fee above information is
D, F comect.I agme of comply with all city and county Ordinances and sum laws relating to
�U building construction.and hereby amhorim apmxnatiws of thiscity mantefupon the
r W move-mentioned property for impecuon purposes.
(We)ag.0 to save,indemnify and keep hmnlea the oy of Cupcnino against
„E'y p0.jy liabiliuv.Judgmcnts,cvu anal which meyin my yamucagainstraid Cly
J in conxquena Ong is permit.
APPLICANT N A AND WILL COMPLY ITH ALL NON-POINT Issued by: Date
SOURCER U I 5 tug
V Re-roofs
Slibuun of IicmUConvm r Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or futwe building occupant swap or handle hamdav material
_jfidarned by the CuPenka Munitl I Code,Chapter 9A2,and tiro Health and Safety
.ScNen 2ss7x(a)7
❑sins All roofs shall be inspected prior to any roofing material being installed.
Na
If a roof is installed without first obtaining an inspection,I agree to remove
Will he applicant or future building occupant use equipment or dcvlaa which
emit hmardnus air con=,.U a road by the gay Area Air Quality Management all new materials for inspection.
Dlwict7
Dy. u
1 hew mad W limitations materials nquinmcnts under Chapter 6.95 afthe Califor-
dieHra , etyhe emcf. 07,25377�dI1114ntl the buildingJma not c hatmnmL that It b myfy the occupantofthe
m uimm mel dorm taufOm mayDate
q p „roSignature of Applicant D,k All roof coverings to be Class"B”or better