05100125 CITY OF CUPERTINO /o-�+-.a �'e asr, '�° * _ �z.
BUILDING DIVISION PERMIT liQ d =Ile .CTR I1�FaORMA.TI N-
a ,1 ' ... N,aE�<'S '3 .n•e-at,' t.
BUILDING ADDRESS: FINN BROTHERS CONSTRUCTIO g" "'05100125
10745 N DE ANZA B1,V it 105 41
R'S NAME: PERMIT ISSUE DATE
BAY COLONY INVESTORS -II IN 1475 SARA
PHONE: SANITARY N0. CONTROL NO.
(408) 252-9131
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
O 0 0 0
pp LICENSED CONTRACT'OR'S DECLARATION Job Description
uE1 hereby affirm Nn 1 am licensed under Provisions of Chapter 9(exa mancln$
u� with Section 70100)of Division 3 of the BusimYs and Prafeuiom Cade,AM my license is
N in fun rases and effectL a 352y 1 L NEW CONDO-1, 194
;Ljz Lknn� 1Class
F Da¢ i_pr cmancrtorDoiUPAJ
ARCHITECTS 0 N it
I understand my plans sbsil be and As public records
A.
'QLicenced Pmfessimul
3 OWNER-BUILDER DECLARATION
�<E1 herehy aRmi that I am exempt Prem the CenlOelara License Lew far the
.O o following memo.Permit
(Section 7117 L5,Business uW Pmhvinm Code:Any city or tum
5$ which acquires;a permit ac construct.Wer.improve,h permit
or Riau any om Ant 2 i
prior at is issuance,also acquires Nc applicant for such permilm file. igned suumcm Valuation
C Net he is licensed pursuant to Ne provisions of the Contractor's UcenmLaw(Chapin9 Sq.Ft.FloorArea
i (commencing with Section 7000)of Division 3 of the Business and Pmresslam Code)or
$ that he is exempt thercfRm and the bub far the alleged esamption.My violation of
Section 7031.5 by any Applicant for a permit subjects the applicant m a civil penalty of Occupancy Type
Out mart Nan A.hundred dollars(5300).
❑I.aowmrof Ne property,army nnployetwlN wager atheh mlecompensedon,
willdotheworkand Nese isnoliomMdo,onemdroraalo(Sec.7(344.Sutioess Required Inspections
and Profesmou;Cade:The Contractors License Law dao rot apply 0 an owner of 9 P
property who exildsMirs ey.thereonand wbodowamichwaft himselfter through his
awn employment,provided d u such imptovemante tae MI intended w0flered forsxle N.
however.Ne build n{or improvement is told within oro year of ex mplauon.the owaer�
builder will Mve the burecn of proving Nat be did ani build ar improve fear Purpose of
tale.).
I,a owner of the propeny.am exclusively contracting with licensed ms
nam s b
oo
cnmct the Project(Sec.704x.Businev W Professions Cade:)The Customers U.
cave law des not epPly m an owner ter property was butlW or improv,thenen.and.
who contracts for such ton jecls with a conbmmr(s)licensed pursuant to the Contactors
License Law,
❑1 oro exempt under See. .a tier P C for this reason
Data
WORKER'S COMPENSATION DECLARATION
hereby aMan under penally of perjury arc of due fallowing deelarMons:
tn+e and will munuin a CeNneR of emuenl or siGlmum far workers eompea.
AMM,As provided far by Section 3700 of dhe labor,Cade.far Ne Performance of do
wa�wbieh Nib issu
s permit ed.
I have and will maintain Workers Compensation Intolerance.as acquired by Station
3700 of the Labor Cade.for Out performance of the work for which this petmit Is blues
My Work.—eLcounamuchon basurm Cartier W Polity um r I:
Carrier. Policy No.:
ERTIFICATE OF EXEMP ION FROM WORKERS
COMPENSATION INSURANCE
(This merlon nod sol be completed if the permit la forme hundred dollen($100)
or Ica.)
I certify that In the performance of the work for which Ns permh is issued.)shall not
employ any person in my manner an as In became subject to the Workers'Compenaatian
Laws of California.Dau
Applicant
NOTICE TO APPLICANT:If,after malting this Ceninnte of Exemption,you should
become subject in d,Workers Compensation provisions of the Labor Code,you most
2 forthwith comply with such provisions or this Permit shall be dame!revoked.
zO CONSTRUCTION LENDING AGENCY
f^ Iheacby afrim that dart is.omtrunian leading agency for Ne performance of
C4> the work for which this permit is issued(Sec.7097.Civ,C.)
QLenders Name '
z 1<nders Address .
U Q I certify that I have Rad this,application and mu that the above information is
Ly F coned.I agree to comply with all city and county on intoe and sou law$relating to
0 U building contraction,and hereby autho ea representatives of this city to enter upon the
11.1
.have ms.judgcdpmperlyst for inspcnion pugmsea.
LL (We)agree to ave.indemnify and keep b trnlea the City of Cupertino against
era ti liahilitics.judgmcnu,cam ezpenms whichm In any way Aceme agunnraid City
U•'Z incanhC`AW a gra n o(Nis permit. Date
�-+ APPLICANT N R DS AND WILL MPLY WITr'H'.ALL NON POINT Issued by:
SOURCE R U Y-17-41-
Re-roofs
Si{noun of pliwHAZARDO Data of Roof
HAZAADOUSMATERIALS
pan,,oLOSURE Type
WIII cite applianlsfuture building Co aaupanlu9.1 anhandleHalthAmaters)
deserted ly Ne Cupe"ano Muni' 1 Code,Chapter 9.12.and the Health and Wcly
.Section 25532(1)7 All roofs shall be inspected prior to any roofing material being installed.
❑Ye No
Will the$ppllt'ml ter fYIYR by m$ttCupanl Yoe ellalpmut ordo,!=which If a roof is installed without first obtaining an inspection,I agree to remove
emit hmsrdous air can.,'... fined by Ne Bay Asea Air Quulty Management all new materials for inspection.
District?
❑Yea d Nu
I have mad thehmarduuamaudal$requiremcn under .Chapin Q95ofthc Califaw
nice HcaIN�SSafclyCaM,SeNau23305.25377 and J4.IundenuM Nwifdre building
does no ur ly ham anL Net it u my Repo thlllty m notify Nt scupant of Ne
require trod �hi oma pno,m iauanc cmncate a�`cu Signature of Applicant Date
r 7-— All roof coverings to be Class"B"or better
Owner or autboumd agent Das