05100126 CITY OF CUPERTINO
BUILDING DIVISION PERMIT C'01 'T1L�•`. •' R' '� � � '"
s ,s •ha i MIPo "a Fv*..5•.a' .�' �„a 7 I.�',„ tri �_. ire.
BUILDING ADDRESS: PINK BROTHERS CONSTRUCTIO .T"”" 05100126
10745 N DE ANZA RMT it 107
R'S NAME: PERMIT L.EUE DATE
BAY COLONY INVESTORS II INC1475 SARAjQGA AVE
PHONE: SANITARY N0. CONTROL NO.
(408) 252-9131
BUILDING PERMIT INFO
-ARCHITECT/ENGINEER:
. BLDOO ELECTO PLUMBO MRCH
p j LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby affirm that I am licensed under previsions of Chapter 9(commencing
sato Section 70110)ofDiviaion 3 of the Bunn.and Professions Code.and my license is
afullmrcederfeet. 3491411. NEW CONDO-1, 518
Z LicenseCan
lan Lk.g
Dam —C.L.,
sq-. ARCHITECTS DEC R
i 2< I understand my plans shell W used As public rtcard,
i butyl U
' Licensed Professional
m 5 OWNER-BUIIAER DECLARATION
1 hereby alErm that I am caempt from the Contractor's License Law for de
.0 o fallowing mason.(Section 7031.5,Business end professions Code:Any city err county
3 a M which requires a permit to cramroar alar,imprew,demolish.nn repair any structure
_Zs prior At is issuance,also requires the applicant for such permit to file a signed statementValuation
O that he is licensed pursuant w the preLi
visions of the Contractor's ccnm law(Chapter 9 Sq.Ft. Floor Area
4 (commencing with Section 7000)at Division 3 at the Bustrese and Prekssions Cads)or
$ that he is mompt memfrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit wbjects the applicant to a civil penalty of Occupancy Type
not mom dun It hundred dollars 015001t.
❑I•As owner of the prepeny,u my employees with wages as their wk compensation,
will do the work,and the,aumum Is nat intended or offered f..We(Sm.7614,Business Required Inspections
And Profession,Code:The Combustion',License law does not apply w an owner of q P
property who builds W imprewa Hereon,andwha doessuchwul,Mmselfor Waugh his
ownemployces,Provided thatsuch imprnvemesu arc not intended asa@red forsula If.
however,the building or impmvemwt is sold within aro year of wmplction.the owner.
builder will have the burden of proving Nat W did not build or improve for purpose of
oak.).
❑1,a,owner of de Property,am exclusively contracting with licensed comseve s to
conwuct the pmjecl(See.7044.Business and Pmfeulans Cade:)M Cam mctor's Li'
came taw does sot apply to an owner of property who Wilds or improves marten,ad,
who contracts for such prejecu with a conmcar(u)Ilesnsed pursuant to the Camnewr,
Lcense Lew.
❑1 am exempt under Sm. ,B k P C for this mason
Data
WORKERS COMPENSATION DECLARATION
/I hereby&Man under penalty of petjwy ane of the fallowing declamdana:
1 hew and will mainuin a Certificate of Consent to ulf-insure for Worker,Compn-
sation,as provided for by Section 3700 of the labor Cade,for the performance of the
or which this permit is issued.
work
and will madman,Wofhh Compensation Insurance,As required by Section
3700 of Ne labor Code,fW th petformenesof the mark to which this person is issand.
My Workcf tion N uranan cart.,and Polity
Cartier. a I Policy
CERTIFICATE OF EXEM MON FROM WORKERS'
COMPENSATION INSURANCE
(Thu section need an,be completed if the permit is fanone hundred dollen(511301
or less)
1 cenify Net in the performance of the work for which this penal,is issued,1 shall not
employ any person in any manner an a w became subject a Oe Workers'Campensution
Lava of California.Data
Applicant
NOTICE TO APPLICANT:If.afar making this Certificate of Exemption,you should
become subject ue the Worker's Compensation previsions of Ne Labor Code.you mum
O forthwith comply with such provisions or this permit shall be deemed revoked.
z r~y. CONSTRUCTION LENDING AGENCY
[r 1 hereby affirm Nat them is a construction lending Agency for tit performance of
r1. Bre work for which This permit Is issued(Sec.3097.Civ.C,)
W Q Lender's Nam. '
a z lender's Address
U C) I certify that I have read this application and Auto Net Ne Alton information is
Dy F caned 1 agree to comply with all city and county ordinances and sate laws relating to
pU building cooswctian,and hcrebyamhmim rcprou,nmives Or this city to care rup.n the
shove-mentioned property far inspecuon purposes.
F LL (We)agree to save,indemnify and keep harmless Nc City of Cupertino,gains
fA liebilities,Judgmenu,crosuand expeaes which meyl any way acrneagainetaaid Cily
U`� in consequent th/SRS
fthis permiLAPPLICA U S AND WILL C PLY WITH ALL NON-POINT Issued by: Date
SOURCE GU `
V Re-roofs
Signature App ieanuac,or Dat
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant Or futon building Occupant sate W handle haamdea material
defined by the Cupertino MunI I 1 Cade,Chapter 9.12,and the Health and Safety
Section 25532(0)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yea
If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building Occupant use equipment or devices which
until mmueous air conuminanu yiJeOncd by the Bay Area Air Quality Management all new materials for inspection.
District? Cf/
❑Yes Nu
1 have read the Wmldnnsmakrlals reqs jrcmenu under Chapar6.95 of ere Caller.
ria HcalN ly CoML
05.155 mW25534.1undmand lhetifthc Wading
does an u y hawit is m responsibilitya noul'y the WT,.t Ofthe
requi n m wi9 Maniacc 'III ofoc alacrity. Signature of Applicant Date
;y7'e� All roof coverings to be Class"B"or better
Owner ear wooriyed agent Data