05100134 CITY OF CUPERTINO .�
BUILDING DIVISION PERMIT Ci�N'TR:4.GT0"..R'I ,FORMAT'IaN' '
BUILDING ADDRESS: PINN BROTHERS CONSTRUCTIO b PERMIT No.05100134
10745 N DE ANZA BL 7
R'S NAME: PERMIT ISSUE DATE
BY
COLONY INVESTORS II IN 1475 SARATOG
PHONE: SANITARY NO,
CONTROL NO.
(408) 252-9131
'IECDENGINEFR: BUILDING PERMIT INFO
ARCHI
BLDGO ELECTO PLUM
O O
LICENSED CONTRACTOR'S DECLARATION lob Description
F 1 hereby aff,m that I am licensed under ,pmWslom of chapter 9(commemoin{
EV with Section lIXNp of Diviaian Sof the Bu,Imu and Profwiom Code.aM mylkenscu
in full fmcaandofrea.,8 NEW CONDO-1, 320
Lketmus��Class 'V Lic.• 35aQ��
Date li�l9�wL 1-3Umr)KAIlum {a
A�RCNITECTSuctor,��R7RsII7TrD)N
i 1 Understand my plans shall roused u public mceNs
i U
.a Licensed Pns(euienal
a OUIIDER DECURATION
i 5 I W rehy affirm that
I am am tempt from IM Gmrectara License Law for the
I]o fallowing mason.(Smdm]03 LS,Business and Pmfmsium Code: ea city or atony
$ which rtqui,ur m permit m eons due shat.W forst deermit t of repair any structure $282968
Sifn that he itiuuegepruartquirus lW visions o forsuch onaranmitmicensrile ae ned Law(Chapter
Valuation
C thatheisIkcmdpuuuantsstheprovisionsoftheCommcssr'aLkaacLaw(Chaplet9 Sq.Ft. Floor Area
1
(commencingheisump,theNromon and thenof Division rth al Businm end Pouon.Any vi Coen)or
Lou io u exempt any
and the basis for the alleged the exrmant W a civil
it penalty
of
not ea titan by any reddonlfor s(apermitsubjecttheapplkantm•rivllpenaltyof y Occupancy Type
not mart dun five hundred dollars(5300}
❑I.ummrofthepmpwy.ormycmploycmwfthwgmutheks ic=Pcmdon,
will do the work.ared the structure 1,mtlnanded uraffered fmsaic(Sec.70M.Bougnms Required Inspections
and Pmfm eaalaCode:The Countesses Ltam Law dean mi apply b an owner of q ,
property who bu Ilds m imprevu thereon,end who does such work himself m Nrou{h his
own employess,provided that coach improvements are mtimmWrA oroQe"d for sale.IL
however,tht Wilding or improvement i,mld within tete you of cemplctian.the owner.
builder will have the Wmcn a(proving that ne did set Wild m improve for purpose of
sale.).
0 1.as war of to progeny.am exclusively convecting with licensed..=to.to
consumer the project(See.7044,Business and Profession Code)The Contractor's Li-
cess law dm not apply to an—1 of P,o1enY who Wilds or improves the..and
who cormanl for such projeoa with a amrecter(G Banned purgsam an the Condamine-
License
onn moesItem Law.
❑tom eauoptunderseu ,B&Pcfstismaann
r Data
WORKER'S COMPENSATION DECLARATION
"'by drop under Penalty of perjury nm of the following decimation:
I haw and will maintain a Cmtifiat of Consent an self-blurt for WorkeesCamper.
aetion,as provided for by Section 3700 of the,Labor Code.for the Penamuae of the
mrs for which this permit is blued.
Wf'h�.and will maintain Workers Compensation Insurance,as required by Section
7700 of the labor Code,for to per(osman"of Ne wmkf wmehild permhnlmsed.
My War eyi�epm1pl yseda�n Wusanaarnmmdpoliny berate: �G
Grtim:k. �`^w� s PoliryN Ty.L
CERTIFICATE OF EXEMPTION FROM ORICERS
COMPENSATION INSURANCE
(This section need not W completed If the Permit is fortune hundred dollen($100)
or less)
1"Idly thou in the perfomanee of thin work for which this permit is issued,I shall set
employ any person in any manger an u an became subject ss the Worken'Compemdan
Laws of Califomia.Dat
Applicant
NOTICE TO APPLICANT:If,after making this Ccnificat of Exemption,you should
become$Uhl=an the Workm's Compensation provisions of Ne Labor Code.you mug
.�. 0 forthwith comply with such provision or this Permit dull W deemed invoked.
Z h CONSTRUCTION LENDING AGENCY
f'a Ihareby a@m that dart is a construction lending agenry,far the mrfmmeecc of .
f� > the work for which tht permit Is issued(Sec.7091,Civ.C.)
dQ Lender's Namc '
.7 z Lemitr Add.
U O 1 comfy that I have wad this application and set that the move belt."dun is
Is.F cortex.I agree on comply wit all it,and county tediousness and stat laws raising inOU Wilding construction,and hereby authoric,mpreenwives of NiseitymenlvruPnnthe
t2J about-mention ed pmPcrry for inspection nPulposea.
0. (We)agree to save.indemnify and trep trunnion the City of Cupertino against
rn l'abilitia,Jud menta ems nth expensus which yin ane vete eccmc agalnstaaid City
conseq a the g g m this permlr.
APPLIC NT U DER Nos AND WILL OMPLY WITH ALL NON-POINT Issued by: 62i Date
sous REc Re-roofs
Slgnatu ApplianUComaacssr Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the appliant or future Wilding gecupantstore Of handle hrsarGous materia
defined by tit Cupertino Munie' I Code,Chapter 9.12.and the Health sad Safety
section 255324)? All roofs shall be inspected prior to any roofing material being installed.
E]Ym
If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future Wilding atopen,use equipment ar dcvicm which
emit haurdnus air conlsminaBfoodd by the Bay Area Air Quality Management all new materials for inspection.
District? a u
❑Yes No
Ih read thehvardlmsmateriaLsrequi measunderChapterh.95ofthe Calico,
niaHcal k afutyca eesima15305,25577 d 25574.1 undmoud thatifdte Wilding
does. art dy hoe Ruanethg0umyr sPondiIiIytemd`Ydousupantofthe
aqui on hi IWMCI poor 10him ceofaOntific Occupancy. Signature of Applicant Date
All roof coverings to be Class "B"or better
Owge authomnd"gem Dat'