05100143 CITY OF CUPERTINO � .' 't, "' °-' '' "`�
BUILDING DIVISION PERMIT 3 sC41ITRACT(QR.INFflRMr`kTIQN '
BUILDING ADDRESS: PINN BROTHERS CONSTRUCTIO SREaMITND.05100143
10745 N DE ANZA BLV # 311
R'S Ir NAME:
PERMIT ISSUE DAM
BAY COLONY INVESTORS II INC1475 SARATOGA AVE 08/17/2006
PHONE: SANITARY NO. CONTROL NO.
(408) 252-9131
BUILDING PERMIT INFO
ARCHI'IECf/ENGINEER: BLDG ELECT PLUMB MECH
g g LICENSED CONTRACTOR'S DECLARATION Job Description
i�u FF4 1 hcmby affirm that 1 am limwd under pmvWans of Chapter 9(commencing
S with Section 7000)afDivWon 3 of the Busircst And Professions Code.and my Immure It
, m in full Come sad cffecL l°t k NEW CONDO-1, 638
InZ License Clos�Lle.N
'F Date a.m.
ARCHITECTS DECLARATION
i 1 understand my plans$hall be used As public records
s
G Licensed Professional
sy OWNER-BUILDER fr DE CLARATION
I bunchy a1Tmm that I am exomptempt from du Conuutoea Lieenu Law for the
:CC following mean.(Section 71D I.S.Business and Protrusions Calc:My city or county $351138
i sig which nequma•permit On cmd WmL alter,hnpmse,dcmalish,or repair any tram.
'nor to its Issuance,Wu mqulm elm applicant forsu in Permit On III.aalgned auumem Valuation
• < that he is licensed pursuant mthe provisions ofduContractor'sLicense IAw(Chapter 9Sq.F[,FloorArea
2 g (commencing with Seniors 7000)ofDivision]of Ne Bustin.,and Prarcomn$Code)or
.. that he is eumpt ft fmm and the bum for the alleged---Pd--My vi-mult n of
Safion 7031.5 by A"applicant far Permu subjects the APPlteant m a civil Penahy of Occupancy Type
not mart than five hundred dollars(5500).
0 I,As owner o(the property,m my dnploym with wages As their sole compensation,
will do the work and the =turn is Out Intended or offered for We(Sec.7044,Bu$it¢ss Required Inspections
de
and Professions CaThe Consumes Lm=Law Clop al apply m an owner of 9 P
property who builds a improves mracon.and who does such wart himself orthrough his
awnemploym.provided that such imprmemgtu art at intended oroQud ferule If.
however,the building or improvsmenl'u sold within ane year of completion,the$war.
builder will low the burden of proving that he did Out build or improve for purpose of
umJ.
0 1,As owner of the Property am aaduaivelY--muting with lianxd conuumrs se
construct the proleti(Sec 7044.Besiocas and Professions Code:)The Conm$emes Li- -
C.,,..taw does..,apply man sumer of property who bull"or improv mddan,And
who contracts far each projects with acontocter(s)licensed Pursuant to,rate Commelaes
Lteeve Law.
❑I am exempt under See. .0 k P C for this moan
er Dau
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of dm following decimations:
I hew and will maintain•CeNOgm of Consenlw self-Intim for Werteea Compen-
sation,q provided for by Section]700 of the labor Code,for me performs.of de
wort which this permit u mead.
I have And will malnmln Workers compemathm INarance.LV osp lmd by Section
]700 of the Ube,Code,far theperformacoofthe wo tf which Nis permit is Issued.
My Wor a Compensation Inwnn-came,and Paliry �(
Gsrier. Policy No. �(
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This ualan need not he completed if the Permit N forced hundred dollen(g10)
fir less.)
I cntifv that in me perfomanco of me work for which this permit is issue.I Nail not
employ any person in any manure As m become subject to the WorkedCompensation
Laws of California.Dau
Applicant
NOTICE TO APPLICANT:If.after making this Ce-Incam of Exemption,you should
become mbjea An,the Workee$Compensation provisions of the Labor Code,you must
O O forthwith comply with such provisions or this permit me])he decree revoked.
Z CONSTRUCTION LENDING AGENCY
(-i I hereby affirm that dem is a commission lending agency for die perfermaac of ,
a 9 the work for which this permit 4 issued(Sec.3097.Civ,C.)
C] LaecesName
z l.and er$Add.
U Q I certify tho I have read this application and state Nn the above information is
IL f-r correct.I agree m comply with all city and county mdinam:3 and state laws relating to
0
Wilding construction,and hcreM1y authorize mprcscnmtives of this city mCOW upon the
V
NU above-mentione proarty,for inspection pummes.
gy (We)agree to save,indemnify and keep hamdess the City of Cupertino against
H Nl liabilities mcnm.co d.-,,r It in ane way see=Against mid City
UZ coda- theg ngafthmpemh' Date
^' APPLI A N E ANDS AND WIL OMPLY WITH ALL NON-POINT Issued by:
SOUR R T
9-11-0*
Re-roofs
Signalum afAppligHAZARDOU Date
HAZARDOUS poWe MATERIALS DISCLOSURE Type of Roof
WIII the applicant or forum building eccuputume err hostile haurdam material
defined by me Cupertino Muniei Cade.Chapter 9.13.and the Health and Safely t
Section 2553x(.)7 All roofs shall be inspected prior to any roofing material being installed.
0 CIC
Will me applicent or future building amvpant uta equipm-t or devices which If a roof is installed without firs[obtaining an inspection,I agree to remove
emit hosrdons air canumin-u fmcd by the Bay Ama Alr Quality Management all new materials for inspection. 1
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❑yes Nu
Ila maJ Nth daumamrialsmquyyyyyyemdms underCMPter G95afine Caiifory
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Heal @ tyCa �etions25505.35525531.1 undersmndthmifdu building
Joe"era cu I a enan4tho0ism _Iachililymnotil'Y aeupmtof the
myuire eel h agd met poor to aaracdrti5C asap�y Signature of Applicant Date
Ownet Or aYN-rVLd agent s_1i� D,te All roof coverings to be Class "B" or better