05100144 CITY OF CUPERTINO •s
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BUILDING DIVISION PERMIT �`l.�l\I' "
BUILDING ADDRESS: PINN BROTHERS CONSTRUCTIOV rMITND'05100144
10745 N DE ANZA BLV 4 312
R'S NAME: PERMIT ISSUE DATE
BAY COLONY INVESTORS II INT 1475 SARATOGA AVE 08/17/2006
PHONE: SANITARY NO. CONTROL NO.
(408) 252-9131
BUILDING PERMIT INPO
ARCHRECffENGINEER:
BO EO PLUMB MECH
oG LICENSED CONTRACTOR'S DECLARATION lob Description
lot C 1 Mmby affirm that 1 am licensed under provisions of Chapter 9(commencing
tJ with Sation 70000 of Division 7 of dm Businea and Pmfoaiuns Conn,and Cry noose is
infan(arnand.ffm 9. BIZ NEW CONDO-1, 320
License An as, �Lu.M
p
Dam�L=.17_��—Contracmr 11/A[
ARCHITECTS DECLS�ATIbI`I,
i AR 81W 41
I understand my plain shall be used u public records
Licensed Professional
OWNER-BUILDER DECLARATION
1 hereby.filmSect on 1 1. exempt Business an d r Cosions, rs License Lew for tW
p p fallowing moon.(slit i 7(OIA ,abor, end are.darn Caor:Any cloy s county
which requires a permit m consist alar,improv,nnmollih.or mpalr any annum $282968
prior in its issuance.also,rcquirm de applicmt for such permit to file a signed suumem Valuation
< Thu he is licensed pursuant m the provisions of the COnincmri license LAW(chaptv9 Sq.F[. Floor Area
e5 8 (commencing with Sedon 7000)of Division S of the Business And Professions Code)or
Nat W is eeempt flecrefinam and the Wait,fm the alleged esempdon.Any violation or
Section 7031.5 by any applicant for a pamil Stbjecn the applicant in•Civil Penalty of Occupancy Type
not mare than free hundred dollars(5500).
❑I,uawasofdmpropmy.ormyemployemwithwegmuthebmleeompeuation,
Will do the work and the tounum Is not hurdled aanered foraale(Sec.70N,1konew Required Inspections
and Profession Cade:The Conuacmr's License Law does oat apply m an owner of q P
property who build,or improve thomon,and who domsahworkhimselforthrougn his
own employee,pm bCd the such improwmmu tie aatinnnfed oronerW for de U.
however.the Wilding or improamsnl is mid within one year a(campution.the owner-
builder w111 have the Writes of pmving Nat W did rot build or improv far purpose of
Mo.).
❑1.u Owner of the prepeny.Me eeclusiwly conoacting with licensed mnuctaa in
consuoct the project(Sec.7044,Business said Professions Cade:)The Caavacnrs U.
cense Law does not apply to an owner of property who Wilde or improv theme.and
who contracts for such projects with a cunuactoRa)licensed pursuant to the Contractors
License law,
❑
1.exempt under see .B de P C for this maser,
Den
WORKER'S COMPENSATION DECLARATION
hereby afrum under penalty of perjury om of the fallowing declantiotu:
1 have and will maintain a Ccnineu of Consent m wINna a for waters Compon-
aadon,m provided far by Section 3700 of the Labor Code,far the performance Of the
xro�i p40 which Nu pvmit ie issued.
1 have end will maintain Workers Canpeasnian Insursme,u required by Section
3700 of the Or Code.far Nc perfarmattcn of the wah f which this pcmt(tie loved
My War a m notion Insurance cartiv end Polity
Cartier. Polity N
ERTIFlCATE OF E(EMPPON FR WORKERS'
COMPENSATION INSURANCE
Rhee section ae0 mthe canpleted if the permit is foraw hundteddollars(5100)
Ic,L)
1 unity that in the pafamance of the work for which this permit is issued.I Mall not
employ any poison In my manner m u to Wcame object to the Worked Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,after matlng thin Cenirow of Escmption,yon should
become subject m the Worker's Compensation provisiam of Ne lana Code,you mow
Oforthwith comply with such provisions or Nis permit shall W deemed revoked.
„Z,t ti CONSTRUCTION LENDING AGENCY
Fr Iheeby affirm that then Is a construction lending agency for the performance of .
LYi> the work for which this permit is Wood(Sec.309T,Civ.C.)
W QLander,Name
7 z Lenders Arkansas .
U 0 1 certify that I have read this applicalmn and sum,that the above information is
I. F COMM.I agree to comply with all city and county CNinanas and sum laws misting in
C)U Wilding eannmction.and hereby authvim represcnmivo of this City to enter upon the
W above-menti...d property for inspection purposes.
O. (We)agree to save,indemnify and keep harmless the City of Cupertino against
liabilities, iftimdri
andmpensu ich stayu my waycme agalut aid City
APPLI rice DAND ILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUR R NS.
Re-roofs
Signature arApplicatilconturecurr Dau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Be applicant a fuse Wilding occupant sum or handle hstardoes material
deRned by tie Cupertino Mun(ci Cade.Chapter 9.12.and the Health and Safety
SeNan 25332(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Ym Na
Will de applicant or future Wilding=Open[use equlpmem or device which If a roof is installed without first obtaining an inspection,I agree to remove
emit huardnm alt cantsminmu u tined by the Bay Ama Air Quality Management all new materials for inspection.
MAIM,?
❑Yes Na
I hew read ate hvudtau malOriats equiremcw unnnrCWpur 6.95 of the Califon
ria Health Sefcty Cadc&�#
X.1 undersand tharifde Wilding
doe nut a y haw llity u notify 0o,occupant of tie
rogoie on n n aenlnow 0jfcuj jy06 Signature of Applicant Date
Ownv a stn d agent 1�i ]Date All roof coverings to be Class "B"or better