05100146 CITY OF CUPERTINOv r'd arc a'>� '�"� �'
BUILDING DIVISION PERMIT ,covrR�.cT�I�zlvoTrorr.e-
BUILDING ADDRESS: PINN BROTHERS CONSTRUCTIOZ uR11NO'05100146
10745 N DE ANZA 1;LV it 111
PERMIT ISSUE DAZE
R'S NAME:
BAY COLONY INVESTORS II IN 1475 SARAT
PHONE: SANITARY NO,
CONTROL NO.
(408) 252-9131
ARCHiTEC(ENGINEER: BUILDING PERMIT INFO
BLDG EO PLO O
1Gp LICENSED CONTRACIOR'S DECLARATION lob Description
I hereby affirm that I sm thorned umkr provisions of Chaper 9(Commencing
U wide Section T011D)of Division 3 a(de Business and Pro(essem Cade,anmy licensee
immlrmaameffbcL 6 ,cagy NEW CONDO-1, 638
Liamc ass Lle.g
t-, Dam _Cantruur I[�g
ARCHITECTS DECLA AFIOI'a ""—' L
j U i urs
ndeumu l my plans shall M used public meools
G
t, Licmued Professional
'u,3OWNER-BUILDER DECLARATION
l I hereby aRna Nat I am exempt from the Camnames mss License law far one
.p o following reason.(Section 70313,Business and Profession$Cade:My City or County
ig� which rmium,a permit as CWdCmL after.amprow.demolLN,car eePat,any suuerue $351138
iy prior m its issuance.also requires de applicator rat such Permit m fele a signed suement Valuation
3 G this he is licensed pursuant hetiePmvislomofthe Connector's L3armLaw(Chapter 9 Sq. Ft. Floor Area
i (commencing with Section 7000)or Dwisican 3 of de Business and Prof...,CMe)or
$ that he u exempt therefrom and site basis for
the
alleged eamption.My violation of
Section 7031.3 by any applicant for a permit subjects she applicant to a civil penalty 01 r v v Occupancy Type
nut mom than five hundred dollars($50D).
❑1,our owner of she propotry,on my employe.with wages u their sole ompeessil
will do the work and thesteueere a not amended Cantered tor.le,(Sec.704.Business Required Inspections
mad Profession Cade:The Consciences Liaise law don aur apply in In Owner of q P
pmperty who bu ilds car improves thermn,aM who does ouch wok hi malf car through his
awn emptoymcn,provided Na such improvements are not InuredM ora@CoA for cele.IL
however,the building or Improvement u sold within ane yea of ComPlation.the cur cr-
builder will haw the burden of proving that be did not build or improve for purpose of
isle.).
❑1,an closer of the property,am nuluavely conaterng with licensed contractors e
onsrmct dee project(Sec.7044,Business IM Profaelam Code:)The Contraeror's U.
came law dan not apply m an owner of property who Wilds or improves theeon,and
who contracts for such projects with acontracti licensed pursuant m the CanMON'S
Licence Law.
I]lam uempt unties See. ,B&P C far this season
Date
WORKER'S COMPENSATION DECLARATION
1 heecby aRiem under penalty of perjury one of the following decaanti al:
1 haw and will maintain a Cerdfiotn of Consent an albbeure for WorlmesCompen-
nation,an provided for by Section 3700 of the labor Coda,for the performance of the
wort jOr which thin lumber Luued.
1 have and will maintain Worker's Compensation Insurance,u required by Sccdan
700 o(th bar CM..to,the performance of the it N,which thin permit in issued.
My War �emation Wuramre.rtier Cosi Paliq lar - I
Cartier. aPolNo:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu sectio need notbacomploM If iee permit Is far am hundred 011.({101)
or ass)
1 certify dot in the paTurroanea of the wort for which thin permB is lased,l shall ata
employ any person in my Counter an an e became subject to the Worker'Compensation
Laws of California.Dee
Applicant
NOTICE TO APPLICANT:If,&net making this Ceulfs.m of Escreption,you should
become subject an the Workers Compensation provisions of the labor Cade.you am
U z forthwith Comply with such provision or this Permit shall be domed ewked.
z•O CONSrRUCTION LENDING AGENCY
[.r I hereby drum that them e a Construction lending agency for to performance Of
the work far whim the permit u issued(Sec.3097,Civ.C.)
III Lenders Name
z landera Adders
U Q 1 citify that I haw end this application and suis this the above Information is
D.F torten.l ogee to comply with all city and county ordinances and sue laws relating to
OU building construction.and hereby auuome repreanutims of this city no cnserupnn the
D CII show mcnuuncd property far imp, ...Purposes.
(We)agree to ave,iadcmmfy and kap haemes the City of Cupemno against
rFi N Iiabiliti.,ludgments,cum aM.penrus which morn any way acme.&amt aid City
U z in con c of the g {of this Permit.
^ APPLI NDS AND WILL PLY WITH ALL NON-POINT Issued by: Date
SOUR
Re-roofs
sign o Applicni Canu iter DataOf Roof
HAZARDOUS MATERIALS DISCLOSURE Type
Will the appli.m"Faurabuil ' gacuramistoreorhaMlehavAam
ommrid
fined by the Cupertino Munif Cale.Chapter 9.11.and site Health and Safety
,Section 15571()? All roofs shall be inspected prior to any roofing material being installed.
e
w ❑Y. Nu
Will the applicant or future bu' mg aemalm ata equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit haysrdnus air conuminenu Omd by the Bay Aee Air Quality Management all new materials for inspection.
District?
❑Ym No
[have
eJ the haudnusmeeradamquircmea unJee Chopwr6,95ofthe Califor.
nil Health tasty Code,Sect 133113.3337)enJy 74,lusuleeund thutifWe building
docs�rm r h eat Net h is my r. Q�l2hlliry w nofy Ne acupat of Nc
mghitsca ertincem car ccuPanry. Signature ofApplicant Date
4elonany if All roof coverings to be Class"B"or better
I orlead agent Dam