05100147 CITY OF CUPERTINO ' 'F ^a�'`'3""'"' r ' ,
BUILDING DIVISION PERMIT �c, rxaA �raIrroR.>vl.arlorr
BUILDING ADDRESS: FINN BROTHERS CONSTRUCTIONS..... x'05100147
10745 N DE
R'S NAME: PERMIT ISSUE DATE
BAY COLONY INVESTORS II INQ 1475 SARAT
PHONE: SANITARY NO. CONTROL NO.
(408) 252-9131
ARCHITECf/ENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
pop LICENSED CONTRACTOR'S DECLARATION Job Description
i U I hereby'M m that I AM licensed under provisions of Chapter 9(tommcncing
vim Section 7")of Division 3 of Ne Business and Fofnsio O Code,aha my license is
hN in full fora and effect. ;$3°iIL NEW CONDO-1, 320
LiMmxA Qin L�.
ik- DamD �/.aarate�
—V_rsN �_`^�ARCHRECISEC
sS DECL�Pow+^'•aa l
I understand my plain shell be used As publm records
lyUk�
Licensed Protean...I
m 3 OWNER-BUILDER DECLARATION
i 1 hereby Aman Net I am exempt from the Conmmar's License Law for the
.p o fallowing moron.(Section 7031.5,Business and Pro@nsions Cade:Any city ar only
which requires•permit An cons"CL ser,Improve,demolish.or m*r any umctum $282968
4;w prior m its issuance.also mquim me applicant rorsuch Permit to file a signed Statement
i Q that he is licensed pursuant to the previsions of NeCon=IM'sUcenmLaw(Chapter 9 Sq.Ft. Floor Area Valuation
5 $ (commencing with Section 7000)of Division of the Business and Professions Cash)or
3..
that ha ts exempt Merefrom and the breis for the alleged exmpton.Any violadon of
Section 7031.5 by my appliesnl for a permit subjects dm applicant to a civil penalty of r Occupancy Type
not me.Nan rive hundred dollars($309).
0 1,a owner of Ne property,or my employe with wages As their mle compensation,
will do Meworh.and thesououm is noUmmruiedararrered forsam(Sm."",Business Required Inspections
and Profassions Code:The Canessam's License Law does rot apply m m ower of q P
property who builds or improv Jwean,and who does me h wart himselfor through hos
Own empl.yma,proNded that such Improvements art trot intended eaafferW f ersale.If.
however.the building or Improvement is sold within aro Year of complmon,Ne mamar-
builder win hive IW burden of proving Most bo did hint build or Improve for purpose of
sale.)
1,u ow=of an,property,am eachrowly contracting with Bcensed mntrmmm in
conswct Ne protect(Be,7004.Business W Profession,Code:)The Conrnnoh Li.
cense law docs Out+ppty to an owner of property who Wilds or improv Hereon.ane.
who contracts for such Projects with amotracur(O 110-MO Pursuant m the COMtrsetur's
Licmma Law.
❑1 am exempt under See ,B&P C for this reason
Dam
WORKER'S COMPENSATION DECLARATION
reby Nino under penalty of Perjury mm Or the following declaratiehe
I have and will maintain a CanTfiesm of Cement In self-Insure for Warkerts Cormam
salion.As provided for by Section 3700 of the labor Cade,for the performance of the
wart f hieh this permit is issued.
have end will maintain Worker's Compensation Insurance,As required by Section
3700 of the labor Cade.far Ne performance of Ne weak for which this permit is imced
My Walker' VAMA as Insurance tinier and Policy n xeI I�
Cartier.0 Policy FROM
`E
CERTIFICATE EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
rlbk section need not ho completed if the permit Is feaow hundred dollam(SIM)
nr Ins)
1 century Hot In Ne performance of Me work for which His Permit is issued.l shall nm
employ any person in my manners.u m become subject to the Workers'Compenmbon
Laws of California.Dam
Applicant
NOTICE TO APPLICANT.If.After making this Certificate of Exemption,you should
become subject m Ne Workers Compensation provisions of Ne labor Code,you most
O faMwith comply with such provisions or Nmit is pershall W domed mveked.
Z rn CONSTRUCTION LENDING AGENCY
[-x I hereby amrm Nat Nem is a conmucOnn lending agency far the Performance of -
CYiNe work fur which this permit is issued(See.3077,Civ,C.)
W Q Lcndces Name
7 Z Lender's Address
U0 I certify that I haw read this application and sum Nn the show:information is
U.P cmxe I agree in comply with tll city and county ordlnanm and aura laws relatingm
O U Wilding connection,and hereby anthorim repmacnmiv of Nis City to enter upon de
W aboiliti wted Pepeny Tea lnsto
Pmn puryoxs.
(We)agree to saw,indemnify and keep harmlea the City Of Cupcnin.Against
i
fajy liebilites gmenu.cosu andexpertms whi hmaY in any way amNC+jainsl wit Gly
nto of the ting o"o pcnnl
^' APPLI A U DE ANDS AND W L COMPLY WITH ALL NON-POINT Issued by: Date
SOU G S.
1 7"x Re-roofs
Signe rtof ppResntConummr one
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will lhe'pplic+nt Or fume Wilding .pantaloons,handle havNaus m+xrisi
Fdefm:d by tin Cupertino Municipal Code.Chapter 9.13,and IW Health and Safety t
Satan 255324)7 All roofs shall be inspected prior to any roofing material being installed.
Ow, ❑Na
If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building Meepant use equipment Or devim which
AMR dem mOsel air mnuminants as defined by the Bay Area Air Quality Management all new materials for inspection.
Chinn?
❑Yes ON.
w mwith hmwdnusmawrisismquimmenuundcr Chapmr6.93oftheCalifor-
Alai th Safety Ide,Sectons255n5 5533md25334.Imdcrwandthatifthe Wilding
U.
m .11 e e tenant Nett my rosrmumbility m n.dl'y to occupant or the
requ J aWmetptor 'yumceofaCcW moroccupancy. Signature of Applicant Date
w/7A,0{ All roof coverings to be Class"B"or better
Owner tar authorized orient Date