05100148 CITY OFCUPERTINO 'a q(& aaa* ,t' a�: d'x *�' `• � "'� '•' r?
BUILDING DIVISION PE NT?ORMATION
BUILDING ADDRESS: PINN BROTHERS CONSTRUCTIONS.MR NO'05100148
10745 N DE ANZA BLV
PERMIT asue DATE
oR'S NAME:
f
BAY COLONY INVESTORS II IN 1475 SARATOG
SANITARY NO. CONTROL NO.
PHONE:
(408) 252-9131
ARCHRECT/ENGINEER: BUILDING PERMIT INFO
BLDG O PLUMB MEOCH
LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby affirm That 1 em linenacd under PMAIMna of Chap-9(commencing
withSection70110).Division3of tho Bueinecoand Profeawm Codd,aM myliana is
in full Come and affect. S �E' S2us 1b NEW CONDO-1, 320
Llccneealus Lw.N
iF Dale " TooaUARCHESIEN r
I understand my plan shall he used u public moords
IyU
:0y LicctwJ Professional
'N 5 OWNER-BUILDER m DECLARATION
NI hereby affirm Nal 11. eumpt s an the Conuacmo License Law for 0A
O fallowing mason.(Section 703 t.3,Business and Pm(esiuM Calc:Any city err county
fag which requires a permit w nostrum.alma improve,dermAlm,ter repair WY aauCome $282968
_2< prior w an
its iuucc.elm inquires the applicant for such Permit in Ek a signed statement Valuation
C thin he is licensed punusnuothe prevision oftheConuwtor's License Law(Chapter 9 Sq.Ft.Floor Area
I�a (commencing with Section 7000)of Division 3 of Ne Business and Professions Code)or
.. Nat he b aumpt therefrom and die bub fm the alleged exemption.Any violation of
Sccnon 703 1.5 by Ary applicant for a permit subjects de applicant in a civil penalty of r v Occupancy Type
not mare Nan five hundred dollars(5300).
❑I.uowner of Ne property,err mY ennployee with wean udre'v suleeompmcotion,
WBI de Ne Welk.Nd NeaWmYm is oat intended err aRCRd(ter YlC f3aa.7D1a,BLLLIVII Required Inspections
and Professions Cade:The Con9ants's License Law does m1 apply w an mvner aq P
property who builds a improves thereon.and what doer surd work himself w through his
Own employee,presided Nu such improvements are collimates oroReled forsele.If.
however.the building or improvement is sold within one year of completion.the awn".
builder will have the burden of proving that he did sot build or Improve for purpose of
ante.).
❑1,as owner of the property me exclusively...aacrims with Iianred a OOKM-to
construct the project(See.7014.Business and Pmfessiae Cade:)The Comotow's U.
cease law doe not apply in an owner of property who builds or improve Merton.and,
who contracts for such projects with a comranwr(s)Centered pursumt in the Connoisseurs
License:law.
❑I am comp,under See ,B h PC for this mown
Date
WORKERS COMPENSATION DECLARATION
I hereby of me under penalty of perjury mon of the following decli n0ons:
I ham and will maintain a CeNOata of Consent In self-Insure for Workers Compere
scion sus provided for by Sutton 3700 of the Labor Cade,for the perfm ramose of Ne
we or which this permit is issued.
1 haw and will maintain Worker's Compessation Insmma,as inquired by Section
3700 of Ne Labor Code,for the perfarotstece of Ne volt for which this permit is luucd.
My Worker nation Idmranco came and Policy n A_
Cartier: Polwy No: �O �IJI�fI-
CERTIFICATEOFEKFA1FnoNFRO RKER9'
COMPENSATION INSURANCE
Crossixtion need wt be completed If the pcmtir Is for one hundred dollars(5100)
or Ic3s.)
I comfy that in Ne performance of the work for which this permit is issued,i shall not
employ any person in any mmlmrse u A become subject to the Workers'Componsation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:IL after making this Cenifow of EsearPtim,you should
become Subject in the Workers Compensation provisions of this labor Code,you muse
0 forthwith comply with such provisions or Nb Permit shall he daW re
mvoked.
z^ CONSTRUCTION LENDING AGENCY
[-a I hereby affirm Nat there is a comtrvctinn lending ages'for the Performance of
W 7 the work for which this permit Is issued(Sec.3077,Civ,Q
W�Q Lender's Name
a Z Lenders Address
[� 1 certify that I have read this application and sow that the above I.(..Our,b
IL cones.I agree in comply with all city and county ordinanees and sum laws misting to
0 buildingconstruction,
to save.
ify ad epmsentativeof Nis Ofymcnter Upagino ago tine
W above mentioned property for inmcc.on purposes.
gy (We)agree w cove,indemnity and kap hay in m the City of Cupertino s id City
aE'.y st
y liebilitie.judgmenu.costs andexpenua which may in my way asrncagairm add City
U z in canreq of the granun a(Nis Permit.
t••� APPLIC/ DER IDS AND WIL OMPLY WITH ALL NONPOINf Issued by: Date
SOUR
/�-dL Re-roofs
Signature of Applicarm Commoner Daw
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the appliam or Nmm building occu entuum or handle haurdous material
de0ned by the Cupertino
Munici I Code.Chapter 9.11,.4the Health and Safety
.Section 73532(,)7 All roofs shall be inspected prior to any roofing material being installed.
[_]Y. o
Will the applicant err(umm building occupant use cyuipmmt m dcvias which If a roof is installed without first obtaining an inspection,I agree to remove
emit hmedous air amaminanu as food by the Bay Area Air Quality Management all new materials for inspection.
Dooncrt
❑Ye u
I havemad Ne huaednua mamdab mquimmenm under Chapwr6.95 of the Calirary
nia HcolN& cty Cada.sections 25505,25533 and25534.imderslatd thatlfthe building
LH
not sly he nett,0.11.b my j4poni in mdfy that occupmt or the
myulre n i metpriarwiuu aar,ce taAarOcnap Signature of Applicant Date
Ate W All roof coverings to be Class "B" or better
Owner a wNorved gent Date