05100149 CITY OF CUPERTINO '?e� � w^3x ''` "�"��<` -x'-• ,a:'. '
BUILDING DIVISION PERMIT �.CUN:'�TRAC, .'I�OR INFUVTA'TIO1V.Am
Mfr NO.
ft
ft
BUILDING ADDRESS: t PI �'a BROTHERS CONSTRUCTIO 05100149
10745 N DE ANZA BLV 4 317
R'S NAME: PERMIT ISUEDATE
BAY COLONY INVESTORS II INV 1475 SARATOG
PHONE: SANITARY NO. CONTROL NO.
(408) 252-9131
BUILDING PERMIT INFO
ARCHITECT/ENGINEER:
BLDG ELECT PLUMB MECH
Oi] LICENSED CONTRACTOR'S DECLARATION lob Description
UW I hemby AM m that I am licensed un for previsions of Chapter 9(commoocing
with Section 70M)of Division 3 of this Business and Professions Code.and my license is
SSS in full force and effec0 Z NEW CONDO-1, 431
Liccnu Class Lk.N
if•p Date Contractor
7W CI ry rs D
I understand my plant"I be used as Pu is moths
is V
G Licensed Professional
OWNER
-BUILDER DECLARATION
I 1 Wrehy aUirm Nm I am eacmpt from the Conor a or's License Law for ted
.00 fallowing mason.(Section 7031.5,Business and Pmfesdum Code:Any city or county
which requires a permit to conauuct,ohne.improve•demolish,or repair any awcture $306763
-iy prior to its issuance,men requires the applicant for such Permit to file a signed fuemcnt Valuation
e < that beislicensed pursuant tothe provisions ofthe Comment's LiccnuLaw(Chapter 9Sq.Ft.FloorArea
`s g (commencing with Section 70W)of Division 3 of the Business and Professions Code)
ur
that he is attempt thmefrome and Ne basis for the alleged exemption.Any vloladun of
Section 7031.5 by any applicant lo,a Permit subjects the applicant to a civil penally of r Occupancy Type
not mart Nan Ove hundred dollars(5300}
❑1,u owner of Jia propmY,a my employees wIN wages u Nek uleeonpeaastion,
will do the work.and theswaum is notlnended motioned RumtIc(Sec.7044.Business Required Inspections
and prefrsdon Cain:The Conoum's License Law does Out apply te an owner of q p
Posen who hullds or improves daeswn,and who dam such wank h iceucf or drauth his
own employmm,providedthat such improvements are wit. Med".11cedfade E.
however,the buildingor Impmwnest is sold within ons Yens of compledan•the owner-
builder will have the burden of prorine that he did out Wild Or improve for Purpose of
ask.).
0 I,as owder of ted property.am eadumvcly conuanding with licensed convents u
coatrued the project(Sec.7044,Business sad Professions Code:)7W Conwcur's Li-
come Law does not apply 0 an owner of properly who Wilds of improm daemon•and
who contracts for such projects with acomraemr(s)licensed pursuant In the Onufflcues
License Law.
❑I am exempt under Sec. ,B JtP C for this season
r Dau
WORKER's COMPENSATION DECLARATION
hereby affirm under Penally of perjury one of the following declan0one
Ihave 0 will maintaina Cervts
Ocaof Conservmself-losme for Workds Compen.
.if..,u provided for by Section 3700 of the IsWr Cade.for the peRonnance of the
woh f r which Nis permit is istad
haw and will maintain Workofs Compem lion Imunnes,as required by Section
3700.1'the LJba Code,for On,perfomsnee of the wok for which this permit is handed.
MyWar ore emadanyle, uartio and Policy n
Cartier. ...,�, vJL Policy No
R7IFlC IONFR M WORKERS'
COMPENSATIONINSURANCE '
(Tbissectia need nut W compleed if the 1.11 13 future hundred dollars($1001
leu.)
1 certify Not in use performance of the work for which Oda permlt is issued,I shall not
employ any person in any manner an as in become subject to the Woken'ComPenution
Isws of California.Doc
Applicant
NOTICE TO APPLICANT:If.afar making this Cenificate of Eumption,you should
become subject te Ne Worker's Compensation previsions of the Labor Cede,you mum
Z forthwith comply with such provision or this permit shall W domed revoked.
ti O CONSTRUCTION LENDING AGENCY
(ti Ihemby 0.that then u a cortsuuninn lending agency for led Performance of
Ci > the work for which this permit is issued(Sec.3077.Civ.C.)
Undoes Name
7 Z 1<nonfs Address
O Q 1 anify than I have rood this applitmim.and sum Inn the eWve Information ice
Ip.(~ correct.l agree to comply with all city and county ordinances and rete laws relating to
0V building convection,and hereby authorim mpmsenmtiws of Nis City to enter upon the
4 ahuvc-mcmiunetl property for inspection purposes.
f. (We)agree to save,indemnify and keep harmless Ne City of Cupertino against
y IiacomanLJ cnuemuand expenses which may In any way seems agelml said City
in conte nc of Je erect of Nis permit.
^� APPL ANT N E DS AND WILL OMPLY WITH ALL NON-POINT Issued by: Date
s0U 0. U A
Re-roofs
Sie o ran onuamor Dae
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Je apPliantm future Wil ingocoupant more o handle haurdow material
de0rcd by the Cupenido Munro Cadc.CTapler 9.12.and the Health and Safety
.Section 255324)? All roofs shall be inspected prior to any roofing material being installed.
0 Yes cre
Will the applicant or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
cmlt herardous air cotu eimnts a food by the Bay Am Air Quality Management all new materials for inspection.
District?
Oyu
I have mad thehvard,ms materlais mquimme unonr Chapter 6.95 ortm cantor.
nla Hcal lett'Coon, coons 255 U5,25533anJ 534.1 un@Hund Neifthe Wilding
does no ort Oy hew nant,Nat It is my map IM1llity te notify IW acupent of Ne
requi cn h WmeIprioranissumc wccrtileam foccapetey. Signature of Applicant Date
����� All roof coverings to be Class"B"or better
Owner or aulhorisd agent Dam