05100150 CITY OF CUPERTINOBUILDING DIVISION PERMIT C®NTRAGTOR�IIFORK T'J
a%'$YP+_R"#sa_,or+'Y .may? rk'.5 as,>yz..• u' v„
BUILDING ADDRESS: PINN BROTHERS CONSTRUCTIO r""x'05100150
10745 N DE ANZA BLV 4 319
R'S NAMIT
E: PERMLSSUEDATE
BAY COLONY INVESTORS II IN 1475 SARATO
PHONE: SANITARY NO. CONTROL NO.
(408) 252-9131
ARCHIIECUENGINEER: BUILDING PERMIT INFO
BLDG EO PLUMB MO
loo LICENSED CONTRACTOR'S DECLARATION Job Description
i ad F I horeby affirm Nn 1 un licensed under pmvidons of Chapter 9(commencing
'i with SeNonlOW)of DlvWon S ofou Businessland Prafwiuns Codr,aM my license is
an inr,IlrameaMeIT NEW CONDO-1, 358
Lieevr Clw Lld.a Z
Data & A Contractor
ARCHITECCSDECLA A
i I understand my plans shell be used u public recordist
�6
Licensed Professional
i OWNER-exempt ROEC CoutraON
i I madea amrm(Stardom ml 1 1. exempt from Ne Cosional o :censeMyc law far du
c00 whiih acgreasoavermin7onstr Budncss and Professional Code:My city or county
53 which inquires issuance.pmm0 tu consuthe alum rat far ea dmmolW,ri repair any auumure
•iy priormits nseprsuantad the oms omo far mehpetor's fsleasigvJataument
� that he at licensed purmentmthe pmvisiov of dm Contractor's l.ksna law(Chapter Floor Area Valuation
(commencing with Social,7000)of Division 3 or the Bamuusand Profession,Cade)or
that he IS exempt m ftaun and the basis for the alleged exemption.Any violation of
Section 7031.5 by say applicant Tau a permit subjects the applicant to a civil penalty or z,jill MIRtiler V U Occupancy Type
not mom than firs hundred dollars ISM
❑I,u ower of die pmpeny.a my employes wish wages m Nei mle eompenadon,
wiildo Newark,andth sin umumtinmMetlmonemdfo,,.k(Sec.70N.Bmineas Required Inspections
and Pmfessiav Coa c The Colossuses License Law dors ret spplY u e
an ower of q P
property who builds or improves thereon.and who does such wart hWxlr or through his
own employees,Provided that aueh impremareaau art ret intended oraRered far We If.
however.the building or Improvement is sold within oro You of eempieli",me awase-
builder and have the burden of proving dist he did rat held or improve for purpose of
sale.).
❑1,as owner of the I m acny,am escWively contracting with licwed conoactan to
mvwet the project(Sec.7044,Business and professions Cade:)The Contractual al-
cove taw does not"Ply in an owner of Property who builds or improves damson.and.
who contracts fm such pmjceu with a communnas)licensed parallel as
the Co nsc m's
Limme law.
❑I am exempt ureas See .B&P C far mist memo
Data
WORKER'S COMPENSATION DECLARATION
hereby affirm under penalty of perjury am of the following declwaoOv:
lcl.yml
ave and will maintain a Certificate of Cannot self-Wort for Waukee'COmpco-
,as provided for by Section 7700 of the labor Code,for W Performance of the
r which this permit u blued.
hove end will mainuin Warmes Compensation Insurance,as required by Section
at me labor Code.far Ju performance of the work for which dtis permit u Issued.
orker pevadon Insurancecaner and Policy 6er: Polity No
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This xctioe need an,be completed If me permit Is foram humbeddo0w(SI00)
or less)
1«airy that in the performance of the work for which this permit is award,)shall not
employ any Penon loamy manmrm u he become subject u the Worker'Campemation
Laws or California.Data
Applicant
NOTICE TO APPLICANT:If,after making this Cenificam of Exemption,you should
become subject to the Workers Compensation provisions of the labor Cade,you most
.J O foMwith comply wish such provisions or this permit hall ac dsemed rooked.
„ZN. CONSfRUC ION LENDING AQENCY
PIMmby+Rlrm out ft.it.construction lendingagnuy far the perfurm4muf
E> the work for which lids Permit It kumd(Ser.3097,Civ.C.)
V4 ALeadees Nmnc '
gl� z Louder.Address
U Q I certify that I have read this application and stall that the above Infamodua Is -
P correct.I agree M comply with all city and county ordinances and sum laws milling to
�U building conm,ctian,and hereby authoda represematives of this city to enter upon the
altAPPLA
miuned us.coo forinspeecu purpoxs.
(We)agile to save,indemnify and keep harmless;me City of Cupenino ag+imt
nF.t fA u.tos dnperaet which yin any way acasue+gunst aid City
the g n g of this permit. Date
t, D• S ANDS AND W. MtILL OMPLY WITH ALL NON-POINT Issued by:Fw� �l Re-roofs
anvowdraemr Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Win Ne applicant or to,.building Occurred shore or handle autumnal mamri+l
ONad by the Cupertino Municipal Code.Chapter 9.12,and On Bandit and Safety
Sectiar 255324)7 All roofs shall be inspected prior to any roofing material being installed.
de
❑Yes a
Will oar applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air conumivnu as definetl by the Bay Arca Air Quality Management all new materials for inspection.
District?
❑Yes No
I ham to W hwsairm materials requirements under Chapter 6.95 ofou Califon
.is I ka,111111rVoyCoade.Sections 25505.25533 an 314.1umkrawld mmifshe Wilding
docs t cu OY haw nava Wt n o my re' IhllitY m natil'Y ties occupant or the
req, me icl cmetptiormiwuanc rrCcnificau�°`mansY. Signature of Applicant Date
���Off' All roof coverings to be Class"B"or better
Owner ser .LF.61.0 agent Dau