05100151 CITY OF CUPERTINO ,'+.
BUILDING DIVISIONPERMIT , x.r TI(U.
BUILDING ADDRESS: FINN BROTHERS CONSTRUCTIO PERMIT No.05100151
10745 N DE J
R'S NAME: PERMIT ISSUE DATE
BAY COLONY INVESTORS II INC1475 SARAT
PHONE: SANITARY NO. CONTROL NO.
(408) 252-9131
ARCHI'fECT/ENGINEER: BUILDING PERMITINFO
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Gid LICENSED CONTRACTOR'S DECLARATION Job Description
u 1 hemby affirm that I an Beamed under provisiom of Chapter 9(commencing
with Section 70011,of Division 3 of the Bram.and Proleadom Cade.and my license is
i y in call fame and.ffeel NEW CONDO-1, 320
e Z License Class J�Lk.M
fik, Dam Cont ECL I "Vit
qW ARCntlimu ,Oapubli Ms r^�
I untlemmnJ my pians shall he mad a puM1li mrnrds
iyU
Licensed Pmlceional
G
y OWNER-BUILDER DECLARATION
)c c 1 hereby.(Taro thus 1 1. exempt from the Contracfauns Cu t:Any C Law for the
:cc o following moon.(Section 703 L5,Bualtar. and Pmfee oil Cade:Any city fir county
1 m w which eequiren a Permit m.nmVun.alar.in Prove,dcmolWO or repair any structure $282968
Prior b its iuuance,also requima the applicant forwch permit b file a signed sulement Valuation
_s< Nathehliccnaud PuwanttathcpmvisiomofheConvmoriLcenseaw(Chaper9 Sq.Ft. Floor Area
`t-$ (commcncingwiNSecdon70W)of Divhion3of Oc Butinma dProfmions Cade)or
.. Nat M IS exempt uerefrom and the buds for than alleged ammpdon.Any violation of
Section 7031.5 by any applicant far a permit subjects the applicant te a civil penalty at AP14 KWffifjeT U U Occupancy Type
not mom than five hundred dollars($SW).
0 1,as owner of the property.or my employcm with wage as their auto compemadea,
will do the work and lite mmctum Is nut Intended or offered faradc(Sec.70 N,Business Required Inspections
and Pmfeabm Code:The Conammes License Law docs rot apply b an owner of q P
propenywW WilMfirimprowathereon,aMwho dmfsuch work mango,through hu
awnemp1. ,provided uaauch impnvements..at intended orationed for sale If.
h.a .me building or improvement is old within am year ofcompledm.the owner-
huildv will have the burden of proving that he did not build Or improve far purpose of
sale.).
❑1,a owmr of um Property,am aclutively conussting with named contractors to
construct the pmjm(Sec.7661,Business and Profus)am Code)The Conuactara lj-
come law dints opt apply Or an owner of property who builds ar)mprova thereon,and
who convects for such prejecta with a contractor(s)licensed Pursuant b lite contractor
License Law.
❑lamaemplmder See ,B&PCfarthlamaaun
r Data
WORKER'S COMPENSATION DECLARATION
I hereby arum under penalty of perjury One of the fallowing deelaradom:
&,"I n and wii m motho a CeniReme arc...i an aelf-Imam far Worker Compen-
sedon,a provided fm by Section 3700 of the Labor Code,for the performance of the
wish fir which Nis permit is inued.
I have and will maintain Worker Compntsation Inwace,as required by Section
7700 of sae Lather Cu..fm the pamentrame of the wmk far which dua Permit is i—ml,
My War oro eMO..Imm�nce pnier and Policy
Cartier. Polley No:
CERTIFICATE CI•EKEPdMON FROM WORKERS'
COMPENSATION INSURANCE
f f hu motion need rot ac cam plead if am permit la fm am hundred Oil=($100)
or less)
I certify that in sac performance of the work for which this Permit is Isamu.l"I mat -
employ any pesmn in my mamncren as an become subkct to the Worker'Compenaadon
laws of Caltfomia.Data
Applicant
NOTICE TO APPLICANT:IL after making this Cerificse of Faemption.you ahoaW
become subject to the Workers Compensation provision of the labor Cade.you mean
vJ 2.' forthwith comply with a eh provisions or this permft shall bedmmW ranked.
?O CONSTRUCTION LENDING AGENCY
f" 1 hereby affirm than dem is a connotation lending agency for the performance of
a> nim work fm which this permit u iumd(Sec.3097,Ci,C.)
L1J Q Landers Nam.
az Leaders Addme
U0 I certify Nat I have read this application and sub tau the above information IS
LL E' mrtect.1 agree b comply with all city and county ardinancu and sue laws relating to
OU building eonswction,and hereby authorim mr,noutivea of this city to enter upon the
W aleve-mcmtioned property for impection purposes.
F 6. (Wm)agmc to ave,indemnify and keep herniae the City of Cupcni apinst
N liabilities.Judgments,costs and eapesum which may in any my accuse agalmt sold City
UZ into or the On,of tau Permit.
APPLI A UND ANDS AND WI COMPLY WITH AA}}jj..NON-POINT Issued by: Date
SOU ONS. (�17W
Q aBFT Re-roofs
Sitnmure afAppliaHAZARDOU Data
HAZARDOUS MATERIALS mauveDISCLOSURE Type Of Roof
Will Oso applicant m future Wilding oceupat.dore or handle hrnmous material
defined by the Cupertino Municipal ado.Chapter 9.tL and the Health and Safety
.Section 255324)? All roofs shall be inspected prior to any roofing material being installed.
❑Ya
Will the applicant or future building oceupat use equipment m devbms which If a roof is installed without first obtaining an inspection,I agree to remove
.mli hsumousair anctand tea need by the Bay Ams Air Quality M34af nt all new materials for inspection.
Diaa)ct7
❑Ya a
It, madthemamuusmmedahmquimmemundcr Chapmr6.95orthcCsliror-
nhHeal c1Y 'am235(I5. JJ am125574.1 undcanand tau if de Wilding
lima n c n fik Net II h y,aibilily b notify dee mcupat of the
note rometpd.rm uanmafacemraa�°;a Signature of Applicant Date
`k '/ .0i-"moi All roof coverings to be Class"B"or better
Owner m authan ed agent Dam