05100152 CITY OF CUPERTINO :z r I rk& .�7 # h,s J
BUILDING DIVISION PERMIT cL11TIt'A.( TR'I1�FUTrMaTlpr�v
nes?.+$r."' v`A- . "
BUILDING ADDRESS: PINN BROTHERS CONSTRUCTIO SERMITNO.O5100152
10745 N DE ANZA BLV
R'S IFNAME: PERMIT ISSUE DATE
BAY COLONY INVESTORS II IN 1475 SARATO
PHONE: SANITARY NO. CONTROL NO.
(408) 252-9131
ARCHRECT/ENGINEER: BURRING PERMIT INFO
BLDG EO PLUMB ME�CH
;op LICENSED CONTRACTOR'S DECLARATION Job Description
i F 1 hmcby arm Jap 1 am 1'xxved under pmviaioro of ChaPmr 9(commencing
6 aibSectim,7WD)of Dfhdun7of Ne Bmm—aA Prefeaslmu Cadc,anl myli--h
,l2y
in full oueanaerrent b941z NEW CONDO-1, 517
,�: infullfinea�L .g
:Fp Dam� 4!7 / Comnvaor
CTS DEC ION
i 1 undcrmnJ my pew still W used a pis sc rccands
tyU
toy Licensed Pmfetianal
rt OWNER-BUILDER DECUBATION
I hereby a(fmn that 1 am1. .sumps from the Canons Co LiAny C Law O for the
p o fallowing reason.permit
co,sho5.Bushes and one.de Professions Cam:Any oily m countyre
S$(L which acquires a permit re en es the ape.Improve,demolish,,rar mash any amntum $325199
•Zi damkItsctmncprsuarequire,the for such Penni.mfureamle a egocdwmmem
< thaMisMemeapursoanllaJim,pma:;warthe can.memralx<�La.(empmr9 Sq.Ft. Floor Area Valuation
FFG (commencing with Section 7000)of Division 7 of the Business and Profeaions Cade)or
9
and be a exempt thesefruro and the basis for the alleged egempdot.Any violation of
Sanen 700I5 by arty applicant far a permit subjects he applicant an a civil penalty of r Occupancy Type
not mare dam five hundred dollars(SSW}
I,as M.of the property,an my employes with wags as Dep wk eompeaathn.
wll do the work and the structure is not WonW
lud o offered for satin(Sac.7044,Business Required Inspections
and Pmfeadaa Cod,Tae Ca eacme,Luras law matter act apply m a awaer of q P
Pmpeny.M Wildserimpmwatheeon.andwMdmssmhworkhimselfmthmugbbu
own employes.provided that such impravemanu am no.intended onRcrtd for tale IL
however,the building or Improvement h sola within aoc year of enmpletion.the owner
builder will have tM burden of pmvinB But he did Out build or Improve for purpose of
alt.).
❑1,m maga of the propenY.am aeladvely contracting with licensed contractor or
construct the Project(Sac.7044.Business go PrefeVmN CMc:)The Commoners LI-
came law does oat apply m an owner of property who Wilda or improve thereon,ad
who contracts for such prejecre with aconuactartU Beraud pursuant m the Guarantees
License law.
❑I am exempt under See. ,B k PC farthis masa
o Data
WORKER'S COMPENSATION DECLARATION
1 hereby alarm under penslty of perjury ore of Jte following declemlons:
i have and will maintain a Cetiftae of Consent to self-imam for WorkcesCompen-
anon,as provided far by Section 7700 of the labor Cade,for the Performance of tome
workf which this permit is isuud.
haw and will maintain Worker's Compensation Insurance,as required by Sccdan
7700 or the labor Cade.for the pedormuce of the work for which this penal,is Issued.
My WarIt emanon Iran ce carrier and Paltry mbar w:
Carder. Policy
CERTIFlC COMPENSATION
ATION ON 0 RKERS'
COMPENSATION INSURANCE '
(This section steed tmtbecemplemd if the permit is comm hundred dollars($100)
or Teri.)
1 cenVy mot in the mrmrmanca of the work far which this permit is Wood,l shall not
employ any person in any mannerso as to become subject to the WorkerCompensation
Laws of California.Dale
Applicant
NOTICE TO APPLICANT:Jr.aper making this Certificate of Exemption,you should
become subject to the Workeh compensation previsions of the lahw Coe.you mum
O forthwith comply with such provisions o this Permit shall be deemed mwked.
„zy CONSTRUCTION LENDING AGENCY
{-s I Money affirm that them is a construction lending agency for the performance of
ai me work for which Was Permit Is issued(Sec.7097.Civ.C.)
Gin Lmoloes Name
Z)Z Lendees Addrear
U Q I=try that I have read this application and sum the.the above Information is
4. F comma t agree to comply with all city and county ordinances and sum laws misting to
0U building convection,and hereby authorize mpescnutiws of this city to enter upon the
Uabove-mentioned property for inspection purposes.
(We)agree to ave,indemnify and keep harmless;the City of Cupe Lina againn
„F„y liabilila,ju csterling,comsod'apcases whichmay In anywayacem agalalaid City
Uz in consul tt the steng of this permit.
^ APPLI/NT D uTANDS AND WI COMPLY WITH ALL NON-POINT Issued by: Date
SOU ER NS.
'1 '06 Re-roofs
SignM torAfflicMUCamismalor Dae
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will tM appliam or future Wilding aceupsotmom of handle haamam material
dclined by f Cupertino Municipal Cade.Chapter 9.12.and tM Hallh and Safely
Section 23372(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Ya
Will tie applicant or future Wilding occupant use equipment ordevies which If a roof is installed without first obtaining an inspection,I agree to remove
craft hvardous air conumimnts as deflncd by f Bay Area Air Quality Management all new materials for inspection.
District?
❑Ya Nu
I have read the bastNom rmmri aH tequiremonts under Chapter 6.97 of de Cali fon
nu Hm safn�Ud2553427774.1 understand thati(Ue Willing
Jaen t c n0onsiM1ilitY m notify Ne aceupml of tie
qu' m r accnlrreaeaOcsvpsoq. Signature of Applicant Date
���y-a6 All roof coverings to be Class "B" or better
Owner o sothonma agcm Dam