05100153 CITY OF CUPERTINO
BUILDING DIVISION PERMIT 1CQNI1�FORMAT, 7
t :v,;'i;'iN• s Yg vC :4. '� a � u«s 3
BUII-DINGADDRESS: s PI BROTHERS CONSTRUCTIO SRFRfMITND.05100153
10745 N DE ANZA BLV
R'S NAME: PERMIT ISSUE DAM
BAY COLONY INVESTORS II IN 1475 SARATOGA AVE.- 08/17/2006
PHONE: SANITARY NO. CONTROL NO.
(408) 252-9131
ABUILDING PERMIT INFO
RCHITECTIENGINEER:
BLDG ELECT PLUMB WECH
D 0 0 0
app LICENSED CONTRACTOR'S DECLARATION Job n
affirm Description
i�+ I beareby arm that I am licensed under provisions of Chapter 9(commencing
:� with Section70(lu)of Division3ofthe BM—aM Profaduns Codc,rnEmy geormis
•l Infullfmceandeffect 3Cyq/L NEW CONDO-1, 334
m Pl? license lass Lie.#
iJ Date CIntraMr
RCHIIELTS DEC
LA 01 r
i 1 unecrsund my Plans shall W used as public reform
i CLll
had LicenscJ Professional
y
OWNER-BUILDER RDECLARATION
i 0 0 I Mnhy.(Srm an I am
escmpt from the Contractor',C a :Anse Law for IW
:00 o following mason.permit
t 703 L3,Business and ve.do ati Cote:Any city or<o tura
UOLY
S$ry which rtquama a puma fu pores aet,abu.improve,h remit,Cir mash ed tuuctum $285969
.ZY grat he islissuance,
ursago
nt W to ane applicant for sucCar pClan's icam.le a ave(Chapter
statement s�o ThuWulkcnscd pursuantmtite Provialons of the Canuumri lJeense law(ChaPter9 Sq.Ft.Floor Area Valuation
`� (commencing with Sutton 7000)of Division 3 of Ne Business and Profusion.Code)or
that he is exempt therefrom and the basis for the alleged asempJon.My violation our
Section 7031.5 by any applisvtt for a permit subjects the applkuf m a Civil penalty of Occupancy Type
not mom than five hundred dollars(5500).
❑1,an owner of the property,or my empioym with wages as their sale compensation,
wig do the work and the stntemm is oat intended or offered far aak(Sec.7044,Bum. Re uired Ins ections
and Professions Cade:The Ommu m's LJcerue law does rot apply m an Owner or q P
Property who Wildaoramproves tterean.and whodeesamhwork himselfor through his
awn employee,provided that such improvemau are mtinmided oroQued(anile.If.
however,Nn building or Improvement is sold within am year of completion,the owner.
builder will have the burden of proving that M did Out bhtild or improve for purpose of
tile.).
❑1,u mvner of the property,am conclusively contramang with licensed conuanan in
conshmct the project(Sec.7DM,Business and Professions Code:)The Conuacmr!La-
cave Law does not apply m an owner of property who Wilds or improna themon.and
who contncta for such projects with a conuactons)licensed pursuant to the Con(ncmrs
License law
❑I oro aempt under Sec .B h P C far the mason
erDam
WORKER'S COMPENSATION DECLARATION
smeary afr ou under penally Of Perjury one of the following deet rWmu:
haw and w01 maimant aCertifham of Concent 10 self-insure far Workers Camper-
sma0n, provided for by Section 37M of the Labor Code.for Ne perimmeme of tie
o r wM1ieh this permit u issued.
w i hale and will maintain Wormes Compensation Insurance,u required by Section
3700 of Me labor Code.for the performance of Ne work for which this pcona,u issued.
My Wargere�mpemNo��n Ie/uam..aster end Policy tuber am: .�j
Carsier. ^_PaIIry N �Q _gam.
CERTIFlG7E OF EKEMPTION FlIOM WORKERS'
COMPENSATION INSURANCE
(Thu section need not be completed If tie Permit Is foram hundred dollen(SIM)
or leu)
I unify lief in Me performance of We rah for which Nis permit is bound,)shall not
employ any person in any munmr so u to became subject in Me Worlui Competencies
Laws of California.Dale
Applicant
NOTICE TO APPLICANT:If,after mating this CertiBam of Escmpiion,you should
become subject or tho Workers Compensation provisions of the Latour Cade,you most
O forthwith Comply with such provisions Or e
this permit shall be domed mvkcd.
CONSTRUCTION LENDING AGENCY
y
[+ Ihereby M.that ft.I. canmuctinn lending farm,far dcfamil -orm.of
r1, > the work for which this permit is issued IS=3097,Civ.CI
fL3 Q Landers Name
7 z Landers Add.
U Q 1 ceAfy Net I have read this applicators and arae that the above informed.is
LL F correct.I agree m comply with all city and county ordinances and sum laws relating to
0U Wilding construction,and hereby mahatma reproomantivu of this city to enter upnn the
r W aWvomcnfiuned property for inspection purposes.
LL (We)agree to save,indemnify and keep harmless the City of Cupertino against
tFs rA liabilities,judgments,costs and expcnsu which may in any way accrue against said City
U z in ctnseq of the gr inL of this Permit.
., APPLIC UNDE . ANDS AND WIL OMPLY WITH ALL NON-POINT Issued by: Date
SOUP. Gy1 9 s^ X-I ),q; Re-roofs
Sign Appliam/Conmcter Data , Of Roof
HAZARDOUS MATERIALS DISCLOSURE Type
Will tc.ppliant or future Wilding eccrepamsort or handle hmrdons m tuamd
derned by tie Cupertino Munatip ode.Chapter 9.13,and the Health and Safety
de,Section 35532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Ya
Will the appelcm,or future Wilding occupant use equipment or doll.which If a roof is installed without first obtaining an inspection,I agree to remove
emit havallom air coraminsncs as darned by the Bay Area Air Qualify Management all new materials for inspection.
District?
❑Yes a
I have seal the hvud.material,refrain nts underChgam Q95ofthe Giifm.
nix Flcal IyCode.See' 25505,1533an 531.1 uhNerssndthatiftie Wilding
nus n worn hove u 4 Thu b is my m hu Eahy w notify ate occupmn Cir the
nyui onto cl metpdanuissues enalk 'oc pmry. Signature of Applicant Date
owner«,.mad.<d agent 3 7-4)4 All roof coverings to be Class'B"or better