05100154 CITY OF CUPERTINO I' 7�f a f,:ia
BUILDING DIVISION PERMIT ) CO 'QRANPUAMA,TIQN
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i10
ING ADDRESS: FINN BROTHERS CONSTRUCTIO SRMITND'05100154
745N DE ANZA BLV PERMIT ISSUE DATE
R'S NAME:
BAY COLONY INVESTORS II IN 1475 SARATOG
PHONE: SANITARY NO. CONTROL NO.
(408) 252-9131
ARCHr1ECTENGINEER: BUILDING PERMIT INFO
BLDG EO PLUM O
MECH
lop LICENSED CONTRACTOR'S DECLARATION Job Description
ti I hereby affirm Nat I am limned under Pmvuiom of CMPbr 9(mmmmming
' with Sccuan7ultdf.Dlvidan3af me Bueixssand Praferiom CoM,aM mylkense is
h�a in full fomeaMef(ttL fZ CONDOS-COMMON AREAS
Licen CIsss�La
i N Dab 8.6 Conbeebr
g ARCHITECTS DECLA 1
i$ 1 urte erund my plans shall W used m PON rcenrt
ayU
rQ
Licensed Professional
OWNER-BUILDER DECLARATION
I hereby at I em exempt form ten leanion Co a:Any c Law co ten
j p o following moron. (aniSection 7(171.7.Business and ove.de loll Calc:Any city m county
1$ which requires a Permit requires
the eller,i t for such
demolish,or"pair any swmura $226589
-iy priorbits issuance,also acquire.the applicant for suchpermr's Licme Ls.(chapter
Valuation
that he is liccmsed pursuant be me Pmvisiom of the Contractor's hicerrx law(Chapmr9 Sq.FL Floor Area
z (commencing with Seems,7(333)of Division J of the Business and ProfMiom Coda)Of
that he is exempt mcrefrmn and to basis for,the alleged exceptions.My violation of
Becton 7071.5 by A"applicant for a permit aubjeess the applicant to a civil penalty of y Occupancy Type
not mom khan five hundred dollar(.SSOOL
01,as Woof oftis Property.car my employees with rages as their sale=Pe uon,
will do the work.and lhaaw"ure I.not trended"offered forsau(sex.70as-Ballo'. Required Inspections
and Proposed..CodM n
Code:TCosent.Limns n ro
Law donot apply b an ama of q P
proper,who Wilda;or tmmnwa thereon.andwhe doessuch work himsetfortrough his
awn employees.provided that web improvements ata not Wended oroneaed for ad&If.
however.to Wilding or Impmwment is sold within one Year of mmplction,to mvnm-
Wilder will Mw the Wrden of proving two he did not Wild"improve for purpose of
sale.).
Q 1,as Owner or dm property.am exclusively contracting with licensed mnoacbr b
mmtme me pmjca(sac.7014.Business and Prafnaiam Code:)The ConuaaoYs U.
came law does not apply b in Owner of Property who Wilds or improwa thereon,and
who contracts for such pmjeeu with a conlrower(s)licamed pursmnl b the Contraetofs
Licen"Law.
D 11.exempt under Sec. ,a&P C for this reason
n Dau
WORKERS COMPENSATION DECLARATION
Mosby affirm under penalty o(peaJury,one clubs fallowing declarations:
1 h.ve.nd will maintains Certificate of Consent to self-unties far Worker"Compen-
malon,yyyyyq.....provided for by Section 7700 of the Labor Code.Ice Ne pertomhanm o(the -
w rich this perms ie iseucd.
1 Mw mrd will milnutn Warkefs Compematlon Insunnm,a acquired by Section
3700 of Ma labor Cade,for to pedarma ea of the work for which that R-it u I=-&
Mumdoo,�hhh/oe/m�ado Orwa nrttm and Poli
Unser: Policy Nry
CERTIFICATE OF EKEMlfil- FRO WORKERS
COMPENSATION INSURANCE
(Thu ssNm need not be completed If the Permit Is forum hundred dollar($I00)
or ins.)
I certify that in the performance of use,work for which this Permit is issued.I shW not
employ any person In any manner an as in become subject to me Workers'Compensation
Lawful`California.Dab
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
become subject b the WorkerS ComPCoaattan provisions of the Lehr Code,you must
Z forthwith comply with such provisions or this permit shall be dmmed mvoked.
z O CONSTRUCTION LENDING AGENCY
(ti Ihereby atarm that there is a construction lending agency for the performmm of
CL> the work for which this permit Is issued(Sec.3017.Civ.C.)
CU Q Lender's Name '
Lendees Address
U0 I ceNfy that I haw read this application and sub One tic&Wve mfmm-thin is
corm".I agree to comply with all city and county ordinances and mate laws muting to
Wilding conauuction,and hereby wthorin mpreunuttws of this city to cnbr open the
p U
r W ahow-mcmtoncd property for e.pcuan- IC as.
(We)agree to save,indemnify and keep harmless the City of Cupenino against
vF„
Ln
gas oftensnwhtchm gory way a"rvc agiloslaeid City
[)z thea PLIC co egra of this permit.
I
^' APPLIC D.R DS AND WILL MPLY WITHLL NON-POINT Issued by: Date
SOUR 0.E - )-99
O' m Re-roofs
Signuu of HAZARDOUS
ARDOr Dam
HAL (Rune, MATERIALS DISCLOSURE Type of Roof
WIII the a Cupent m future Wilding o Chapter
atom wandthandle Health
md Safety al
de0ned by the Cupertino Municipal .Chapbr 9.12,and the Heilm and Safety
sedan 0y.25532(.)? All roofs shall be inspected prior to any roofing material being installed.
e
Will the 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 Imeardous air conumimnu u d by me Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes u
l4idemwl m. debts mauruisraquiremenu unbsr .Chaptarti.95ofthe Califon
ri.HcVK&V&fatyCO&.3CCDom 2S3U5,25s?,t tib 25534.I understand that if the building
dues t cu Oil how mnanL mat h u m 5/nrmpomlMlby m noBl'y ten mcupant of tic
my me wh'hr s be met poor b is ee Ofa Cortiyhy"al`Ocmpaney. Date
AArg/^ - 06 Signature of Applicant
Ow car amnariLm a our D,b All roof coverings to be Class"B"or better