02100087 CITY OF CUPERTINO
BUILDING DIVISION PERMITCONTRACTOR INFORMATION:
Bu11-115k9kPL9f" 979 STEVENS CRK BLV PINN BROTHERS CONSTRUCTIO SRMI'FN®2100087
W+IsNA*EBROS . CONST. 1475 SARATOGA AVE APPLICAT19IDYBIDUY2002
INE: --F40-8T-252-9131 SANITARY NO. CONTROL NO.
ARCH["I ECFIENGINIiER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
f-oo LICENSEDCONTRACTOR'SDECLARATION �I ��pp
�d F 1 hcrehy affirm that 1 am licensed under provisions of Chapter 9(commencing REVISION--IN HBUSrEer�SR ONLY
with Section 70kBo(Divhaua Sof the Brem.sand Professions Ctale,und my licerseis
„ inlbBforceandaffect. FIELD FIXES (RETAIL) NO NEW PERMIT ISSUED
�Z Licence Class Us.#
czFc Dam Contractor ORIG. 401070014
F=^�l ARCHITECTS DECLARATION
UI understand my plans shall he unit as Public records \C
u�30
Licensed Professional
OWNER"BUILDER DECLARATION
1 hereby alErm Nal 1 am exempt from the Contractors License Law for the \
a a O following reason.(Senn,,.7031.5,Business and Pmfessinns Code:Any city or county
a� which requires a perank tar construct,alter.sapprove,demplixh,or repair any structure
FZiprior In its issuance.also requires the applicant for such permit to file a signed statement
bathe islicensedpursuanuolhepmvisionsofrhe Contmetur's License lsw(Chapfer9 Sq. Ft. Floor Area $728 Va16tion
� (commencing with Section 70001 of Division 3 of she Bmd ness and Professions Code)(it
Wy F§ Nat he is exempt therefrom and the basis far be alleged exemption.Any violation of
Second 7031.5 by any applicant for a permit subjects the applicant n a civil penally of
not more than five hundred dollars($50), C Occupancy Type
❑1.as owner of the property,or my employces wish wag.as their sole eomperuasion,
will do be work,and the structure is not intended or offered for sale(Sec.7044,Business
and Professions Code:The Co .moors License Law ones nos apply to an owner of 102 - PIERS equlred Inspections
property who builds or improves thereon,..it who dtcasuch work himself or through his
own employees,provided that such improvements an,not intended or offered for sale.If. 103 — UFER
however,be building or improvement is sold within one year of completion.Ne owner. 104 — REBAR
builder will have the burden of proving that he did not Wild or improve for purpose of
.]a.). 105 - ANCHOR BOLTS
❑ I,as owner of the property,am exclusively contracting with licensed consumers m 106 - SEWER & WATER
construct the project(Sec.70W,Business and Professions Code:)rise Contractors Li.
conn law does not apply to an owner of property who builds or improves themon,and, 202 — UNDERFLOOR PLUMBING
Lwho icense Lewcontracts toy such projects with attmuacmr(531ittnmd pursuant to the Conmcmra 203 - UNDERFLOOR MECHANICAL
I am exempt under Sec. ,B&P C for this reason 204 - UNDERFLOOR FRAME
�S er Date WORKER'S COMPENSATION DECLARATION 205 - UNDERFLOOR INSULATION
301 - ROUGH PLUMBING
I hereby aRmn under Penalty of perjury one of the fallmving declarations: 302 — TUB & OR SHOWER
0 l have and will maintain a Certificate ofConvennn self marine for Worker's Cons 303 — ROUGH MECHANICAL
si tion,as provided for by Section 3701 of the Labor Code,for the ardommnce of the
rk
Womrwhichmiapensisissued. 304 - ROUGH ELECTRICAL
❑1 have and will maintain Worker's Compensation Inmran x,as required by Section 3 05 — FRAME
3700of the Labor Code,for be performance of the work for which this permit is issued.
."Worker's Compensation Insurance carrier and Policy number are: 306 — HOLDOWNS
Carrier: PolicyNoo 307 - INSULATION
CERTIPICATE OF EXEMPTION FROM COMPENSATION INSURANCE 308
308 — SHEETROCK
(I'hissection need not tecompleted i(thelermil ixfinenc hundreddollars(5108 309 - EXTERIOR LATH
or IC's) 310 - INTERIOR LATH
I certify that in the performance of the work for which this permit is issued,I shall pill 311 - SCRATCH COAT
employ any prison in any manner m aura subject become subjeco the Workers Compensation
Lawsof California.Dam 313 - ROOF NAIL
Applicant
NOTICE TO APPLICAN'T:lf;after making this Certilicute,,f Exemption,you should 501 - FINAL ELECTRICAL ENERGY
become subject o the Worker a Compensation provisions of the labor Code,you must 502 - FINAL PLUMBING ENERGY
z ZO forthwith comply with such
NSTRUCTIONLEns or this DIN shall AGEhe NCY
recd mwkcJ. 503 — FINAL MECHANICAL ENERGY
► CONSTRUCTION LENDING AGENCY
[-t kfrwhichrmthellhcrcisaed(Seeinnlcndie,C.) cylnnhcp:rtbrmanccof 504 - FINAL BUILDING ENERGY
w �
he work nmiaprmivaisseed(Sec.3097.civ.c.) 505 - FINAL ELECTRICAL
IA Q tender's Addm 506 - GAS TEST
D Z lender's Address
U O 1 sonify Nal l have read his application and amus that the above infurre ion is 507 - FINAL PLUMBING
[kaP cement.Iagrceuscomplywithallcityaadcountymdlnaucesandlatelawsr1.1ingl,, 5 FINAL MECHANICAL
0 building construction,and hereby autbnri.c representatives of this city le enmruMtn the
Wabove mentioned property((it ina,cedon purposes. O9 FIN E
0. (We)agree m save,indemnify and keep hvmss thCupertino
ice City of against
h liabilitiesjudgments.costs and expenses which may in any way accuse against said City 55 N G
U Z in consequence of the granting of this permit.
F-t APPLICANT UNDERSTANDS AND WILT.COMPLY WITH ALL NON-POINT Issued by51 WORKS Date
SOURCE REGULATIONS.
Re-roofs 603 - OF BATTENS
Signature of APPlicaHAZARDOUS MATERIALS DISCLOSURE nosactor Dam `ypeof R0®f4 - ROOF IN-PROGRESS -
Will the applicant or future building(acupant store fir handle h rardnus material
�Nn
define�Ycx d by the Cape ins)Municipal Code.Chapter 9.12,and the Health and Safety
:.Sermon 255321.1'! All roofs shall be inspected prior to any roofing material being installed.
7DWriWill she applicant or future building tecupant use equipment et devi"s which If a roof is installed without first obtaining an inspection,I agree to remove
cf?
haauNnux air conmminams as relined by the Bay Arca Air Quality Management all new materials for inspection.
❑Yes ❑No
I hav mad the hommems materials requirements underChaperli 95 of dm CalifonIcalth&Safety C u1c.Sections25505,25533 and 25534.1 understand Nut if he building
not currently have a¢nuns Nat it is my responsibility m nosily the occupant of Ne
irements which must he met Priorm issuance of a Cemlcam of Occupancy. Signature of Applicant Date
eror auNorind.gent Date All roof coverings to be Class "B" or better