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CITY OF CUPERTINO
BUILDING DIVISION PERMIT
COi , TRAG' ORT , F'ORMATI`ON ;r
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BUIL DING ADDRESS:
PINN BROTHERS CONSTRUCTIO
�MrrND.05080176
20128 STEVENS
-R'SNAME:
PERMITIFSUEDATE
PINN BROTHERS
1475 SARATOGA AVE
01/20/2006
ONE:
SANITARY NO. CONTROL NO.
(408)252-9131
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hereby affirm that i am licv:nsed under provisions of Chapter 9 (commencing
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with Schon7M))of DiAsion3of the Businessact Pr Imium Code,andmyIicemo Is
infull Tomeanderfcl
S t'�
NE)l CONDO -1137'
License Clan Lle.I
—
Dau Contractor
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ARCHITECTS DEC A ON
I uromasund my plans shall be used u pub] c necoals
.
Licensed Professional
OWNER -BUILDER DECLARATION
'
I hereby affirm that I am exempt Tram the Contractor's License Law for the
following meson. (Section 7031.5, Business and Professions Code: Any city or county
$243738
which requires a permit to convect, alter, improve, demolish. of repair any mucron,
prior to its issuance, also requires the applicant far such permit to file a signed summer,
Sq. Ft. Floor Area
Valuation
that he is licensed pursuant to the previsions of the Contractor's License Law (Chapter 9
(commencing with Section 7") of Division 3 or the Business and Professions Cole) or
that he is exempt themGom and the buss for the alleged exemption. Any nolalion of
3 XPR r U U
Occupancy Type
Section 7031.5 by any applicant for a permit objects the applicant to a civil penalty of
not mo¢ dun flue hundred dollars ($500).
0 I, As owner of the property, or my employes with wages As their We compensation,
ns Required Inspections
will do the wok tad the Nucture isnot intended m rdlered or We (Sm. 70", BWness
and PmfeWmm Code: The Centimeters License Law doss not apply to an owner of
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property who builds m improv thcauon, and wM does such wart him¢If or through his
own employees, provided Nat such improvements tie no, Inurdd aroaered for Axle IL
however. the building or improvement is sold within aro you of completion. Ma owner -
builder will haw the burden of proving that he did not build ar Improve for purpose of
tile.).
0 1. as owner of the property am exclusively contracting with licensed comraeme to
construct the pmlect (Sec. 7044, Business and Profession Code:) The Comncear's Li-
cense law dace no, apply to m owner of property who build. or Impows ft... and
who contracts for such prepcu with a comractorO licensed pursuant be the Contractors
License law,
O lameumpimam,Sec. ,B&PCfmthisrevon
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WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declan,iom:
ave and will maintain a Certificate of Consent to self -imam far Want Compen-
, u provided far by Section 3700 of the labor Cade. for tha performance of the
lcmier.
for which this permit is issosd.
have and will munum Workers Compe.tion Iowan¢, u required by Serum,
of the Labor Coda. for the performance of the work far which this permit u issued.
orkers Compenaido t Imuran carie, and Policy number are:
Policy Ne.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Qhh section need not he completed If ti¢ permit is for one hundred dollua($100)
carless.)
1 cenify Net In Ne performance or the work for which this Turned, is issued, l shall not
employ, any person in my manner An As to become subject to the Workers' Compewtion
Lava of California. Dam
Applicant
NOTICE TO APPLICANT: If. after making this Certificate of Exemption, you should
become subject m the Workers Compensation provisions of Ne Labor Code, you muss
foMwith comply with such provisions m this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I beauty arOrn cut corn is. conumction leading.gmmy far the perfarmance of
the work for which this permit is issued (Ser. 7097, Civ. C.)
'
lenders Name
Lenderl Address
1 certify that I haw read this application and some Na, the show information Is
correct. I agree to comply with all city and county ordinances and sure laws mladng m
building construe,ion, and hereby authority representatives of this city to enter upon the
above-mcnioned property for inspection purposes.
(We) agree to save. indemnify and keep harmless the City of Cuper ico against
j liablibles, fu nW costs and expeF".ch may lm any way accuse ageaut old City
the Lr sago NILILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOUR ONS.
Re -roofs
Type of Roof
6-64
n an ter R Dam
Signppl—==U's
HAZIRDOUS M IAL4 DISCLOSURE
Will dm.P loom Wi ire asupmtuweor h.ndk
Heartl And Salty
by iM Cupenin0 Muniri Code. Chapter 9.12, antl the Health and Safety
. Section 25532()?
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All roofs shall be inspected prior to any roofing material being installed.
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If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment or devices which
hazardous air contaminants u defined by the Bay Area Air Quality Management
all new materials for inspection. '
Id=nofined
icBYrsAoIhavere
theowdrialsrcquimmcnuundcr Chapterd.95ofdmCaIdirgcal"S
tyCo25573end753]4.1 dndcrundthetifthcbuilding
te.rely aveitismymspomlhilitymnotifytheWCUPmoofthe
mmen Issuance mnceNaamarOccupancy. r�.
Signature of Applicant Date
"B"
All roof coverings to be Class or better f
Oame7y, A Wo'ad agent L Dam
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