05080179�W'
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OF CUPERTINO
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BUILDING DIVISION PERMIT
COI�i'TRrSCTUR INFQRMATIQI.
BOII.DINr ADDRESS:
128 STEVENS CRK
PINK BROTHERS CONSTRUCTIOD
gRMIT"°_05080179
iCITY
ERS NAME:
PERMITISSUEDATE
PINN BROTHERS
1475 SARATOGA AVE
01/20/2006
ONE:
SANITARY NO. CONTROL N0.
(408)252-9131
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
-
Job Description
I Mreby affirm that I am licensed under pmWiom or chapter 9 (commencing
with Section 7000) of Division 3 arrive Busidrasand Professions Code.md my license Is
LlmoeClefull to= andand effe
ti isL. 12
NEW CONDO -590'
Lkenso Clms Lw.N
Dam G
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BMR UNIT
MECL
ARCHITECTS DFGLA Tb N
I understand my plan. atoll be hued u public ecnrds
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt tram tie Contractors License Law for the
following mason. (section 7031.5, Business and Profeeient Code: Any city or county
which requires a permit to cnmwcl, altar. Improve, demolish, or repair any structure
prior an its issuance. aim acquires the applicants for each Permit or Ne a signed uatamens
BIa1M I6 I1R'OYd palA1m1101fIC Pmvlalam of dlC Geatracmfi lJ Yam IJW (Chapmr9
Sq. Ft. Floor Area
Val 47
(commencing with Session 7000) of Division 3 of dee Business and Professions Code) or
Nat he is exempt therefrom and the basis for the alleged exemption. Any violation of
APN Number
Occupancy Type
Section 7031.5 by any applicant for a permit subjects dee applicant to e civil paalty of
not mom than live hundred dollars (Saxe).
36903001.00
❑ I, as owner often property. Y my employers with"sea u their sole compensation,
ns Required Inspections
will do thewark, and the Moore is olinteraed oroffeed fm side(See7044. Business
and Professions Code: The enormities License law tae not apply m an owner of
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property who bulldsorimprows themon, and who doesauch walk himself orthrouth his
own employers, provided that such improvements tie notmeanded motioned torula. If,
however, the building or improvement is sold within am year of completion. the owner.
builder will haw tie burden of proving that he did as build or improve for purpose of
alk.).
❑ 1, as owner of the property. em exclusively connecting with became con omm s to
construct the project (Sec. 70x4, Business and Profusions Code:) The Calamine, LL
cave Law does not apply m an macer of property who builds or improves thereon, and
who contracts for such pmjeeu wide a eanmctor(s) licensed pursuant m We Catramoes
License law.
❑ Pam emmpt under Sec. . B h P C for deal moon
Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury are of Me following declamations:
haw so will maintain a CemRcata of Cement ad self -insure for WorkersCmnpcn-
n, ns provided for by Smilon 3700 of the Labor Code. for dee performance of me
Icalu
for which this permit is issued.
haw and will maintain Worker's Compensation Imursnce, u myuimd by section
of the labor Cade, for the performance of the work for which this permit is hatted.
Work pensamm It.. carrier and Policy number are:
a: v PolicyNo.: e t -/ DI
CE FICATEOFEKEMPIONFROM WORKERS'
COMPENSATION INSURANCE
(Thissectia reed nm W completed If the permit Is forma handed dollar (SIM)
or ksa)
I certify that in Ne performance of dee work for which this fermis is issued. l shell nm
employ any peon In any moneran as m become Subject to the Workef{ Gompensatlon
Laws of California. Dew
Applicant
NOTICE TO APPLICANT. If, after making this Ceniriceta or Exemption, you Mould
become subject In dee Workers Compensation provisions of me IaM Code, you muss
forthwith amply with each previsions m this Permit shall be damW mvaked.
'
CONSTRUCTION LENDING AGENCY
I hemby .done that Them h a comwctbn lending agency for Ne pc,f.mrm. of
the work for which this permit is Issued (San. 3097. Civ. C.)
Leaders Name
,
Lenders Address
1 certify that I haw mad this application and state that the above infomha itm is
correct. l agree an comply with all city and county ordinances and sum laws relating w
building consw on, and hereby euthoum representatives or this city menmr upon dee
above -mention mpcny fort on purposes.
(We) a w save, in nif and kap harmless she City of Cupertino against
Itabilities,jud tacosts dex whichmaylnanywayaccamagumisad City
in consegan the g ng of tit' permit.
APPLICA NDER ANos ND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE U ATI S.
Re -roofs �iZG
a-
Signa o an Data
HAZARD OS MATERIALS DISCLOSURE
Type of Roof
/iI the applicant or future building occupant same or handle havndous memo&[
defined by than Cupertino Municipal Code. Chapter 9.12, and the Health and Safety
c, Section 255320)7All
Oyu
roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, l agree to remove
will dee applicant or future buil as occupant tie equipment In devices which
mit hanrdom air com emimmw as recd by me Bay Area Air Quality Menagemenl
all new materials for inspection.
District,
❑Ym Na
Iheve me hma9:Mwdals rcquimmcnuunderChapmr5.93afineClifarnos
FwalmkS yCaM50.5undcrosnd muirshc building
tau not eu ly he I It i my mspomibility m notify she oceupsm of the
mquimmca stlissanerarocenlficamnrOcapency
Signature of Applicant Date
All roof coverings to be Class "B" or better ti
own Mvmasem Dam