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CITY OF CUPERTINO
BUILDING DIVISION PERMIT
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COIYTRALRiN)N"C1iMA'�IOV;
BHILDING ADDRESS:
PINN BROTHERS CONSTRUCTIMgRMIT
NO -05080184
ER'S NAME:
PERMIT ISSUE DATE
PINN BROTHERS
1475 SARATOGA AVE
01/20/2006
NE:
SANITARY NO. CONTROL NO.
(408)252-9131
ARCHITEC (ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
-
Job Description
I lumby dorm that i am Mansel under provisions ofch.pw, 9 (romancing
with Section 70110) err Division 7 of the Business and Profrulam Code. and my license is
on loluara.nd arras ;z7 3 �q 1 Z
NEW CONDO -6101
Dated l� ContrxrarBMR
UNIT
ARCHrrEcrS DECLAR ION
I uederuand my plans shell be used As public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that I em exempt from the Contractors Ltcmse Law for the
following mason. (Section 7031.5, Business and Pmfesdum Cade: Any city or county
which requires a permit to construct, alter, improve, demolish, or mpoir any structure
prior an its issuance, alae requires the applicant fanuch permit to Ric s signed mmmcnt
that he is liansod pursuant to the prevision of the Conumar's License Law (Chapter 9
Sq. Ft. Floor Area
Val
(commencing with Section 7000) of Division 7 of the Business and Professions Code) or
that he Is mempt therefrom and the basis for Ne alleged exemption. Any violation or
APN Number
Occupancy Type
Section 7071.3 by any applicant for A permit anbJecu the applicant m a civil penalty or
not more than foe hundred dollars ($500).
36903001.00
0 1, as owner of the properly, or my employees with wages a their sole compensation,
Required Inspections
will lathe work, and the net.. isnmintended orolfered bomb, (Sm. 7014, Business
and Professiam Cade: The Contractors Liam Law does not apply a an owner or
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properly who build, arimprrws theme, and who doessuch work himselror through his
own employees. provided that such Improvements Ire not Intended wall formic. If.
however, the building or improvement It sold within on year arcompletion. the owner.
builder will have the burden of proving that he did not Wild at Improve for purpose of
Sala.),
0 1, a owner of the property. em exclusively contracting wish licensed camxrors in
construct Ne pmject (Sec. 7044, Business and Forrestal... Cade:) The Contractor. U.
came law dors not Apply m an owner of property who Wilds or improve thereon, and
who contracts for such pmjecu with a contracmr(s) licensed pursuant to the Contractors
License law.
0 1 Am exempt under Sec. . B & P C for this reason
net Date
WORKER'S COMPENSATION DECORATION
I hereby affirm under parody of perjury am of the following daluatians:
0 1 ham end will maintain • Cerdfteateaf Consent mself-inum for Workers Comped
.be., as provided for by Section 77M of the Labor Lade, for the performance of she
wars for which this permit I. issued.
0 1 lane and will maintain Workers Compensation Insmena, As required by Section
7700 of the labor Cade. fm she performance of she wort for which this permit is Issued.
My Worker Compensation Insunme esmies end Poliry nu her am: O
�i. 1
Carder. as.i J-' S Poliry No.:
CERTIFICATE OF EXEMPTION FROM W RR S
COMPENSATION INSURANCE
(This sectio need not he completed If the pewit is foram hundred dollua(3)00)
or A.)
1 unify that in the performance of the work for which Nis Permit is issued, I shall not
employ any person in any manner an as An became subject to the Workers' Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If, after making this Ccnificmc of Exemption, you should
become subject to the Workers Compensation provisions; of she lJher Cada you most
forthwith comply with such provisions at this permit shall he accrued revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm Net there is a construction lending agency for the Perfawana of
the work for which this permit B issued (Sec. 7097, Civ. C.)
'
Lender's Name
Lenders Address
I artily that 1 have mad this application and state that the .hove information lu
'
contact, I mires to comply with all city and county ordinances and mute laws minting m
hereby emhodse mprexnutirua of Nis city to erect upon the
building conkpperty
ahavnmenti.rinsPed'00 pugl.ses.
the City of Gpenit against
(Wc)ndere ' • d keep hayIn
liabilitie6jund pen which may in any way ¢cmc agdnsl uid City
m s
in consequen. f this wit.U'O6APPLICANDS AN WILL 0MPLY WITH ALL NON -POINT
Issued by: Date 1—ZSOURCER
L ' 'Ob
Re -roofs l5: -�
Signuur onlr Do Date
HAZA0.OUS RIALS DISCLOSURE
.4
Type of Roof
Will fMurebbyy Jingaeupanbmm2. handle h and
04Cicanlar
Health Safety
deRned by the Cupertino MunWfpal Code. Gaper 9.17. and rim Health end Safetyads,
Section 25l72(u77 /
All roofs shall be inspected prior to any roofing material being installed.
Oyes ❑No
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant err futons Ildinaaupant use equipment or devices which
mit hevan(us air canlan film. defined by rite Bay Arta Air Qudity Management
all new materials for inspection.
IDimict?
❑Yes Nulha
the by s ateriab mquimmenu underClupmr693oftheGii(omil"I
8 cayc 5113.23377 and 277th. l undersued the, ifNe Wilding
oes trot cu ally ha a u am st It B my r4PORAfhllhy m notify dC CCCapNI of rilequlmme
hem Primissuanceora a%Mem o'OccuP:cy
Signature Of Applicant Date
yOAll
roof coverings to be Class "B" or betterw C/
r a prized a cm Data