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CITY OF CUPERTINO
�CONTRACTOR�INF.ORMA'IbN.
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
128 STEVENS CRK ft 207
PINN BROTHERS CONSTRUCTIO
ef""'NO-05O80186
R'S NAME:
PBRNIG LSSUfl DATE
PINN BROTHERS
1475 SARATOGA AVE
01/20/2006
NE:
SANITARY NO. CONTROL NO.
(408)252-9131
ARCHITECTIENGINEER:
BUILDING PERMIT INFO
e� PLUMS MECH
O O [�
LICENSED CONTRACTOR'S DECLARATION
Job Description
or Chapter 9 (commencing
I hereby affirm that I RenewedRend under provisionso
with Section 7018) of Division 7 of the Businusad Professions Code. and my license is
inrmlmrwanndeffam.r (7j
NEW CONDO -610'
Licence Iw Lle.g
Dam comruar
BMR UNIT
ARCHITECI'SDECLARA ON
I undersand my plans shall be used u public records
Licenced Professional
OWNER -BUILDER DECLARATION
I hereby amren that I am exempt from the Convector's Licma Law for the
following reason. (Section 7031.5. Business and Profudons Code: Any city or county
which "trims a permit to emmrect. alter, improve, annalist, or ¢pair my structure,
prior In its issuance. aha require; the applicant forsuch Permit he Rlea signed statement
Ft. Floor Area
Val
that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
Sq.
(commencing with Section 7000) of Dlvbian 0 of the Businwond Professions Code) m
that he is except timrtfrom and the bash rte the alleged exception. Any violation of
mber
Occupancy Type
Section 707 1.5 by any applicant for a permit ubjects see applicant te a civil penalty of
not more than rtes hundred dollars (M).
APO .I 801.00
❑ 1, u owner of the property. or my employes with wages as timh ale compenation,
Required Inspections
will do the marks. and dmitumure brat intended or offered for sate(Sec. 7DN, Business
ad P.11as ant Code: The Corenclor's Unrest law dm not apply m an Owner of
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property who builds or improv thereon, and who doessue h work himself or Uuough his
owneemployces, provided that such improvements are not in cement mo@red for sale. If.
however. the building or improvement is aid within am year of completion. the owner.
builder will have the burden of proving that he did not Wild or improve fm purpose of
tile).
❑ I, as awns of the Property, am exclusively contracting with licenand com encs in
construct the project (Sec. 704, Business cad Professions Code:) The Conmcmr's LI-
cew law does not apply man owner of property who Wilde or improves theater, and.
who contracts for such pmjem with a eonaacter(s) licensed pursuant m the Contractor's
License law.
❑ lansmanitundesSec ,B&PCfarthisauoe
'
Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury am of Ne following dmaa0ons:
anand will aremain•CeWriesmofConantaalRlnsumforWorkee.Campn-
, u promicel for by Sartion 7701 of the labor Code, rte me pe rformanm of the
Imr
for which this permit is issued.
have sand will maintain Warkee, Compensation Insurance, u required by Section
of the later Code. fm the perforemox of tite work rte which this pormitist issued.
arkerb Cgmpensail lmureme artier and Policynu bar=:
1�.. _ - v. Policy No.:
R IYF�S' FI�FFXEMPTION FROM WOR ERs'
COMPENSATION INSURANCE
(This smite mad not W completed ifthe permit Is foram hundred do1W (5100)
ar leu)
I certify, that in the performance of the work for which this permit is issued. I Nell not
employ any person in any manners as to Wcomc subject to IW Workers' CompeMNon
Laws of Califaaia. Dare
Appllcat
NOTICE TO APPLICANT: If. after making this Cci iftcac of Eremption, you should
become subject in the Woman's Compensation provision, of the Inter Code, you mut
forthwith comply with two provisions on this permit shall be rimmed revoked.
CONSTRUCTION LENDING AGENCY
I Wreby M.the. Bart is a coninaturt landingagency far rix Nor... .1
,
the work for which Nb permit Is issued (Sec. 3M. Civ. C.)
Lender's Name
,
lender'. Addrw
I certify that I have mad this applicadon and sem the. the aWve information h
eom"L 1 aurae m e ply with all city and county ordinances and sum taws relating to
building eonswcti .udhembyauhodm MpreXnMlivuofOiaoiLytocnMrumnf
ahove-mentioned party for ins an purposes.
(We) reg o ave, imic try keep harmless the City of Cupertino agaiul
Iisb1litun g Wcoauaa a., which may In my way ammagalut Wal City
inco ten the anti alibi omit.
APPLLIICA RST NDS D W L COMPLY WITH ALL NON -POINT
Issued by: Date 'LV "f%
SOURCE R
" L
Re -roofs
Type of Roof
Siena lm HA Aare Dam
xAZARn 5 MATFAIALS DISCLOSURE
Will see applicant or future WildingPow oradI
Hardausmaterial
k. Ch.p
defined by the CupeNm Muni ' re Code. Chapter 9.13. and see Hulth a0 safety
. &.do.35553(a)7
All roofs shall be inspected nor to an roofing material beim Installed.
P P Y g 8
❑Yes No
If a roof is installed without first obtaining an inspection, I agree to remove
Will tis applicant or future bu'Wing occupant use equipment or devices which
rah hauodoua air contaminants as fined by IW Rey Area Air Quality Mangemcnt
all new materials for Inspection.
Disuic@
❑Yes Nu
I he.a aWeard requirements under Chapter 6.95 or dm Califnr.
nia Hulth&S Code. .25 5.35557 and 255N. l unAcma.nd thin done Wilding
docs not torte hat a ant. N t b m mspomlhillty a mufy the oaupat tef da
requiare nth met oto uaaearaceruraatearcacepacy.
Signature of Applicant Date
All roof coverings to be Class "B" or better i
Own t ri cd e c Date