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CITY OF CUPERTINO
BUILDING DIVISION PERMIT
TN'FU ATION
,C.,,O, ,fkACTOR
BUILDING ADDRESS:
PINN BROTHERS CONSTRUCTIMSU"'n"'005080188
as NAME:
PERMITLSSUEDATE
PINN BROTHERS
1475 SARATOGA AVE
01/20/2006
NE:
SANITARY NO. CONTROL NO.
(4 08) 252 - 913 1
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CON`RACTGR'S DECLARATION
lb Description
o
by affirm 1 sm immend under provisions of Chapter 9 (commencing
1 herem Nm
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with Section 7") ofDivieion 3 of dee Business and PrefcuVom Ind my licew is
CCode,
infullforceandcffecx --7
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NEW CONDO -9191
Licenea Clw _�._ Lic. M 1i
Dale — ��� i'. f Canlnmar =i nm, -
m,ARCHITECTS
ARCHITECTS DECLARATION
1 undcfwnd my plena shall he dead a public retards
Licensed Pmfcssional
OWNER -BUILDER DECLARATION
'
1 hereby affirm Nal I em exempt fore the Contractors License Law for the
following mason. (Section 7031.5, Business and Professions Cade: Any city Of county
Which mgdlom a permit to construct. alum, ImpmM. demolish. M repair any structure
$197006
prior to its Issuance, also requires the applicant for Such Permit la file a signed statement
Sq. Ft. Floor Area
Valuation
that he u licensed paramount W the pmvitions of the Connector's License law(Chapm 9
(commencing with Section 70W) of Division 3 of the Businw and Professions Code) or
that he is exempt therefrom and Ne bah for the alleged emmption. Any violation of
3 NgRWTO U
Occupancy Type
Section 7031.5 by Ary applicant for a permit subjects the applicant to a civil penalty of
not mom than five hundred dollen (5500).
❑ 1, u owner of de property, or my employees with wages u Neh mle compewtion,
Required Inspections
will she lire warkend the swclum is not intended m offered formle(Sec. 7014. Business
and Pmfesslons Code: The ConlMon License Law does not apply m an awaer of
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property who builds orimpravas thereon, and who doe such work himsel(or Ihmugh his
oememployem, provided that such improwmanu are not Intended oroRered for We. If,
however. the building or improvement is mid within one year of compledon. the owner.
builder will love the burden of proving that he did eat Wild or improve for purps se of
all.).
❑ 1, as owner of me property, am exclusively contracting with licensed comma mor o
'
construct the project (Sec. 7016, Bushes and Profession Cade:) The Convectors Lt.
caw law dos out apply to an owner of property who builds or improv Ihereaer. and,
who contracts for such projects with a conlnclar(s) licensed pursuant as the ConllMWra
Lwow law.
❑ 1 am exempt under Sm. . B to P C for this won
r Dow
WORKER'S COMPENSATION DECLARATION
1 hereby of ban under penalty of perjury, one of the fallowing deciwdons:
I hew and will maintain a Certificate of Covent to selfdnsum far Wmkeh Camper.
terms, as provided for by Section 3700 of me Labor Code, for the performance of the
work far which this permit is issued.
I hath.' and will maintain Worriers Compensation Inamme ce. se required by Section
3700 of Ne Labor Cade, far Ne performance of the work for which this permit is issued.
My Workellgompensallon lnmesnce carrier and Policy n",kP`ober��ave:�_y
Carrier. �.aAR.I "icy No.: l
CERTIFICATE OF EXEMPT10N FROM WORKERS'
COMPENSATION INSURANCE
(ThLumction need nolbocomplewJ lime permit is foranc hundred &It=(510(y)
Of Mss)
1 certify that In the performance of Ne work fm which this permit it land. I shall not
unplay any Lenon in my manor m Is W became subject as the Wofken' Compewtian
Lswa of Califamia. Dew
Applicant
NOTICE TO APPLICANT. IL after making Nis Cerilicate of Exemption, you should
become subject W the Workers Compensation Provisions of the Labor Cade, you must
forthwilh comply with such provision or this permit shall he daemon revoked.
CONSTRUCTION LENDING AGENCY
I homey affmn Net Nem is a cmmoclinn lending agency torten porfofinemw of
the work for which this permit Is Issued (Sec. 3097, Civ. C.)
Lenders Name
_
Lamers Address
I certify that 1 haw mad this application and sum that the above information Is
coI I agree to camp) with all city and county ordinances and state laws relating to
buiWirtecngconswcticn, hembyauNodmmpfwnutiwsof Niscilymcnwrupnn Nr.
shove -mentioned pro ly for Inspection urpws
(We) agree t w, indemmf P hemalw the City of Cupertino against
Iiathilitim,judgmen cmtsandex w ich may in any way attnoe against and City
m COwQ9armO of a gaming a is pe I.
APPLICANT AND IL MPLY WITH ALL NON -POINT
Issued by: Date
SOURCEREG T NS.
Re -roofs
Type of Roof
—
Signaluw AContractor Dow
HAZARDOUS MATERIALS DISCLOSURE
Will Jac applicant or future building occupant store or handle hazardous mawdal
fined by the Cupenino Municipal Code. Chapter 9,13. and the Health and Safety
. Section 25531(a)7
All roofs shall be inspected to any roofing material being installed.
❑Yce No
prior
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or fortune building Occupant use equipment or dcvico which
heafdaux air conuminaneti Jenne by Ne Bay Area Air Dually Menagemam
all new materials for inspection.
icGYes
I]No
10—w—.7al(A((1bdd?.NA-1
Thaw theher�w mamdalswquimmenu unJcrChapmr&95 of Ne GlifoncalmA,
IyC ,Sada ZSN)5, 13533 anJ 23331.1undcoundNAlfdm building
not cu Ily he awn that Itis y responsibility at nodfytheOccupantofNe
n.a bwh mlbeelpdor f=iwemdfOccupanry.
Signature of Applicant Date
( —pp
"B"
roof coverings to be Class or better
Dow