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CITY OF CUPERTINO77
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BUILDING DIVISION PE ,ilk
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BUILDING ADDRESS:
2012R STEVENS CREEK MAIL)
PINN BROTHERS CONSTRUCT IO
RERMIT NO.0 5080164
JPERMITISSUEDATE
OWNER'S NAME:
PINN BROTHERS
1475 SARATOGA AVE
01/20/2006
PHONE:
SANITARY NO. CONTROL NO.
(408)252-9131
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing
with Section 70(X)) of Division 3 of the Business and Professions Code, and my license is
.
in full force and effect—F, '�"ti �4,)-�
NEW RETAIL ' (2 3 8 8 ' )
License Class t,"J Lic. # c,-
Date f'" 2•.' —" /� ) C— Contractor) rlrtg �� .m
ARCHITECTS DECLARATION
I understand my plans shall be used as puhlic records
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
following reason. (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit to construct, alter, improve, demolish, or repair any structure
$264256
prior to its issuance, also requires the applicant for such permit to file a signed statement
Sq. Ft. Floor Area
Valuation
that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he is exempt therefrom and.lhe basis for the alleged exemption. Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
APW f U 0
Occupancy Type
not more than five hundred dollars ($500).
,
❑ 1, as owner of the property, or my employees with wages as their sole compensation,
Required Inspections
will do the work, and the structure is not intended oroffered forsale (Sec. 7044, Business
and Professions Code: The Contractor's License Law does not apply to an owner of
property who builds or improves thereon, and who does such work himself or through his
own employees, provided that such improvements are not intended or offered for sale. If,
however, the building or improvement is sold within one year of completion, the owner -
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li-
cense Law does not apply to an owner of property.who builds or improves thereon, and
who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's
License Law.
❑ I am exempt under Sec. , B & P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the fallowing declarations:
❑ 1 haae and will maintain a Certificate of Consent to self -insure for Worker's Compen-
sation, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
❑ I have and will maintain Worker's Compensation Insurance, as required by Section
3700 of the Labor Code, for the performance of the work for which this permit is issued:
My Worker's Compensation Insurance carrier and Policy number are:
Carrier: Policy No.:.ay_.
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This Section need not be completed if the permit is for one hundred dollars ($100)
or less.)
,
I certify that in the performance of the work for which this permit is issued, 1 shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject to the Worker's Compensation provisions of the labor Code, you must
forthwith comply with such provisions or this permit shall be deemed revoked.
I
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
' the work for which this permit is issued (Sec. 3097, Civ. C.)
Lender's Name
,
Lender's Address
I certify that I have read this application and state that the above information is
r correct. I agree to comply with all city and county ordinances and state laws relating to
building construction, and hereby authorize representatives of this city to enter upon the
above-mentioned properly for inspection purposes.
(We) agree to save, indemnifyyalfcep harmless the City of Cupertino against
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liabilities, judgmeri� ,costs and expbnscs which may in any way accrue against said City
' in consequence o'fthe granting ppf this permit._
APPLICANT�UNDERSTA DS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date �` �
SOURCE
/G HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
Code, Section 25532(a)7 ;
All roofs shall be inspected to any roofing material being installed.
❑Yes PNo
'
prior
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
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑Yes Nu
I have read_ dle hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health & SafctyCodc, Sections 25505, 25533 and 25534.1 understand that if the building
docs not
of a Certificate of Occupancy.
Signature Of Applicant Date
All roof coverings to be Class "B" or better
Owner -or authorized agcm Date