05050069 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION 'S
A
BUILDING ADDRESS: PERMIT NO.
FINN BROTHERS CONSTRUCTION 05050069
OWNER'S NAME: PERMIT ISSUE DATE
E:RAY rnrnmy Ihn7PqToPq TT . =14175 SAR-ATI2GA AVE
SANITARY C OL NO.
ARCHRECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
u00 LICENSED CONTRACTOR'S DECLARATION
mF1 hereby affirm shat 1 am licensed under provisions of Chapter 9(commencing Job C�rl [ion
z`r$ with Section 7")of Division 3.f the Rawness And Prpfcuions Code.and my license is
nmRfame and cfmaB g�Zq f'L.DEMO (E) BUILDING
lr�� ALE®
j�Z Liccore Class Lk.N
Date l-k91_n Nnuacrer211. a�tCA"IT
_J � ARCHITECTS DEC ATION ~e 7
I undcrsund my plans shall be used As public records /202005
DdV
GG Licensed Professional
a 3 OWNER-BUILDER DECLARATION �. s G Ann
I hereby affirm Nm I i. .empt Imre Nc fOni..C License Law for the /
00 following renson.(enation 703 su Business and vena d ions Code:Any city os county tAtM~f]
K m which rc4ui su a permit to enmwc.Wer,improve.Such
h rempxh,or repair any taurrom
+t—'^ thatMmr oritscensed e,auantto e ftapplicantMe
MsroiuUccose Law(ned hapten
m that me licensed pursuant to of Division
of the Com views and
Prmhw(Chapmr9 Sq. Ft. Floor Area Va uahon
zlz-re (commencing with Senior7000)of Division)of the Business end Prof.xivns Code)or
i $ Nal he is exempt therefrom and Ile haste for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a Permit subjects the Applicant o a civil penalty of 3 24014,0649110 O Occupancy Type
not marc Nan five hundred dollars($500).
D 1,As owner of the property,or my employe.with wages As their rola compensatkn,
will do Ne work and the swetum is not intended or offered for ask(Sec.704x,Business
And Pmressimu Code:The Comiter a License law does Wt Apply 0 An nWMr Of Required Inspections
property who holds or improves thereon,and who doessuch work himself or through his
own employe.,provided Out such improvements Are not intended cr OfferW frowe.If.
however,Ne building or improvement is sold within one year of completion.Ne owner-
builder will have the human of proving Nat he did not build or improve for purpose of
akJ.
❑1,as owner of the property,am exclusively contracting with licensed contractors to
commuter Ne project(Sec.1044,B.iness and Professions Code:)The Contractors Lt.
ecru law does not apply to an owner of p pert who W.da or improves Mo...and
who emmorcu fur such pro em witha cont ctor(s)licensed perauanuo the Contractor's
License law. Q
Dlam em �t de q!. ,B&Pa�C for this resson
Owner Date +a t»
WORKER'S COMPENSATION DECLARATION
I hereby aRnn under penalty of perjury One of the following declarations:
7C337'7.W
have and will maintain A Certifiate of Consent to self-insure for Wrrke"a Compcn-
n,ss provided for by Section 37W of the labor Code.for Ne performance of the
for which Nis permit is issued.
have and will maintain Workers Conepensadon Insurance,As required by Section
of Ne labor Code,for Nc performance of the work for which this permit is issued.
Warkc' oompenaratilon Insurance caria and Policy 1 Ar W4 $a PolicyNO171 rri01at
CERTIFICATE OF EXEMPTION FROM WORKERS' '
COMPENSATION INSURANCE
(Thu M.need not hcemnlIcted irthe permit is torn.hundred dollars(5100)
or less.)
1 ceniry Nat in the performance of the work for which this permit is issued.I shall not
employ any person in any manner an as k become sobjccuo the WOrkerS Compensation
Laws of California.Dau
Applicant
NOTICE TO APPLICANT:If.after making Nis Cenlfiale of Exemption,you should
become subject to the Worker's Compensation provisions of the liber Code,you mum
0M
fowith comply with such provisions or this permit shall be deemed revoked.
z^ CONSTRUCTION LENDING AGENCY
'Tr+ I hereby affirm Nat there is a construction lending agency for the performance of
x the work for which this permit is.sued(Sec.3097,Civ.C.)
lf7Q Undcis Namc
G
Lord 'A Add. -
U 0 1 certify thar I have read this application and state that Ne shove information is
IL t-' correct.l agree to comply with all city and county ordinances and sum laws relating m
V building construction,and hereby mNoris¢preanutives of On city m emer upon the
r U shove-mprope
entioned rty for impaction purpose.
(We).,me to ave,indemnify and keep harmless Ne City of Cupertino against
Fw raA liabilities,judgments.eusts and expc.es which may in Any way accrue against aid City
U Z in conscOmme.of the gra g of Nn permit
APPLICANT UNDER DS AND WI COMPLY WITH ALL NON-POINT Issued by:9 Date
SOURCE G L
S�I)''e� Re-roofs
Signah re of Applicanl/Contracmr Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will into applicant or forum building occupant store or handle Im amo.material
A,dc0ned by me Corot no Munici psi Code.Chapter 9.12.and the Health and Safety
,weLerade.section 35s3xa25532p.)1KNo All roofs shall be inspected prior to any roofing material being installed.
r.
Will the applicant or future Wilding Occupant sex equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit hxvamnus air conuminanu an defined by the Bay Area Air Quality Management all new materials for Inspection.
District?
DYcs • �u
1 have read the haxardnus materials mquirentenss under Chapter 6.95 or Me Califon
ria Health&SafctyCade.Sations 255115,35511 cert)25 d.l undersand thmifure building
does not currently hoe A u a Not it ix my raponsi ilitY m notify the up.1 of the
mquierneou h t etprionuissuanceOf emreaeaf�gvlaa4gw Signature of Applicant Date
Owner of aulhodycd agent Date All roof coverings to be Class"B"or better