05070112 CITY OF CUPERTINO7477777777777777777
BUILDING DIVISION PERMIT (-0,`C,TQR TNFORMATIQN
BUILDING ADDRESS: PINN BROTHERS CONSTRUCTION ERMITNo.05070112
?R'S NAME: PERMIT ISSUE DATE
BAY COLONY- INVESTMENTS II NC1475 S 10/06/2005
PHONE: SANITARY NO. CONTROL NO.
(408) 252-9131
ARCHIECTIENGINEER: BUILDING PERMIT INFO
BLDG
O ff ply l�
�0o LICENSED CONTRACTOR'S DECLARATION Job Description
Mrd�j I thereby affirm Nati 1 am limned under provisions of CMpwr 9(commencing
with Section 701k)of Division 3 of the Business Prolamines Code.and my kicesue is
^� in full force and cocci �, PARKING STRUCTURE UP TO PODIUM
,I Z Umnxe Class Lk.N
;g' Dam 10-') U.3hINCLUDES ELECT/PLUMB/MECH
ARCHITECTS DECLARATION
1 understand my pam'hill M used as public records
� u
a G Lkanxed Professional
OWNER-BUILDER DECLARATION
Z I naso .(firm o n 1 em exempt from the Contractors C's Lieenu Law for the
p O following moon.(Section 703 construct,
Business and Professions Cade:My tiny or county
$�i which m9ulru•permit m cnnnroc,,alcor.Improv,demolish.or repair any nrocmro
_E�n priorm I%issuance.also requires the applicant for such permit to file a signed moment ��.t
that is llcansed pursuant m the poevisinm of doe Contractor',Lkcnss LAW(Chapter 9 Sq.F[. Floor Area )3�I�a 958
vgs
S (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
that he is exempt therefrom and the bub for the allagod exemption.Any violation of
Section 7011.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not mom than fin hundred dollars($500). 32610064 . 00
(�]I,As owner of the property,or my emptoycea with wages As Heir sole cumpensstion,
will do the work,and almnctun is ant intended oroffersd foram(See.7044.Business Required Ins ections
And Professions Code:The CorsocmYs Llama Law data roees apply to an owner of q P
Property who build'or i mprcmen thereon,and who does each work himself or through hu
own employees,provided that such Improvements ate not Ism vim!croffend forsake.if,
however,the building or improvement is said within aro year of completion,the owner-
• builder will have the burden of proving that he did not build or Woman,for purpose of
Asia.).
❑1,as owner of the property am exclusively contracting with Timm rad contraction to
construct dee project(Sce.7094,Business and Prefica on,Cade:)TM Conoactofs U.
mass law dam not apply to an owner of property who Wilds or improves thereon.and
who contracts for such pmjcm wide a eontractoHs)licamad Immune,be dee C.Mrseme.
License Law.
t]I am exempt under See, B d:P C for this recon
rDam
WORKER'S COMPENSATION DECLARATION
1 Mreby alRrm under penalty of parjury,ane of the fallowing deadma es:
❑1 have and will mainWn•CeNOesta of Comeat to self-imam fa Woher'sCo npen-
udan,a provided fur by Section 3700 of dee(aloof Cade,for de perfmar.of dee
wank for which Nis permit is issued.
f.2C1 hoe and will mtlnuin Worker's Compensation laswance,As mquined by Section
of the Labor Code,for Ne performance of the work fmwhich this permit is issued.
CMayrdWeor.rke�h Ct•.TotCal..TmaaxyoCncVe carrier Policy
number rt:
CERTIFICATE
ERTIFlK� N FROM WORKER
S'
COMPENSATIONINSURANCE
LL
('Missectlnn need notbccwnplend little permit is reunion huMteddollan($ia!)
or less.)
I certify that in the performance of the work far which this permit is issued,I shall not
employ any person In any manner an As to hecomesubjecua the Workeri Compemadon
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption.you should
become object to the Worker's Compensation provision{of the,Labor Code,you mut
Q O forthwith comply with such provision or this Permit mall he decmcd ranked.
„Z• y CONSTRUCTION LENDING AGENCY
(r I Manby af0rre that Nen iso construction mnding erg r cy mor Ne perfom auce of
> tie work fur which mm permit i{Issued(Sec.3097,CN.C.)
0G0 Lenemes Name
z Lenders Address
U Q 1 certify that 1 have read this application and sem den the+ban information is
I,r' Mar.I agree to comply with all city and county eadinancea{rad sum law{relating to
Q SVS building cmuouction,and hembyuthodn mprewnutivu afthu City to corer upon Nc
W aMw-mentioned property fm inspection purposes
LL (We)agree to taw,indemnify And neap harmku tie City of Capetian,against
.,y,4 liabllitics.judgments,cmu And cap..which may In any vary oma agomt sod City
C)z in consequence of the granting of this permh.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
$OC}RCER L. oNSLO-7-05--_ Re-roofs
Signawn of AppliY�HAZARDOUS MATERIALS DISCLOSURE Dam Type of Roof
Will the applicant or future building accupuutam or Media hazardous mamdal '
As defined by the Cupertino MuniclPat Code,Chapmr 9.11,And the Health and Safety
Sectio.25532(a)1 All roofs shall be inspected prior to any roofing material being installed.
❑Yes gl Nu
Will the applicant or rutum building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
call.hazardous air conmmimam As defined by the Bay Am.Air Quality Management all new materials for inspection.
Diatrict7 �/
❑Yes RNo
1 haw mad the hazardous"materials requirements under Chapter 6.95 of the Califor.
nia Halth A SafenyCee e,Section 25505.35533 and 155311 understood that ifthe Wilding
d of curemly haw a enma Net k b my responsibility to notify the occupant of the
yup craw m ou0siorWIn m,f Ocrtihaaeafocmpancy Signature of Applicant Date
!�-. 7P1. /0-7-0 S• All roof coverings to be Class"B"or better o
Owner or authorized agent Dots