05100099 CITY OFCUPERTINO . r -�'="' `�'"
BuamncmvlsloN PERMIT gg"ON'T'g'�GTORII�II�URMATF N
BUILDING ADDRESS: FINN BROTHERS CONSTRUCTIO pE" "D'05100099
R'S NAME: �7PERMIT ISSUE DATE
BAY COLONY INVE 475 SARAIQGA AU
SANITARY NO. NTROL N0.
PHONE:
408) 252-9131
ARCHTIECUENGINEER: BUILDING PERMIT INFO
BLDGO ELECT O PLUMB MECH
O O
ice LICENSED CONTRAC DWS DECLARATION Job Description
i U I hereby affirm that 1 aro licensed under Provision of Chapter 9(commencing
is ' with Section 7000)of Division 7 ofthc Disconcerted!Profcasium Code.and my lease,is
m in full form and effect9I7,w NEW CONDO-1, 178
m
,p= uemaasr 6 Lia.. 351
F- Can—
Dau 7rSDUCr � �
as r r — —ARCHITECTS DECLA A
i < I undersand my plans Nall W used rc
as public sords
iy
c� Located Professional
w OWNER-BUILDER DECLARATION
I<S 1 Acrchy olirm than I em exempt from thc Commons License Law for the
.a o following moron,(Section 703 1.5,Business ad Pecie cion Calc:My city or county
i$2which requires a permit to ennalwq allot,improve,dem ollsh,or repair any structure
-Z ser prior an to inurmo.tar requires the applicant for such Permit o Ole a signed statement Valuation
that W u licensed purwenl m Be prevision of BanCantrxbq.F[. Floor Area
r'a Lice con Isw(Chapter 9 S
(commcrMng with Suction 7000)of Division 3af Be Business and Profession Cade)ar
that'he it exempt obo of ern aM the basis Its the alleged esemPUm.My violation of
Suction 7031.5 by any applicant far a Permit aubiecu Ute applicant m a dull penalty of p 0 0 Occupancy Type
nos mom Nm five hundred dollars(SSW).
0 1,as owner of Uu property,Or my empioyen with wages u Neo sole camPenaUon,
w1I1 do the wank•and the aWCIYm Is an[intended or offered faraala(Sec.7044.Business Required Inspections
and Proferran Code:TW Canwcmr'S Littre Law don not apply m n
an ow ,of
pmpeny who builds m improves Names,and who don a uch work himselfus,through his
awn employees,provided that such implavemenu are not intended in offered for sale If.
however,the building or improvement W sold within one year of completion.the owner-
builder will love de burden of M i.g Nat be did MI Wild or improv<far purpose of
sale.).
1.as ower of the property,am sach,owly cmumting and,licenced cenumton m
...zin ea the pmjen(Ser.7044.Business and Profession Cade:)The Caouaemris LI-
--ma Law docs not apply m an owner of progeny who Wilds or improves demon,and,
w.a contracts for such projects with aconuscor(s)licensed pursuant m the Contractor's
am Law.
lam nemptunder See. Bk P C for Nu mason
WURKtJCa Wmru. w.............vnusn
I hereby afr.ander penally of Perjury me of Ne fallowing declandaRC
11 us.rc and will maintain•Cartifrnu of Consent in mlf-inure for WarketaCompen-
sarlm,as provided far by Section 3700 of the Isbor Code,for the performance of the
tuts or which Nu Permit is Wind.
y1ho'
and will indoor.Wmker9 Compensation Irwrance,u required by Section
3700 of the Labor Cade.for the performance of Ne work for which NW permit W bound.
My WorkeY ampuasation Ineunnec certiar and Poliry n Q
Carder. policy No.: -1
CERTIFICATE F EXEMPTIONFROMWORXF
COMPENSATION INSURANCE
(This=im need not W compleud lithe permit Is fwanc hundred dollars($101)
or less.)
I comfy Not in the perfarmanco of tho work for which NB permit W issued.l shall not
employ any person in any mmnerso as se become subject N the Workers'Compenalion
Laws of Califamia.Data
Applicant
NOTICE TO APPLICANT:IL after making this Carolina,of Exemption.you should
becwne subject m Ne WaheYs Compunmdan proviso of the Labor Cade.you moa
.,O foMwtth comply with welt proviran or NW permit shrl W deemed uveked.
,z CONSTRUCTION LENDING AGENCY
FtI hereby afRm dos them W a coMroainn lending agency for the Performance of
C4> the work fw which this permil In issued(Sec.3097,Civ,C.)
QLendI Name
z Lend'es Address
U 0 1 ratify that I haw mad Nis application and sum that the aWw information W
li F' correct.I agree in comply with all city and county aMnancen and sum laws misting in
0 V Wilding
(We). .0to,s.,indhereby amhandkeep teres,ordos city sueenter upon ac
r{17 aW.-ancoli.rad pmpury for inspection pu,pa x_
CL
(We)agree to wve,indemnify and keep hamless Nc City of Cupertino against
sFw('A liabili iudgmcn au aM expenses ichmaylnmywayamluagraatmtd City
G Z into race of a ratingofthispu I1. 7�Q rS
APP 1 STANDS AND\�ILL COMPLY WITH ALL NON-POINT Issued by: Date
Re-roofs
Signature of ApplimabContractar Data of Roof
HAZARDOUS MATERIALS DISCLOSURE Type
Will tic apPlicano w(atom building aceupmoawe arhaMlc harvdous material
Brad by de Cupenina Muni at Dods.Chapter 9.12.and de Health mtl Safety
s rumz5532(.)7 All roofs shall be inspected prior to any roofing material being installed.
0Yn No
0YWill Use applicant or future Wilding occupant use equipment or dcvlaa whish If a roof is installed without first obtaining an inspection,I agree to remove
unit he and as air canumies;Q as 0ned by Ne Bay Arca Air Qurily Management all new materials for inspection.
Diarict7
0Yes u
I hese rcW Beharardcul ma 'aW requiremcw underCMpur6.95 afNe Glifar
IN�h.�,'
5,25577 and 78534.1 undemand NairNe Wilding
1 ct W my rcsPenIbI111Y m notify the occupant of the
req rasuaneof.Cr,�f �6 Signature of Applicant Date
Ownerw authorized a 1 Dam All roof coverings to be Class"B"or better