08040119 CITY OF CUPERTINO � tr�im��♦ ",� --T^ �y'�� `��k�" ' i-
BUILDING DIVISION' PERT o1�TRS� ,C 6kj Fy QyRMA, 400.-i;
Bm1.41�c�a��aE DE ANZA BLVD _ PINN BROTHERS CONSTRUCTION 08040119
NER'S NAME: PERMIT ISSUE DATE
BAY COLONY INVESTORS II INC 20132 STEVENS CREEK BLVD 06/30/2008
PHONE: (408) 252-9131 ITA
SANRY NO. CONTROL NO.
A0.CHITELTIFNGINEFA:
BUILDING PERMIT INFO
BLDG ELECT PLUMB - MECH
0 0 0 0
wap LICENSED CONTRACTORS DECLARATION Job Description
um 1 hmeby afRlm m lice
that 1 amd uder pmvisimu of Chaper 9(commencing
e< wiNScctian]0(f0)ofDiWsion7ofNCBusinnssaMProfcssiumCode,andmylicaneu REVISION—PARKING HANDICAP STRIPING PLAN, RELOCATE
in full forte and error
iq? Licene ms La.g I HANDICAP VAN PARKING SPACE. ORG#05100174 NO NEW
^�0 Dam cN ors DECLARATION PERMIT.
U I underhand my pram shall be used u Public wcords
to
a o t; Linnewd Pmfessioml
5 OWNER-BUILDER DECLARATION
if i bemhy airum Nm 1 am uempt form the Conuactora License Law for Ne -
no following moon.(Section]ID 1.5,Bminess and Profession Code:Any city aro county
e$ which mquires a pemait to construct,al1m,improv,demo)lah,Or repair any sol cture
L=y Prior m its iasmmce,also mquims do applicant forsuch Permit in fele a signed statement
f< that he is licensed pursuant to the pmwsinns of the Convector's LIccne Law(Chapter 9 Sq.Ft.Floor Area Valuation
$ (commencing with Section 7000)of Division 3ofthe Business and PmfeuionsCutlet or $100
try — that he is camps therefrom And the hods for the aneged exemption Any violation of
araC
Section 7071.5 by any applicant for a Inroad mbjeeu the applicant m a civil penally of Number QCCU
nmom Wan five hundred dollars(55(10). 32610064 .�� P Y�'Pe
1,an mvrcr of thn property,or my employees wits wages an deb sole eompenndon,
will do the work,and th ourunt m is not inendd or offered f..ale(Sec.7W,Business
and Profession Code:The Coloratura Licuue Law does not apply W an owner of Required Inspections
property who builds or ire provestheaeon,and who does such weak himself.through his
own employee,provided that such improvement,are not intended eauffered fordo.if.
however,the building or improvement is mid within one year of completion,the owner.
builder will have the burden of proving that le did nut Witt or improve for purpose of
nLeJ.
1,As owner of the property aro exclusively contracting with licenced mnoacton to
comtrvn the project(Sec.7014,Business and Profession Cade:)The Comtrw.]oes Li-
ve Law does mot apply ban owner of property who builds or improves Neuron,and.
who contreta for.tach project,witha mntracmr(s)limned pmwant to the Cmnuume,
Licenve Law.
❑Iameaemptundm See ,B&PCfArun5mnen
canerDam
WORKERS COMPENSATION DECLARATION
1 hereby afBm under penalty of perjury one of lie following declarations,
❑1 ham and will maintain•Certifom of Comem in elf-imum forWoders Compere
nation,As provided for by Section 7700 of the Labor Code.for Our performamc of the,
work for which this permit is issued.
0 1 hale anal will maintain Workers Compensation Insurance,As mryuimd by Sedan
7700 ofthe labor Code.for Ne pemformanec of the work for which this permit is isueQ '
My Warkcra CwnporseaN`n Insurance earnim and Policy number ase:
Carrier a F l�5• Poliry No.: 611001
CER71ECAM OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE ,
Mis Anchor need not he compleed lithe permit Is foronc hundred dollars(SIM)
or tut)
I certify that in the perform..of the work for which this Permit is issued.I shall not '
employ anypemon in my manner an As to became subject to the Worken''Compenu0on
Laws of Califumia.Dam
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should
become sunca As the Workeri Compensation provisions of the labor Code,you most
.,O freNwith orvivNu comply with such pmes or permit dull be deemed rewkcd.
CA CONSTRUCTION LENDING AGENCY
[—� I hereby affirm dun there u a construction Lending agency for the performance of
ai
the work for which that permit is ismed(Sec 7097,Civ.C.)
Lcmice,Name
z Lenders Address
U Q 1 mtify,that 1 have cud this application and Auto that theshow information is
D7 cmecL 1 agree m comply with all city and county omimnco and num laws mining he
and
.0 buildinE camwnion, hereby authorise repseerous of than,aly to cn¢rupon the
W"LICUND
rty fm impaction Pugees /`^�/WS/Cw.indemnify and keep harmless the City of Cupertino all
(qa wandupeves which may in any way attNe agaivlsaid City
C.)z { un{of Nis PermitNDS ANO WILL COMPLY WITH ALL NON-POINT Issued by: Date
Sigmmrd a tractor acRe-roofs
OU Dae
II HAlMDOUS MATERIALS DISCLOSURE Type of Roof
Itgll the
applicant ea future building eavpmt more,rehandle hamdom maerial
u refin6d by Ne Cupertino Mu iPat Code,Chapter 9.12,and dm Heald and Safety
de, eYu ' o
do.15532(47
All roofs shall be inspected prior to any roofing material being installed.
❑
Will the applicant or future building occupant use equipment or dcvicea which If a roof is installed without first obtaining an inspection,I agree to remove
emit Wca mu yr uncommon mono u def red by On,Bay Alta Air Quality Management all new materials for inspection.
District?
❑Yo
1 ave mad to materials requirement,under Clupmr 6.95 of the,Califor.
pian 1 SafetyCode, c6.255I15,25577and2557A.lundcrhondthnifdebuilding
dao l ntiy to
that it is my responsibility m malty the ottupont Of the
regr nmhm pl�issramcofACmifrn atoecrparray.
Signature ofApplicant
Date
owder or an riredage I All roof coverings to be Class'Jg."or better
1