05080165CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
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BUILDING ADDRESS:
PINN BROTHERS CONSTRUCTIO
URMITNO-05080165
128 STEVENS CRK ELY
R'S NAME:
PERM. ISSUE DATE
PINN BROTHERS
1475 SARATOGA AVE
01/20/2006
NE:
SANITARY NO. CONTROL NO.
(408)252-9131
ARCHITECTIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm Nat I am licensed under provisions of Chapter 9 (commencing
with Section 7")of Ion 3 or the Business and Pmfessi... Code,and my license is
mOtRmmeandeffect. �-
PODIUM (25,998') -PARKING
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Lkenau Clur Lm.0
Dam Contractor t
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ARCHITECTS DECLARATION
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1 understand my plans shell he used u public indicts
t'S
Licensed Professional
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OWNER -BUILDER DECLARATION
y
I hereby .(firm Nn 1
uusin from tPi Contractors License law for tM
o
tO
followinguires A (Section 7 Construct, Bvine. and Professluv Code: My city os county
1.
impose, demolish. or mash turc
a permit gmclure
which rite
$14 6 5 7 6 7
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re firesbealtar,
ed
Wo lW applicant for such permismfileuigncJwo:mcm
lensed
incingwJpSectin7")ofviviouafNeCamruessaittnxLow
Sq. Ft. Floor Area
Valuation
thiarmiu p,alwrquithe
$
a
Division of sionsoptor9
(nom C.m) or
Buseged exempt Preon.
(commencing Section7")and
(eat
the r al Any
Nal he u exempt therefrom and Ne buts for the alleged exemption. Any WolaUon of
he is
r U U
Occupancy Type
Section 7031.5 by any applicant for A forms subjects the Applicanua s civil Knotty of
not more than five hundred della. (5500).
0 1, u owner of the property, or my amploycas with wages As their solo compensation,
Required Inspections
will do the work and Ne Nuctom 1. at aroffe.d formic(See7041, Business
and Professions Code: The ConUwtor's License 4w data not apply m an owner of
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property who buildsorha ries thereon, and who dessuch work himseIforthrough his
awn employees, provided Nat such Improvements are not intended araRered forum. If.
however, the building or improvement ii sold within ace year of eampletion. Ne owner.
builder will haws aha human of proving that he did not Wild or Improve for purpose of
.m.).
0 1.. owner of the property, em..arm.iy... =an& with licensed canuanon to
comtroct Ne project (Sec. 70x4, Businest sod Professions; Code:) The Conuaewri U.
cave law docs not apply to an owner of property -who Wilds or improves thereon, and
who contracts for such projects with a comanctorM licensed pursuant to Ute Contractors
Liceve Low,
01 am exempt under Seo. , B k P C far this re.ue
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury am of the following declarations:
rs and will maintain a Ccnlftvu ofConwm toself-insure fM Workers Campen'
IDau
u provided far by Sacdan 3700 of the Labe Code. far Ne infom.nee of the
or which this permit is issued.
ave and will maintain Workers Compensation Insurance, u ox,mmd by Section
f the labor Cade, for the performance of the work for which this permit is Issued.
rkers Cnm m8 lnsu.ntt esnicnnup olicy n tram:
r. ryes, ✓LLA f -c Poliry Na.:
CERTIFICATE OF EXEMPI70N FROM W RKERS'
COMPENSATION INSURANCE
Clbts auction reed not W compkied dIW Permit is for arse hundred dollars ($100)
or less.)
1 eardfy that In the performance of the work for which this Permit is tamed, I Nall not
employ any person in my mannerw. An become.bjaet to the Workers' Compensation
Laws of California Dam
Applicant
NOTICE TO APPLICANT: If. After making this Certificate or Exemption. you abould
become subject in the Worker's Compensation provisions of the Labor Code. you mus
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forthwith comply with such paneiUons in this permit Nall be deemed rooked.
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CONSTRUCTION LENDING AGENCY
I heresy atom Nthem h • construction lending agency for Ju Performance of
the wand for which Nle pee(See.rmit is issued (Sec. 7097. Civ. CJ
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Lender's Name,
Lcnderi Addross
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I certify that I have read this application AM smut Net the eWve information Is
Hcorrect,
I agree to co ply wit all city and county ordinances and state laws relating to
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buildingcomtructio and hereby authodw representatives of this city to enter upon the
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above-memioncdp ray forivpccti rposea.
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(We) agree .ver. indemai and cap harmmss the City of Cupenmo against
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Imbilides,judg ,emuandex rases ich may in any way anew against said City
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mannxqucnce e.ndneo his pc il.
APPLICANT STAN AND ILL C PLY WITH ALL NON -POINT
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Issued by: Date ` 4
SOURCERE
Re -roofs
Signcam/Con r Due
Type Roof
HAZARDOU ATERIALS DISCLOSURE
of
Will Ute applicant or future Wilting oce.p.t gore or haMk IuvuJov semens]
defined Jg Cupertino Municipal Cade. Chapter 9.12, 0.M the Health and Safety
A, Sectiobyn 25532(x)7All
roofs shall be inspected prior to any roofing material being installed.
CYes u
If a roof is installed without first obtaining an inspection, I agree to remove
Will tW applicant of future building =upon, use equipment or devices which
mit havardous Aircantaminenu u de cd by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑Yes
I have ehu mnusmauriam quimmentsunder, Chapur6.95orlhe Ctlifor.
dalluldl Iks" Secuons23 33.J25534.IundcromndthglrNc Wilding
Jos not curm h atenant, this yrespomibilitymnoal'y wcupan rNe
wquiwmcnu ich pilar Am Certificate cupancy
Signature Applicant Date
of
All roof coverings to be Class "B" or better C
own r w xJ.gent Fewb