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05080166z Z� fIj W Q oz UO U. OU U CITY OF CUPERTINO .,� BUILDING DIVISION PERMIT ♦ �a��-7%"'"`">P.: Tl�ti fI11 O MATI©N ��; BUILDING ADDRESS: PINN BROTHERS CONSTRUCTIO CFR UTND'05080166 128 STEVENS CRK if 101 R'S NAME: MIT PERISSUE DATE PINN BROTHERS 1475 SARATOGA AVE 01/20/2006 NE: SANITARY NO. CONTROL NO. (408)252-9131 ARCHITEC (ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION lob Description 1 Money affirm that 1 am licensed under provisions of Chapter 9 (commencing p with Section 7000) of Dbelsion 3 of tho Beat.., and Profussiona Code, and my license is in full force and effcu.' CONDO -922' License Cllus 7 Lk.0 �EW _ Dau _ Contrannr ARCHn=S DECLARATION I undcrsund my plans sMll he and an public wards Licensed Predominant OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Convector's License Law for the following Masan. (Section 7031.5. Business and Professions Can: Any city or county which mquima a permit m matsweL stmt improve, demolish, or ¢pair any ,wnum $197649 prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant in the provisions of l' Contractor's License Law (Charter 9 Sq. Ft. Floor Area Valuation (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he Is exempt themfran and the huis for the Alleged exemption. Any violation of XPRr00 Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not mom Nan five hundred dollen (5500). ❑ 1, as owner of Use preputy, a my employees wide wage, in IMG Win compenndon. Required Inspections will Ute work are IM structure is not intended aoffered for ask (gee. 701,4, Business and Paokasions Code: The Cwusec or's Liam Law dsrs Oat apply u an comer or property who builds Or i mpravea t eemon, and w M dOcs such work himself or through his own employees, provided thatsueh Improvements Am not intended aoffend for sale. If, however, the building or improvement is sold within one year of completion. Ne owner. builder will have the burden of proving that M did sea Wild or Improve fa purpose of ale.). ❑ 1, As owner of the property. am exclusively contracting with licensed convenors or construct the pmjca (Sec. 70x4. Business and Professions Code:) The Convaaor'a U. case law dnes out apply an an owner of propeny.whe Niles a Improves thercon, and, who contracts for such pmjem with acontracmr(s) licensed pursuant to the Conuactoh License law. ❑ 14M exempt under Sec. . B A P C for Nls mann r Date WORKER'S COMPENSATION DECLARATION I'leby affirm under penalty of perjury one of the following declarations: 1 here and will maintain a CeNncak of Consent to self -insure for Workefs Compen- utlon, As provided for by Section 37M of dee labor Code. for the performance of Ne ' work for which this permit is issued. ❑ 1 have and will maintain Worker's Compensation Insurance. n required by Sation 7]00 of the labor Cade, fm the Performance of the work fa which this permit is Lssned. My Worker's ComPenatian Insenna <artiu and Polity n m'r eta: Cartier: r'Q. M_Bd'-S policy No.: CERTIFICATE OF FIX pro,FROM WO KERS' COMPENSATION INSURANCE (Thu section need not M completed if fie Permit is feronc hundred dollars (5100) or lcm) 1 «nify Net in the performance of the work for which Nis Permit is issued, I NAlI not employ any person in any manner an As to become mbjecl to Ne Workers' Compensation Lew, of California. Dau Applicant NOTICE TO APPLICANT. If, afar making oil. Ceninnu or Exemption, you Arnold become subject to the Worker's Compensation provisions of the Labor Code, you most forthwith comply with such provisions at this pewit shall be darned m"Yed. CONYMUCTION LENDING AGENCY 1 hereby affirm Nat them is a construction lending agency for the Performance or the work for which this permit Is issued (Sec. 3097, Civ. C.) ' Lender's Name , Lender's Addmn 1 certify that I haw read this application and sum that the above information Is camel. I gree to comply wide all city and county ordinances and soon laws misting to building construction. and hereby Authorize representatives of Nis city to enter upon the a1mve-mentioned property for Inspection purposes. (Wc)ag to nrc, rode and keep harmless dee City or Cupertino against liabilities,Judg nu, caste and pe whkhm yin any way accrue against avid Clly in eonseganc f e grantin of thi permiti APPLICANT RST DS DWI COMPLY WITH ALL NON -POINT Issued by: Date O -Q C SOURCER Re -roofs Type of Roof ' D ' Signet plkarac De HAZADateA7T3RIALSOISCLOSURE HAZARDO M Will the applicant or future building occupanestore or handle henAous material defined by the Cupertino Municipal Code. Chapter 9.12. aced Ne Health and Saray . Section zss3z(.)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yon u If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building Occupant use equipment or devices which II harardous air contaminants u defined by the Bay AMA Air Quality Management all new materials for inspection. Disvict7 ^L11a✓�V ❑Yes / lb. ehnan' Mquimments underC'pmr6.97"fthe C"ir." ria Healthh5 coda, ssw 27377 and 25334.IundcrstaM thuif"M building does not e rc a ", dot I in mapomibilily to Amity the aceupnt or the mgtione. ton pri iaruawcar A certinnm or occupancy. Signature of Applicant Date ° All roof coverings to be Class "B" or better � Ow r deonacda Dam