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CONTRACTOR INFORMATION,.
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
PINN BROTHERS CONSTRUCTIO
SERMITNG.05080167
0 28
-R'S NAME:
PERMIT ISSUE DATE
PINN BROTHERS
1475 SARATOGA AVE
01/20/2006
ONE:
SANITARY NO, CONTROL NO.
(408)252-9131
ARCHPIECDENGINEER:
BUILDING PERMIT INFO
PLUMSMECH0
BIS
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LICENSED CONTRACTOR'S DECLARATION
lob Description
1 hereby %film that I am licensed under provisions of Chapter 9 (commencing
with Section 70W) of Division 3 of the Business and Professions Code, and my license is
In full force nasi effect -�� i
NEW CONDO -9221
License Class Us N
�(.
Dam Camrecmr (, LN.vI
J `
ARCHITECTS DECLARATION
I understand my plans shall be used an public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License law for the
following moron. (Section 703 1.5, Business and Professium Cade: Any city at county
palr any L
ennIIet, alcor, Improve, demolish, of R61NWm
which require, a Permit m N
$197649
prior to Its Issuance. also requires the applicant for such scr all to IIIc a signed statement
that W is licensed pursuant to the provision of dsc Contmctori License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 7000) of Division 3 of the Business and Pmfamom Code) or
that ha It exempt therefrom and An, basis for de alleged exemption. My violation or
r
Occupancy Type
Section 70313 by any applicants fm a permit subjects the Application o a civil penalty of
not mare than five hundred dollar, (S50o).
❑ I. as owner of de property, or my employes with wages As their sale compensation,
Required Inspections
will dm we*- And the awn.m is nos Intended a offered for sub, (Sm. 7(1 BusiM..
and Profession Code: The Convectors License LAW docs rpt apply man owner of
q P
property who Wilds orimprovss thereon. and whodoessuch work himselforthrough his
own employees, provided that such Improvements tie not intended or offered for sale. If.
however, the building or Improvement is veld within one year of completion, the owner.
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑ 1, an owner of the property, am exclusively contracting with ]!caused contractors m
construct the project (Sec. 7044, Business and Pmfeasian Cede:) The Committeemen U -
came, law deet not apply to an ow er of property who Wilds or Improv therean, and,
who contracts for such projects with a conuaner(s) licensed pursuant m the Contractors
License low.
❑ I am exempt under Ste ,B&PC for this recon
r Data
WORKERS COMPENSATION DECLARATION
1 hereby a firm under penalty of paQury one of the following declarsdons:
1 hsm Certificate end will maintain a Certale of Consem mself-insure fa WerkeraCompen-
"0nn, As provided fa by Section 37M of the Labor Code, for the performance of dm
wort for which this panni, is instead.
C3have and will maintain Workers Compensation Inmranm, u required by Sation
37110 of Ne Labor Code, for the pedormuxx of de wort ra which this permit is Issued.
My Workers Empeamatio. In... earnaand PolirynWrath :
*3 l
CartPolicy No.: 0
C7FNLUP ION PROM WORKERS'
COMPENSATION INSURANCE
(This anion recd sol W Pomplaed If de permit Is retain hundred dollam (SIM)
Ar lent.)
I certify that in the performance of dm work for which this Permit is Intend, 1 shall not
employ any person in any mannerso As be become subject to IM Workers Compemstion
Laws of California. Dam
Applicant
NOTICE TO APPLICANT: If. after making this Cenifiese of Exemption, you should
become sub)w m the Worker's Compensation provtsions of the Labor Code, you mum
forthwith comply vim such provisions or his permil shall W deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that them is construction lending agency for the performance of
the work for which this permit Is imucd (Sec. 3097, Civ. C.)
Lender's Name
,
Lenders Address
I certify that I have read this application and mate that the above information Is
correct. 1 Agree to comply with all city and county ordinances and some laws mining to
Wilding convection dhembysuthodm repreunmiv of Nis city to color upon dm
above-mendonedp rty for lmpcctio am
(We) ages save, indemnify d p harmless the City of Cupemina against
Iiabllitia,judgm ostsandex tan, hmayT anywayaccrueagainal'sid City
APPLICANT in O nIINDS ef I
ILL MPLY WITH ALL NON -POINT
Issued by: Date
SOURCER 445. r
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`
Re -roofs
Type of Roof
Signa 1ianUCenlncl Dam
HAZARDOUSMaERI ALsmmomOSURE
Will IW applicant or (alum Wilding aaupanl Nam or handle huudous material
OCOncdby de Cupertino Municipal COM. Chapter 9.12, and the Health and Safely
. settien zss3z(.>7 —`
All roofs shall be inspected prior to any roofing material being installed.
❑Yes U
.Iding
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future b occupant can equipment or devices which
It hamdous lois contamcfi
inants red by %t Bay Ann Air Quality Management
all new materials for inspection.
DiWiC,7
❑Yes ❑No
Ihawmadtheh mnusmaeri rcquimmenu under CMPmr 6.95 of to Cdife,
niaHoslth hSafctyC ,Savant 3. 333 mu12557a.lunMrstsM thulfthc Wilding
does not currently c • mom at II i my mspontibiliy m nodly dm omupm(of the
requirementswh' umbo ,Poor IntetronnCcrtim,eorOctapanry.
Signature of Applicant Date
All roof coverings to be Class "B" or better Q
owns rte sen Dam