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CITY OF CUPERTINO
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BUILDING DIVISION PERMIT�UI�"RRC
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BUB.DINOADDRFPss:
PINN BROTHERS CONSTRUCTIO
PNITN0.05080168
20128 STEVENS CRK 103
R'S NAME:
1
PERMIT ISSUE DATE
PINN BROTHERS
1475 SARATOGA AVE
01/20/2006
NE:
SANITARY NO. CONTROL NO.
(4 08) 252 - 913 1
ARCHITECTIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
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Job Description
1 hereby affirm that I am licensed under provisions of Chapter 9 (Commencing
with Section 7((10) of Division 3.f the Bush essand PrefcWssn. Code. and my licenseis
N mu more and eff h w vy
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NEW CONDO -922'
License Clea Lk. a } ` ` I I
-
Duke. �� Contractor i AN.l M
1
ARCHITECTS DECLARATION
I understand my plans shall M used a public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractors License Lew for IM
following reason. (Section 703 1.5, Business and Pretensions Code: Any city or county
which requires a permit to construct, eller. Improve, demolish, at repair any structure
$197G49
prior in its issuance, also requires the applicant for such permit to rile a signed alatemem
Ft. Floor Area
Valuation
that he is Beeneed prmant to the provisions of the Conuacton Uesesn Law (Chap Cr9
Sq.
(commencing with Section 7000) of Division 3 of the Business and Pulsations Code) or
Nat he is exempt therefrom and Ne buds for the alleged exemption. Any violation of
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Occupancy Type
Section 7031.5 by airy applicant for a permit subjects the applicant to a civil penalty of
not mart Nan fiw hundred doluta (5500).
❑ I. as owner of the property, m my employee with wages an their sole compensation,
Required Inspections
will do the wade and theatrun.s hoot intended or offered rental. (see 7014, Business
and Professions,Code: The Commences License Law data not apply a an owner of
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properly who builds or improve thereon, end who does su h work himself or through his
own employees, provided that such improvements tae notlnuMrA or offered! for We If.
howewe Ne building or improvement u sold within one year of completion. the owner.
Wilder will have the Wrden of proving that he did net Wild or Impmw, fur purpose of
.10 1.
❑ 1. as owner of the property, am eclwively contracting with licensed conuacwn m
Coanwct the pmjeu (Sec. 7004, Business and Pmfrations Code) The Connectors V-
ceue Law doe not apply m an owner of property who Wilda or impmws thetaon, and
who contracts for such projects with a conuactar(s) licensed pursuant to the Contractors
License Law.
❑ I am exempt under See. B k P C for this recon
Data
WORKER'S COMPENSATION DECLARATION
1 hereby aRnm under penalty of perjury one of the following declanliou:
1 have and will maintain a Certificate of Co..., mself-insure for Worker's Compen-
Come. as provided for by Section 3700 of the labor Code. for the performance of the
were for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance. an required by Section
3700 critic labor Cada, for the performance of the work for which this permR a issued.
olity miser art2:
My WorkeetLaoripmesaflon Insurance carrier and Poli'/
Carrier. ,� Policy No.: / 0 L
CE IFICATE OFE%EMPION FROM WORKERS'
COMPENSATION INSURANCE
(This sec0an need not becompleted time permit is formic hundred dollars ($100)
or len)
1 certify that In Ne performance of the work for which this permit is Issued, I shall not
employ any persen in any interior an u to become mbjeel to the Workers' Compensation
Laws of Cslifamia. Data
Applicant
NOTICE TO APPLICANT: IL after making this Certificate of Exemption. you should
become Subject to the Workeri Compensation proviaiom of the tabor Code, you most
forthwith comply with such provisions or this permit hall W deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby aRsm Nat them is a construction lending agency for the performance of
the work for which this permit is issued (Sec 3097, Civ. C.)
Lender's Name
Itnderi Address
1 certify that I have mad this application and sum the the above Information is
correct. l agree In comply with all city and county ordinances nd some laws reusing to
Wildingconswctio andhetaby nonunion repreunmiwsof Nu city uemeupon Nc
above-mentioned P rty for inspection purposes
42
(We) ago aaw, indent keep harmless the City of Cupertino against
liabilides.judgm ,Cosa and peue Mchm y In any way ... .,trustWd City
in
APPLICANTo a ST m DS ArN� WI COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCERE gab'
i
Re -roofs C7%►�—���
Type of Roof
Signuur A r VCo RID r Dau
HAZARDOUS MATERIALS DISCLOSURE
WII the or e and ety
Wilding arupaptnomorand
a Cuent
imforum
t Safety
defined by Ne Cupertino Muniei tl Code. Chapter 9.12, and tite HctlN and Safety
Health
Section 25533(.)7
All roofs shall be inspected prior to any roofing material being installed.
❑ Yes
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or forum W' ding acupaI sea equipment or devices which
I harardnus itu,imu ne'... u fined by Ne Bay Area Air Quality Management
all new materials for inspection.
'I it
0Ye No
Ihawm thehuenusm nialsmquimmc uunder ChapMY6.95of Lhe Califon
ria Hcalthiks yCode, etiats 703,25577 and 235th. l undersuM dw iftie Wilding
dors not cu lenanr, alis" myrapomihiliiywwdl'y Nceceupm,of Nc
requiremen hi on m pri Iivaaaneeencertinme.foccupan`p.
Signature of Applicant Date
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All roof coverings to be Class "B" or better c:__
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