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CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
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BUILDING ADDRESS:
PINN BROTHERS CONSTRUCTIO
XR
JRMITNO. 05080172
20128 STEVENS CRK 104
R'S NAME:
PERMIT ISSUE DATE
PINN BROTHERS
1475 SARATOGA AVE
01/20/2006
NE:
SANITARY NO. CONTROL NO.
(408)252-9131
ARCHDEC (ENGINEER:
BUILDING PERMIT INFO
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LICENSED CONTRACTOR'S DECLARATION
Job Description
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I thereby affirm Nat 1 are licensed under provisions of Chapter 9 (commencing
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with Section 701111) of Dig' Sof d¢Bearrx�and Professions Coda. and my l' cense is
tot 017.7 ad affect. - -2 s (�
NEW CONDO -922'
License Clue Lic. X
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ljrrk�S
Da¢ Contractor
ARCHITECTS DEC' A77ON
1 understand my plans shall be used as public reemds
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Licensed Pnffiasianal
OWNER-BUH.DER DECLARATION
I hereby affirm that 1 em exempt from the Contractor's License Law for the
following reason. (Section 7031.5. Business and promotion, Code: Any city or county
which requires a permit to conuruc, alter, improve, demolish. or repair any structure
$197649
prior ser its issuance. slam requires the applicant for such permit to file a signed satemenl
that he is licensed Vermont to dm provlalons of me Contractor's License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 70)0) of Division 3 of the Business and Professions Code) or
Nu M Is exampt therefrom and the basis for the alleged exemption. Any violation of
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Occupancy '�YPe
Section 7031.5 by any applicants for a permit subjects the applicant to a civil penalty of
nm mom than five hundred dollars (5500).
Q I, u owner of the property, or my employco with wages as their sole compensation,
Required Inspections
will do the work, and the structure is not intended or offered for sale (Sao. 7044, Business
and Pro(evioro Cade: The Contractors License Law data net appy to me owner of
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property who builds or improvesdemon. and who dawauchwork htmselfor trough his
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own employees, provided mat such improve scr u an, natimmnded creamed for sale. IL
however, the building or improvement is sold within ane year of completion, the owner.
builder will have the burden of proving that he did not build or Improve for purpose of
ask I.
Q 1, as owner of me property. em exclusively contracting with licensed contractms to
coastroct the project (Sec. 7044, Business and Professions Coda:) The Contractor's U.
cove law done not apply to an owner of property who builds or Improves thereon and
who contracts for such pmku with a conuanor(s) licensed Pwawnl to the Contractors
License law.
Q 1 am exempt under Sec, . B & P C far this mason
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WORKERS COMPENSATION DECLARATION
I hereby alarm under penaty of perjury oro of the following deelasasions:
shave and will aCCni37M of fureforerformaCompere
provided far 3700 of the "outcome. for the performance of the
for by Ss he"otcome.
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work for which this permit is issued.
mi Issued.
Q 1 have and will maintain Workers Compensation Insurance. as required by Section
3700 of me labor Cade, for the performance of the work for which this permit is issued.
My Workers{nation Insurance cam krand Polity number am:
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Cartier,T -V s ?— Policy No.: 1'
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
f@u section need not he completed If me permit Is for one hundred dollars(51(10)
or less.)
1 certify that In the performance of me work for which this permit is issued, I shall not
employ any person in any manner an w to become subject to the Worker'Compemation
Laws of California. Dam
Applicant
NOTICE TO APPLICANT: If. after making this Certificate of Exemption, you should
became Subject to the Workers Compcaseuan provisions of me labor Code, you mea
forthwith comply with such provisions or this permit Shall be demand revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that mem Is. construction lending agency for the fano maace of
the work ser which mice permit is sound (Sm. 3 . Civ. C.)
Lender's Name
lander', Address
I conify that I have mad this application and shim that the show infmmaion u
corns I a&= to comply with all city and county ammonium; and arm laws mining to
building construction, and hereby authorise representatives of this city to enter upon the
show -mentioned property for inspection purpose,
(We) agree to save, indemnify and keep harmless the City of Cupertino against
Iiebilitias,Judgmo u,cosu neer which may in any way accrue againstsaidCity
in wnvequeoce me g n& of is permit.
APPLICANT DER AND AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date D—s
SOURCER LAD _
0` iSL
Re -roofs
Type of Roof
Sigoau, Sao lar Data
HAZ OUSMATERIALStstowoSURE
II me applicant or (atom building occupanumm or handle haraNuas material
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defined by the Cupertino Mun .pal Code, Chaptor 9.11, and the Health and Safety
. Snctian 25632(.)7
All roofs shall be inspected prior to any roofing material being installed.
QYta No
If a roof is installed without first obtaining an inspection, I agree to remove
Wilt the applicant or future building occupant use equipment in devices which
It haranious air corms iNnts deeded by the Bay Area Air Quality Management
all new materials for inspection.
District?
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IAhay.Lhc�hazard smetode requiremcntaunderChep¢r5.95a(meCalifarniaHc4l,
'ons2550 25533mdM34. 1 undermndma if the buildingJars
nuta nano met is my pmuihility be notify the occupan. of me
requireb et 'retia ois CemOcamaf c�.pancy.
Signature of Applicant Date
Cl
All roof coverings to be Class "B" or better `�
0w Jag OI Data