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CONTRACTA
BUILDING DIVISION PERMIT
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BUIL DING ADDRESS:
PINN BROTHERS CONSTRUCTIO
9""TNO05080173
012
R'S NAME:
FERMITL4UEDATE
PINN BROTHERS 105
1475 SARATOG
06
NE:
SANITARY NO. CONTROL N0.
(408)252-9131
ARCHITEC IENQINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hereby affirm that 1 am licensed under provisions of Chapter 9 (cmmmencine
-
with Sudan 7000)of Division 3 of NC Businumand PronfessionsCo4p.endryy liecomu
in fun force and effect.
NEW CONDO -610'
License Clue Lic. a
X1.5
Dem Canlncmr
— RCHITECINDECLA:A ION
1 undertund my puns shall be tired u public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am uempt from the Comascmr's License Law for the
following mason. (Section 703 1.5. Business and Professions Code: Any city or county
which requires a permit to construct, alter, Improve, demolish, or repair any structure
$130765
prior of its issuance. aim sequins Iho applicant for such permit to file a signed sutemem
Conuecmr's Licenm Law 9
Sq. Ft. Floor Area
Valuation
that W is licensed Natural to the provitimes of the (Chapter
(commencing with Section 7") of Division 3 of Oc Business and Professions Cade) at
that he is eumpl therefrom and the Wise for the alleged emmption. Any violation of
3TRpfVggRW,77uOccupancy
Type
Section 7031.5 by any applicant far a permit subjects the applicant to a civil penalty Of
.at more than five hundred dollars ($500).
0 1, We owner of the property, m my employees with wages as their sale compenudon,
Required Inspections
will do the work. and the suuetum is not intended or offered fonale(S.C. 7014, Business
and Pmrossians Codi: The Commences URnY law dta abut apply m an owner of
9 P
property who Wildsorimpomms thereon. and who doessuch.,k himselfar through his
own employees, provided that such Improvements the not intended.raRaed rorsak. If.
however, the building or improvement is mid within ane year of completion, me ow ver.
builder wits boom Ne Women of proving ren he did not build or Women far purpose of
oke.).
0 L as comer of the progeny. am =elusively convening with licensed connection to
Construct fie project (Sec. 7014, Business and Professions Code:) The Coommcmr's Li-
cenm law it...,apply in an owns of property who Wilds or improves thereon. and
who can== far such projects with a cman ati licensed p namem an IW Carmichael
Lice. law.
0 I am =empl under Sec. . B k P C for Nu reason
Dam
WORKER'S COMPENSATION DECLARATION
I hereby alarm under penalty of perjury one of the following deachimli mi,
I hove end will immmin • CenkOcate of Cement m self-insuro far Warkeel Compem-
udon, m provided for by Section 3700 of the labor Code. for thm performance of Iht
v Ok for which this permlt is issued.
❑ 1 have and will maintain Workab Compende loss Insurance, as recruited by Section
3700 of the Labor Code, for the performance of can work for which Nis permit is issued.
My Warktea Co permIm" Ins... Cartier and Policy nu ram:T �VI /
Carver: -A MCe,Polity No.: V
FlCATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
rrhu section reed not W completed if the permit is reform hundreddoRas(e10))
Car lass.)
1 certify the, in the performance of me work far which Nis permit is issued. I shall at
employ any person in any former an as in bemme subject to the W.rktaa' Compensation
Laws of California. Dem
Applicant
NOTICE TO APPLICANT: If, atter making m . Cemftram of Emmption, you should
'
become subJecl in the Worier's compensation provisions of the labor Code. you am
forthwith Comply with such pawidov of this Nermkl shall W deemed mated.
CONSTRUCTION LENDING AGENCY
I hereby affirm that then is r cansuuclinn landing a0ency (a, the performance of
the work for which this permit is issued (Sce. 3097, Civ. C.)
1 mal Namc
Unfree, Address
1 certify Nat I ham read this application and sum that the shove information is
Correct. I agree ro comply with all city and county ordinances and sum laws muting to
building convection, and hereby mNorim mprcmmnims of Nis city to cola upon the
shove -mentioned property for inspecdon purposes.
(hoc) a 1. cave, indemnify and keep hsrmma, the City or Capetian aim
j liabilidu,J., enu.emts =perms which may in my way acme gains) aid City
in con" of the tine rthis
permit.
APPLIC NO STA S AN WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOUR ONS
-
,:O
Re -roofs
Type of Roof
Sig ppl for Date
AZ OUS MATERIALS DISCLOSURE
Will the applicmt or future building occupant lom or handle hmardoes material
lined by the Cupertino Municipal Cade, Chapter 9.13, and me Health and Safety
Section V55324)?All
Dales
roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without firs[ obtaining an inspection, I agree to remove
Will the applicant or future building =open, use equip racm or devices which
It haaardous air conamioanu as dcnned by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑Yes u
I ti the huaNmsyyynnnme.asmqunements under Charter 6.95 of dm Calirm.
e30
"5.U533md255N.ImMcmandmaiftW
nis Hu mlc, ggp>q Wilding
docs not c t y ham mm� et h u my maponsihility m notify tic aceuNant of Ne
mymro n I W m prior 1 issuancc.f a Ccnifcate of Occupanry.
- igC �
Signature of Applicant Date
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All roof coverings to be Class "B" or better G
o ,mh.dm em Dam