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CITY OF CUPERTINO
TORANFORMA' ION »
BUILDING DIVISION PERMIT
,C,0NTR�I.C,
BUIL DING ADDRESS:
PINN BROTHERS CONSTRUCTIO
gRM1TNO. 05080174
20128 STEVENS
R'S NAME:
PERMIT ISSUE DATE
PINN BROTHERS
1475 SARATOGA AVE
01/20/2006
NE:
SANITARY NO. CONTROL NO.
(408)252-9131
ARCHITECOENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 humor affirm Net 1 am licensed under previsions of Chapter 9 (mmmcucing
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with Section 70(10) ofDivilion 3 of the Business and Professions Code, and my license is
infullfolceandeffecL -2
I
NEW CONDO -9221
LlcenseClau t ' Lic.g y
Dow - o -•n G. C'numewr LI ppaj,
ARCHITECrSDECLAR TION
I understand my plans shall he used as Foote mcords
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Communes License Law for the
fallowing reason. lSaction 7031.5. Business and Prolesdons code: Any city or county
which acquires a permit M conswe, aIle, improve, demolish, or repair any slmaum
$197649
prim to its issuance. also acquire the applicant for such pumit to rile a signed statement
Sq. Ft. Floor Area
Valuation
that he is licensed pursuant o the provisions of the Camber's License Law( Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Prore sinna Cade) or
than he b esempt thualmm and the bub far the alleged exemption. Any violation of
5XW RMWer U
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a Nvll penally or
not mom Nan fin hundred dollars (SSW).
❑ I, as owner of tW property, or my employes with wages as their ole compensation.
Required Inspections
will du the work. and themuctam is not intended or artemd tun We (Sm. IDN, Busies..
and protamines code: a Commum's License Law does an, appy to a owner of
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property who Wild.. Improver therann. and who doessuchwmk himself indhomgh his
own eunployus, provided our such Improvements seenmimsended.offered for W. IL
however, the building or improvement Is old within am year of completion. the owner-
bullder will hew Oso burden of proving that he did not Wild or improve far purpose of
.1. f
❑ I, as owner of the properly, am exclusively contacting with licensed contractors to
construct the project (Sec. 7044. Business and Professions Code:) The Convenor's U.
came Law does not apply to an ownu of property who Wilds or improves thereon, and
who contracts fm such pmjecu with acontractor(s) licensed pursuant to the Convector's
License Law.
❑ 1 am exempt under See. . B At P C for this mason
r Data
WORKER'S COMPENSATION DECLARATION
1 hemby a1Nm under penally of perjury aro of the following dulanllons:
I haw and will maintain aCendleslo of Consem to self -insure for Womar's Cumpen-
utlon, u provided for by Section 3700 of the labor Cade, for the perfenamon of the
work far which this permit is ia.d.
❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section
3700 of die Labor Code, for the "fumanm ordre wart fer which this permit is issued,
My Workse-Yyr-�•ampensa0on Immounm canner std Paliry nu Wr em:
�Ut
Cartier. Ilk 14+ _ G Polity No.:
CERTIFlCATE OF EXEMPr10N FROMW RKERS
COMPENSATION INSURANCE
(TITh suction need not W completed lithe pmmil is layout, hundred dollen ($100)
or lura
1 certify that In the performance of the work for which this permit is issued. I shall not
employ any person in sty mannerm u to become subject to the Workeri Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If. ,flu making this Curren, or Exemption. you should
become object to the Worker's Compensalion provisions of the Labor Cade, you mess
forthwith comply with such provision or this permit shall W dumed mated.
CONSTRUCTION LENDING AGENCY
I hereby affirm dw them les consvuctinn lending agency for the performance of
the work for which this permit Is laved (Sat:, 3097, Civ. C.)
'
Lender's Nemc
Lender's Address
1 Modify that 1 haw read this application and sum that the move information is
conal. I agree to comply with all city and county ordinances and sou laws relating to
-
building constmaion, and hereby authorize reprounutives of this city to enter upon do
cove-memioned property for inspection p rposes.
( Wel seg I sew, indemnify and keep harmless the City of Cupertino against
Imbilitmajudg ts, emu anile which may in any way.c. against old City
I'd rlrnll.
APPLICANTSA WILL COMPLY WITH ALL NON -POINT
APP
Issued by: Date Z.J ^ rJ
U=STm
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Re-roofs
Type of Roof
Signuure u ser Data
NAZA ATERIAIS DISCLOSURE
I the applicantser fudre Ilding=open[ rare or handle hmarduu mamrim
dented by the Cupertino Municipal Cade. Charm, 9.13, and the Health and Safely
Section 35533(.)7
All roofs shall be inspected prior to any roofing material being installed.
(Dws o+(
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant of future Wilding ouupanl use equipment or devices which
unit hersrdous air conouninants as dcrined by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑Yes u
I hawse haaamous m abmquimments under Cheptor G95 of the Califnm
nix Hcalih&Set Codc,Scc' s35 5,35533and8534.1undcnunduallfthe Wilding
does awl cunt h a m mL the 1 b my msponsihility to badly the unqual of the
mquimmcnts met arm a ancoof.ct,dilmmaoroccupancy.
Signature of Applicant Date
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All roof coverings to be Class "B" or better C�
Own omsda Da¢