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CITY OF CUPERTINO
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CONTRACTOR INFyORMATION
BUILDING DIVISION PERMIT
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BUILDING ADDRESS:
PI ROTHERS CONSTRUCTIO
.9RMITNG.05080175
20128 STEVENS CRK 107
Its NAME:
PERMIT LSSUBDATE
PINN BROTHERS
1475 SARATOGA AVE
01/20/2006
NE:
SANITARY NO. CONTROL NO.
(408)252-9131
ARCHITECTIENGINEER:
BUILDING PERMIT INFO
BO ELECT PLUMB WECH
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ON
LICENSEDCONTRACIOrpmD
Job Description
of Chaper 9 (commencing
1 hereby d0nn thm 1 am If under omor
.
Division 3 ofmc Businwand Profcssiona Cod.end mylicense b
offs,Bu nd Prol s
with gallonAnd?=)ofeffect.
in full force and effect. - z 2
NEW CONDO -610'
Licence CIA Lin. X
Dam ContractorDEC
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LLA TION
illheARCHITECTS As
i undnund my plans spoil he used u public recnrN
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirms that I am .."i from the Conuactors License Lew for to
following reason. (Section 703 1.5, Business and Profession Cade: My city or county
$130765
which requires a permit to conduct, alter. improve, demolish, or repair any structure
prior m its issuance, also requires the applicant forsueh permit in file a signed,utemcm
Sq. Ft. Floor Area
Valuation
that he is licensed pumtent to the provision of the Connectah License Law (Charter 9
(commencing with Section 7MAH of Division 3 of the Business and Profession Cale) or
tut be u esempt therefrom and the basis for the alleged exemption. Any violation of
r
Occupancy Type
Section 7031.3 by any applicant far. a permit subjects the applicant to A civil Penalty of
net man man five hundred dollars (5300).
O I, a owner of the property, a my employees with wager an their sale compenuton,
Required Ins ections
will do the work. and the structure B not intended at offered for ask(Sec. 7044, Bminess
and P.Imni s Cade: The Conuacmes License Law Coca Int apply u An awmr of
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propmy vh0 bui ld, or improves menus, and who doer,och wast himself or trough his
ownemploycea, provided that such impnvemenu are Int InteMed Confront for male. If.
however. me building or improvement is sold within one year of completion, the owner.
builder will have the burden or proving that he did not Wild or improve for purpose of
sale.).
O 1. As reamer of me propeny,.m exclusively convening to licensed eonueema to
contract me project (Sec. 7014, Bninw end Products. Code:) The Co desseme. U.
cense law does net apply to an owner of property who Wilds or improves thereon, and.
who commcu for such projects with a conleAcier(U licensed Forward to the Conuacme.
License Law.
O 1 am exempt under Sec. . B k P C for this reason
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following decimations:
an and will maintaina Certificate of Consent to self -inure for Worker, Compete.
ItData
As provided for by SeNon 3700 of pis labor Code, for me performance of the
farwhichthispermitisissued.
ban And will maintain Worker's Compensation Insurance, As required by Section
of the Mbar Code, for the performance of to work for which this permit la Issued.
orker, Csaampurm on lnunnce carrier and Polity num ran:
er. ` m D ra'M dL Policy No.: 1
'
CERTIFICATE OF E%EMPTION FROM WORKERS
COMPENSATION INSURANCE
(This section head net uncompleted If the permit Is for one hundred dolim (SIM)
or Ices.)
1 certify that In the performance of the work for which this permit is issued, l shill net
employ any person in any mwmrm an At hecome subject to the Warkers Compenstion
Law, of California. Data
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you Mould
become subject m the Worker's Compcwton provision of the Ieha Code, you mind
forthwith Comply with such Provision or this permit shill W demand revoked.
-
CONSTRUCTION LENDING AGENCY
1 hereby affirm that thea B • contcalm. lending Agency for the Performance of
the work for which this Permit Is Issued (Sec. 3097, Civ. C.)
lender's Name
lender, Address
I modify that 1 have read this application and sum that de above information is
correct. ) agree to comply with all city and county ordinances and suss law, alating to
prnutins of this city to enter upon the
building construction. and hereby authorin rew
above-mentioned property for inspection purpose,.
(We) eg. in rove, indemnify and keep harmlw the City of Cupertino Against
IiaNlitca.Jud,ni costs apensee which may in any way amus against said City
in eonxgane of they nga Nis permit.
APPLICA NDER AND AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
soURCER 445.
Re -roofs � J
Type of Roof
- 'O
Sigw iHor Dau
=&R OUSMATERIAISDISCLOSURE
Will the applicant or futum building occupant store or handle Womlour material
fined by the Copan]" Municipal Code, Chapter 9.12. and the Health and Safety
Section 33532(.)7
All roofs shall be inspected
to an roofing material beim installed.OYe,
ON.
prior
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future Wilding occupant use equipment or devices which
MIL havurdom air ruminants as 'defined by to cry Area Air Quality Management
all new materials for inspection.
DiAuic17
Oyes ❑No
I have hva s data mquitcmcros under Chapter 6.95 of the Califor,
nim Hca d Cad tau 505,25533 and 3533/, l understand tm ifte Wilding
don net cu A marl. at h u my nsponihiliry m notify me acupant of the
mquinmc sibem P rmismanecoraccruncatearoccupency.
Signature of Applicant Date
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All roof coverings to be Class "B" or better
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