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CITY OF CUPERTINO"
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BUILDING DIVISION PERMIT
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BUIL DING ADDRESS:
PI BROTHERS CONSTRUCTIO
gRMITNo05080177
20128 STEVENS CRK 109
-R'S NAME:
PERMIT ISSUE DATE
PINN BROTHERS
1475 SARATOGA AVE
01/20/2006
NE:
SANITARY N0. CONTROL N0.
(408)252-9131
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDGO PLO MECH
O O
LICENSED CONTRACTOR'S DECLARATION
lb Description
o
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
wiln Section 7") ofDi,i,i..3 of the Business and professor. Code, and my he.. is
in full force and effect) 1 Q t'2—NEW
CONDO -9191
License CltL g
Dam .� � COSlamor w
ARCHITECTS DECLAR TION
1 unders and my plans shall M used sspublic cmda
Licensed Pmfcssi... I
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
following mason. (Section 7031.5. Business and Professions Code: Any city or county
$197006
em
which .,.I. • permit m construct. alto. Improve, demolish, or rtput, any atmrt
prior m its in ame, Wo mquimA thC applicant fofsuch permit m rile a signed sutement
Ft. Floor Area
Valuation
Nat he is licensed pursunna do, provisions of the Contractors Ldmnse law(Chapter 9
Sq.
(commeneing with Section 7") of Division 3 of the Business and Profcsions Code) or
that he u exempt them(rom and the basis for the alleged exemption. My violation of
13kFN Milriber
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of
not tome than five hundred dolim (SSW).
❑ 1, as owner afdne property amymoployces with wageaea theirmleeompenudon,
Required Inspections
win do the work. and thesuumarefs Out intended aroReredforsala(Sm.7oaa.Box.
e: The Conor's Licwe law dans hat apply m in Owner of
and Profusions Cadaan
q
property who builds or improves, therden, and who dues such work himmlf ser through hurt
own employees, provided that such improvements are not intended unaltered for agile. IL
however. the building or impmwment is told within am ytu of mmpledon, Ne owner -
wilder wiB have the burden of proving that rte did not Wild or improve far purpose of
sskJ.
Q 1, u owner of tiro property. am uclusivcly contracting with licensed contractor, to
construct the project (Sec. 7044. Business and Professions Cade:) The Contrmmfs Li.
cense law does not apply to an awns of property who builds or improves dmmen. and.
who contracts for such projects with a<ontraanrtq licensed pursuant to Ik Contractor,
License Law.
meaemplunderSec .BkPCfmthtsreason
DamWORKERS
COMPENSATION DECLARATION
I hereby affirm under pe ashyof perjury arcof the fallowing declarations:
ave and will mainuin.Cenifrcem ofC.nunt u self insure forWodmt'aCompen-
I
, as provided for by Section 3700 of the labor Code. for the performance of Ne
for which this Permit is issued.
ave and will maiwin Wmkels Compwtin Insurance. u required by Section
of Ne labor Code, for the performance of de, won for which this Permit is issued.
ovets compensation Insurance camim and Policy n bencyt'e t
Carver. :A+d-s'th! �"t Poliry No.: `
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
This section med not Wcamplemd ifde, permit is fororm hundred dollar ($I001
or lest)
I certify the,1r, the perfmmanee of the work far which dais permit is issued. I shall am
employ any pmmn in any manner an as m become subject in IK Workers' Compenulion
Loos of caflmais- TWO
Applicant
NOTICE TO APPLICANT. If, after making this CeniRcate of Exemption, you should
become subject to the Waver's Compensation provisions of the Labor Code, you must
foMwide comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
'
I hereby affirm that Vert m a construction lending agency for the Performance of
the work for which this permit Is issued (Sm. 3097. Civ. CJ
Lender's Name
Landers Address
I ecnify that I have read this application and Sum that the above inform W un i,
Comm I agree at comply with ail city and County ordinances and slam lam misting to
on and hereby auhmim MIXONO tiM of this City to enter upon the
buildin8 cons 'on;
alwve-mentian proper,yforinspecdonpurpows.
fy and keep hmmltss NC Cily of Capertino againri
(WDAND
IIab11NGdex n,G which may I. any way.. against Hid City
in consegthe of is permit.
APPLICD AND W L COMPLY WITH ALL NON -POINT
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Issued by: Date Tic A
Re-roofs
Type of Roof
—5Z07
Signa liean 1 Data H R $MATERIALS DISCLOSURE
ill this applicant or Futuro building atone or handle material
e, Chapter Health a
a"Jefined by the Cupertino Municipal Cade, Chapter 9.13. tori the Health and Safety
Section 35533(.)7 /
All roofs shall be inspected prior to any roofing material being installed.
❑ Yu @AO
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future bujiding Occupant use equipment or devices which
It husamous air cmmmimo!! a flrcd by the Bay Arca Air Quality Management
all new materials for inspection.
District ✓
❑Ycs ONO
I he. the hvardr star lsmquiremcnuunderChopmr6.95oftWCalifon'
niaaulth& clyCadc, Sc x-25 5.25533ndMS34.1undammdthalifthctmilding
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does not cu 11 am a ant the t is my sponsibilk, w ramify the mcupam of the
roquirtme me,nasi anceofmcenlncamafOccupency. 6
20 -
Signature of Applicant Date
All roof coverings to be Class "B" or better Q -
o th rimJe n