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CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
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�CONTRACTORANFORMATION ;
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BUILDING ADDRESS:
PINN BROTHERS CONSTRUCTIO
_IRMITNO.05080181
20128 STEVENS CRK # 20
ER'S NAME:
PERNMISSUEDA7E
PINN BROTHERS
1475 SARATOGA AVE
01/20/2006
ONE:
SANITARY NO. CONTROL NO.
(408)252-9131
ARCHI EC IENGiNEER:
BUILDING PERMIT INFO
BLDGO PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
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Job Description
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1 am licensed miter provmns of Chapter 9 (cnmrametsg
1 hereby afnrm thatW
whh Sccdon 70q)) of Division 3 night, Busixss a d fassiva Cotic'mil my It.. is
in fullfmrce and c9eaC e 1 Z
NEW CONDO -9221
License Clue Lia, I
Dau - Cmmat
ARC SDECLARA 10
I undersand my plana shall he used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby aQirm that 1 am exempt from the Contractors License Law for the
following moon. (section 703 1.5, Business and Prufessiva Code: Any city or county
which requires a permit to construct, alar, improve. demolish, or mpalr any structure
$197649
prior a its issuance.also requires the applicant for well permit to file a signed moment
dot W is licensed purwanno the pmvisioa of the Commutes License La. (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 7000) of Divistan 3 of the Business and Professions Code) or
that he Is eurnpl therefrom and the basis for the alleged ass mpdoo. My violman of
3 RWrWb1er_'7aOccupancy
Type
Section 70313 by any applicant for a permit wbjeeu the applicanuo a civil penally of
.at mac Ill. firs hundred dollars ($500).
D I, as owner cribs property, or my employeu with wages as gab sole compensation,
Required Inspections
will do the walk and damucture is nt intendednrnffered panic(Sec. 70". Business
and Prefesdman Code: The Cmntr s Li mene Law doze ore apply a an owncr of
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property who Wilds orimpram Neeson,and whodoessuch work himulfor duough his
own employees, provided that such improvements an, not Intended oroBered for sale. If.
however, the building or improvement is sold within one year of completion, the owner,
builder will bare the burden of proving Nat he did not Wild or improve for purpose of
sale.).
(3 1. as owner of the property, am exclusively contracting with licensed convenors to
coustwct the project (Sec. 7044. Business and Ivofasions Code:) The Comnsucrs U.
anus taw dao not apply a an owner of property who Wilds or improm thereon. and
who comacufor such peasant with a eonuaaors) licensed pursuant a the Carmine$
License Law.
D 1 am exempt under Sec , B & P C for this reason
Data
WORKER'S COMPENSATION DECLARATION
I hereby alarm under penally of perjury ane of the fallowing doclumons:
1 ham and will maintain aCenifcate of Consent a self -insure fa Wallace. Compen-
aatron. u provided for by Section 3700 of the labor Code. for dte performance of Out
work far which this permit is issued
❑ 1 ban and will maintain Wakars Compensation bsmrrantt. as required by Section
3700 of the Labor Code, for the perib masa often work forwhich Nis permit is issued.
My Worker. Compensation Iranian= eaniennd Policyn Wr aa:
Carver. �d Qy1rt,R 2„� Policy No.: 6— s
CERTIFICATE OF EXEMPTION FROM WO KERS'
COMPENSATION INSURANCE
(Tbb section need not becompleted if de reach is tams, hundred dollus (SIM)
or leu)
1 certify that In the Performance of Ne work for which this permit is Issued. l shall not
employ any person in any manneru as to become subject a the Workers Compeamion
taws of California. Data
Applicant
NOTICE TO APPLICANT: If. after making this CeniO,av of Exemption, you should
become Subject to the Worker's Compensation provisions of the Labor Com. you most
follwilb comply with such pinvisians or this pencil hall W deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there Is • coatwodnn lending agency far Ne perfurn enceof
the work for which this permit is aimed (Sze. 3M. Civ. C.)
Lenders Nam,
Lenders Address
1 minify that I have mad this applicadon and sae that Ne above lnfomution is
conn. I gree to comply with all city and county ordinances and since laws minting in
building construction, and hereby mthodne repreunutim of this city in enter upon the
man -mentions property for impeclion purposes.
(We) a to sat,' y and tete, harmless the City of Cupertino gainat
liabiligesjud enu.ea meas us which may In any way acme againat said City
in APPLICce of the TANDf ANO W LL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE 0 S.
1 �-0 _U
Re -roofs
sign pp It Date
HAZARDO S MATERIALS DISCLOSURE
Type of Roof
WIII the a forum building store or handy hanrduamaterial
Cooccupant
defined by the Cupertino Munl I Code. Chapter 9.12. and the Health and safety
C. Mil
de. Beeler 25532(ay?
All roofs shall be inspected prior to an roofing material being installed.
No
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant ar fume siding oceuic m use equipment a devices which
emit hazardous all conaminanu 0ncd by the Bay Area Air Quality Management
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all new materials for inspection.
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dna tree a n0y ho a ¢tan sat it u my responsibility m nogly the aceupant of Ne
myuirem uuW IpriorwissumttofaCcnificeaoL970y.,04
Signature of Applicant Date
All roof coverings to be Class "B" or better G
o r nriees Dae