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BUILDING DIVISION PER
' TIAGTOR�INFOZ'IA"CIC1N:-
Bua.DINGADDRESS:
PI BROTHERS CONSTRUCTIO
�RMUNo.05080182
20128 STEVENS CRK 203
R'S NAME:
PBRMrr ISSUE DATE
PINN BROTHERS
1475 SARATOGA AVE
01/20/2006
NE:
SANITARY NO. CONTROL NO.
(408)252-9131
ARCHI'fEC (ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hereby affirm tial 1 am licensed order provision of Chapter 9 (commencing
with Sceuon 7") of Division 3 of the Business mrd Profession Cord. and my license u
nmll(a.andenxet _
NEW CONDO -922'
LicenseClass Lk, g
Dam Contractor P"A VL
ARCHTIECTS DECLARATION
1 understand my plans shall W used u public records
Licensed Pnsfcssional
OWNER -BUILDER DECLARATION
I hereby, al loo; that 1 am exempt from the Contnaols License Law for the
fallowing recon. (section 7031.5. Business and Prelcmion Cure: Any city Or county
$197649
which requires a permit W construct. Alter, Improv. demnflah, m ropalr MY xtmcare
prior m its issuane. also requires the applicant for Such permit m file A signed stsmment
Sq. Ft. Floor Area
Valuation
that he b licensed pursuant W the provision of uW COALActorl License law(Chapter 9
(commencing with Section 7000) of Division 3 of the Business And Professions Code) or
that he is exempt therefrom and the bub for the alleged exemption. Any violation of
r
Occupancy Type
Section 7031.5 by any applicant for a permlt subjects the applicant to a civil penalty of
not mote than five hundred dollars (5500).
❑ 1, u owner of the pmpeny, m my employees with wages ss limit sok compensation,
Required Inspections
will do the work and the structure is not Intended or offered for sale (Sec. 7044. Business
Ad PredicationsCode: The Contractor's License Law docs not apply W an owner of
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proper who builds orimpmns Ammon, and whodassuchwerk himselfor through his
ownemployces, provided that such improvements are not intended mortared for sale. If,
however, the building or improvement Ice cold within one you of completion, the owner
builder will have the burden of proving that he did not Wild or Improve for purpose of
sale.).
❑ 1, as Owner of the property, am exclusively contracting with licensed contractors W
construct the project (Sec. 7044. Business and PreleWons Code:) The Convector's Li.
cone raw does not apply W an mmr of property who Wilda or improves Thereon, and
who contracts for such pmjec%with a convaetor(s) licensed pursuant W der Contractors
License law,
❑ I am exempt under Sec. ,BkPClorthlamson
ArDow
WORKER'S COMPENSATION DECLARATION
I hereby affect under penury of perjury one of the following declaration:
❑ 1 haw end will maintain • Cenificaw of Coastal W wlf-inuw fm Wodon'S ComPem
utim, u provided for by Section 3700 of the labor Code. for The performance, of der
work for which this permit is issued.
❑ 1 hese and will maintain Workers Compensation Insurance. u ox a red by Suction
3700 of the labor Code, for the performance Of the work for which this permit is issued.
My Workels Cg_yAcush ion lnsunna carrier and Policy number tie:
Cartier. I G.. YIA•GJ-' Policy No.:
CERTIFICATE OF EXEMPTION FROM WORK S'
COMPENSATION INSURANCE
(Dols Auction need not W completed If taw Permit Is foray hundred dollen ($100)
or less.)
L e nify that in the performance of The work for which this permit b issued. I .Nall not
employ any person in any mannerm u W Wcomewbject W der Workers' Compensation
laws of califamia. Dau
Applicant
NOTICE TO APPLICANT: If. afTer making this Certificate of Exemption, you should
Wcome Subjcd to the Worked Compensation provision of the labor Code, you must
forthwith comply with such provision or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby dorm that there Is • eonmucMr lending agency for the perfurm.na of
the work fur which this permit is Issued (Sec. 3097, Civ. C.)
Lender's Name
1<nderl Address
1 certify that I have read this application and stag that Ac eWvA information is
correct. 1 agree W comply with all city and county ordinances and show laws relating W
building construction, and hereby autherim representatives of this city to enter upon the
anovcmemioncd pro ray for Inspection proposes.
(We) agree 1 save, Ind keep hum ss Ne City 0r Cupertina against
liabilitles,judgmen ,costs sande mea hkh me Any goy acenm agtlmuaid City
o
in consequence of cgraming this it.
APPLICANT A S AN WIL OMPLY WITH ALL NON -POINT
Issued by: Date — sd -V 6
SOURCE REG 1
Re -roofs
Type of Roof
i
Signatureon DAM
HAZARDOU 'MATERIALS DISCLOSURE
Will the applicant or future Wilding Occupant stem m handle huardon material
as defiad by the Cupenlno Munici el COM. Chapwr 9.11. and the Healthand Sdety
Section 15331(.)?
All roofs shall be inspected to any roofing material being installed.
r] yes o
prior
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or furore Wading Occupant use equipment Or devices which
emit ha'rsahms air conlaminanu M Jeri d by the Bay Ama Air Qudity Management
all new materials for inspection.
Digin?
❑Yes ❑ u
I havere Ahuardasma wi,.31 cats un der ChMtcr6.95oflhe Califmr
ria H.10& d Code,Seeu 303. SJJuW155Jd. I undenaM dm if the Wilding
dace Act cum ban a u na that lt' my ponability W Artily the aaupaut the
reptireants At prier ism aoflcmtireew'foc Amey.
Signature of Applicant Date
t �w
All roof coverings to be Class "B" or better
Owar t. t ,<d.gcrl