05080183CITY OF CUPERTINO
$q,0NTRACT0R INFOAmM9
BUILDING DIVISION PERMIT
B�IUDING ADDRESS:
PINN BROTHERS CONSTR1JCTIO1�9R`d"NO05080183
20128 STEVENS CRK 4 204
1
EWS NAME: I
PERMIT ISSUE DATE
PINN BROTHERS
1475 SARATOGA AVE
01/20/2006
NE:
SANITARY NO. CONTROL NO,
(408)252-9131
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMBMECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
I thereby farm that I am licenumd under Provisions of Chapter 9 (commencing
with Section 701 of DA0n 3 of the Business and Prometheus Code, and my liceirm Is
in full farm and off.l. _. Z / 2
NEW CONDO —9221
l-�D
Lic... Cl. Lie. z—
Dam Coniancro, vi a ;:1W kloutx:
M""'CTS DIECLARfTIONP
I �
I ..&.ad my plans admit be used a public houods
a
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm Nat I am exempt from the Conumme, License Law for the
following mann. (Sation 7031.5. Business; and Profession Code: Any city or county
which accumus, a Permit in consumer, alter improvechmalal or repair any structure
$197649
prior so its issuance. also requires the applicant for such permit w rile a signed imeamen,
Ft. Floor Area
Valuation
IMI ba is imenecd pursuant W he provisions, of Use Contracter's Lwasse Law (Chapter 9
Sq.
(commencing with Salon ]WO) of Division J of Nc Busimae and Prolevinm Cnde) era
Nat u exempt everefrons and ft basis for Ow alleged exemption, My .101.110. Of
PQ Mti er
Occupancy Type
Stion 7031.5 by applicant far a permit subjects ft applicant to a civil penalty 0 f
ec
.at more short five, hundred dathea, (MOO).
0 1, . mamor of me Property, or my employees will .1. as their .1, completed...
Required Inspections
will 0 the wank an the sonclude is not inmn&d or offered for ask(Sea. 7014. Business
and Proficustiones Code: The Comeactses Licens: Law ideas act apply M an ower of
property who builds or improved, thearem, and who does such work himself or through his
own croployesca, provided that such imprevempenu am an, mount creamed for sale. If.
however, the Wilding or improvement is sold within am year of completion, due owner.
builder will have the burden of proving too, he did not build or Improve far purpose: of
.in')
0 1, as camer of the property, am cacludively comastaing, with licensed commercial; he
consumer the project (So. 7014, Business lad Prolassimus Cede:) The Commerce, Li-
mns Law does not apply to in owner of property who Wilds or improm thereon. and,
who contracts, for such projects with A contrastar(s) licensed purcount to the Comomme.
Lice. Low.
C:] I am 'e'empt under Sao B & P C for this main"
at Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm, under penalty of perjury am of the following declarations:
I ham and will maintain a Certificate of Consent W self -insure for Worricar's ComNn-
tion, a provided for by Section 3700 of the Labor Code. for the performance of the
Ic
work for which this Permit is loved.
0 1 have and will maintain Weaker's Compensation lanamona. as required by Section
3700 of the Labor Code, for the performance of the work for which this prom, is Issued.
My Work cfa Clarpensatim, Insurance carrier and Policy number are:
Fl-� I- LAA,6,1!`'� Policy Na.:.,li �16
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(nob sedan need not becompleted If the posent, is foraric hundred doilara($100)
or Ica.)
I certify that In to performance of to work for which this permit is issued. I shall not
employ any person In any mannersa as W become subject to the Worears'Compicoution
Laws of California. Data
Applicant
NOTICE TO APPLICANT. If. after parking this Certificate of Exemption, you should
become subject to the Worker's Compensation prevision of the Labor Code, you must
fairthoith comply with such p ... hit... or this ricaritricill be accrued revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that them Is a construction lending agency for me Performance of
Ne wars for which ulds permit is Wood (Sm. 3097, Civ. C.)
Uncm,'s Name
Leaders Add.,
I certify, that I have read this application and too thal the starve alternate. I.
concur. I agree in comply with all city an county ordinances and soon laws mining 0
building construction, and hereby inuffiturin reprosenutivas Of this City to emir upon me
above-mentioncil property for inspection purposes -
(We) aide to cave, indly d man harmless the City of Cupertino igniter
" me
hl,ctdap cilia which mh may laturtywayce. agillost said City
a ctdan
in de. th 2,
de. th, &.1' 90fthis it.
NGERST NDSA D WILL COMPLY WITH ALL NON -POINT
APPLICANT NO 6N
Issued by: Date /'2-0-0/
SOURCER
Re -roofs
Type of Roof
Signer f lZRIGLATINUILS DISCLOSURE Data
Will be, applicant ., future Wilding occupsent state or clock hirearmus material
defined b the Cut a no Mom pal Code. Chapter 9.12. and die Health and Safety
'We M'.y.25S32(.`y"
All roofs shall be inspected prior to any roofing material being installed.
,ON.
If a roof is installed without first obtaining an inspection, I agree to remove
Will
I the applicant or future Oldint =.part um equipment or dcvicts which ch
IF. I. us air conumninum" defined by ft Bay Area Air Quality Management
all new materials for inspection.
Dht,ict? 5K
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OYU ON.
IN ad the ova rusen dALsmquim=nmun&,CMpwr&95ofLheCalifo,
him
nishicath etyCodc. am 505,25533annI2553aluddicesurniftifect Wilding
J
act it haw Awn.4 ad it a y nespershility ut redly the mcumm, of the
Zdoes
mq.!.. bum nor cance.fa Continuum "foccupsaincy.
P;
Signature of Applicant Date
I —
916-06-
"B"
—
All roof coverings to be Class or better
ren fV11hari7zel age ir Dam
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