05080185CITYOFCUPERTINO
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BUILDING DIVISION PERMITCONTR
CTORANFORMATION
BUILDING ADDRESS:
PINN BROTHERS CONSTRUCTIO`M'TNO'
05080185
20128 STEVENS CRK 209
ER's NAME:
PERMrrfSSUEDATE
PINN BROTHERS
1475 SARATOGA AVE
01/20/2006
NE:
SANITARY NO. CONTROL NO.
(408)252-9131
ARCHITECTIENGINEER:
BUILDING PERMIT INFO
BO ELECT PLUMB MECH
O
LICENSED CONTRACTOR'S DECLARATION
Job Description
o
I ham ereby affirm that I licensed under provision of Chapter 9 (commencing
with Section 7") of Division 3 of the Business and Pmfmluru Code, and my license he
In full fora and ease —
NEW CONDO -919'
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License Clan Lie, 0
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Dam —• Contractor
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ARCHITECTS DECLA A ON
I understood my puns ffiatl ue used as; public records
Licensed Profmi... I
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the
following mann. (Section 7031.5. Business and Pmtessions Code: Any city or county
which requires a permit m convect, alter, improve, demolish, or repair any structure
$197006
prior to its issuance, also requires the applicant for such permit to fie a signed.mrement
Ft. Floor Area
Valuation
that ue islicunseJ pursuant to the previsions of the Contractor' License Law (Chapter 9
Sq.
(commencing with section 7000) of Division 3 of the Businaa and Protections Ccde) or
that he is exempt therefrom and the basis for the alleged exemption. Any vioution of
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Occupancy Type
Secdm 7031.5 by any applicant for a permit subjects the applicant to a civil mostly of
not mom man Ow hundred dollars (S500).
❑ I, as ownerof0m property,amywpl.yc. with wag=es thcoseueomperathm,
Required Inspections
will do the work and theaumctum isnot intended Or offered for true (See 70N, But.
and Professions Cade: The Contractors License Law doss rot apply to an Owner of
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property who builds o im prows thereon, and who dao such work himself or through his
own employers, provided than such improvements ate not Inu m akin oo@red for Lela IL
however, the building or impmeament is sold within aro year of=mplcaon, the owner-
builda will have the burden of moving that he did rot Wild or Improve for purpose of
sale.).
❑ 1. as Owner of the prapeny. am exclusively convecting with licensed contractors to
consumer the project (See. 70". Business aM Professions Cade:) The Contractor's Li.
cause Law done not apply to an owner of property who Wilds or improves meson. and
who convects for such projects with a contracto(s) licensed pursuant to the Contractors
License Law.
❑ lam exempt under Sec. ,Bk PCforthisrouon
er Date
WORKER'S COMPENSATION DECLARATION
1 thereby sffhm under penalty of perjury roto of the following declarations:
❑ lh.mmdwlllm.mudn.Cm%f=mG ersComo-
ofnsenti.self-IaureforWorkpe
adan, u provided for by Section 3700 of six Isar Code, for the Performance of me
work for which this permit is issued.
❑ 1 haw, h and will maintain Wos Campemtion Wourance. u required by Section
3700 of the labor Code, far me performance often work for which this permit is issued.
My WorkW penudon Income= carrier and Policy nunumberam:-
A "I i C
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Grrier. Zk1F M.P. J—< Policy No.: I
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu sectinu need not W computed if flue Permit is Income hundred dollar ($100)
or leas.)
1 certify that In the performance of the work for which this permit is Issued. I shall not
employ any pawn in any manner an as to become subject to the Workers' Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption. you should
became subject to the Workers Compcuadon provision of the Labor Code, you meet
foMwiO comply with such pmvisiam or this permit shall ue domed re ulcoC
CONSTRUCTION LENDING AGENCY
1 hereby affirm mat then u a..it.. unding agency for the mg... of
the work for which this permit is issued (Sec. 309'7, Civ. C.)
'
Umders Name
Lenders Address
I certify that 1 haw read this application and some that the move information is
emrect. I agree to reply with all city and county ordinances and sun laws relating to
oildingconswc n, and hereby aumarise mpresenutiws of this City to enter upon on,
above -mention, propertyfor etian purposes.,
(We) a ronew,' con y sad hep hatmlm the Cimy Of Cupertino against
I101110es•ju nu,cos ndex a which may in any way acme against mid City
in consega that unto his Permit.
APPLI TAN AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date — -20—r 6
SOURC LAT
Re-roofs��L
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S' Da
a ApPlicaVCa m
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HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
WIII the applicant or future Wilding hapm t naerr handk h alloa material
U defined by dC
o Cupertino Municipal Codee.. Chapter 9.13, and the Ham and Safety
a. Section 75533(.)7
❑ Y=
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicut of futum builorlig ocupunm use equipment or devices which
mit haaknus air conuminanu a toed by thO Bay Area Air Quality Management
all new materials for inspection.
DiWict7
krlalsrequiremcnu underCopurA.95oftenGll(orvrial3nel)5,
35533anJ2573q.ludenuMthatifine Wilding
4�-.n�7
tlane noiti my responalhillmytonodly the=euplt of the
rcquimmr iaaanaOnceknnam.2ul!ncy.
Signature of Applicant Date
I 6
All roof coverings to be Class "B" or better C,
O o vcd erg Dan
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