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CITY OF CUPERTINO
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BUILDING DIVISION p$jZMj'I'
'bon'
=�COIVTRACTOR,INF�ORIIATIOIY
BUILDING ADDRESS:
PINN BROTHERS CONSTRUCTIO
SERMIT No.05080187
ER'S NAME:
PERMIT ISSUE DATE
PINN BROTHERS
1475 SARATOGA AVE
1 20 2006
ONE:
SANITARY NO. CONTROL NO.
(408)252-9131
ARCHITECT ENGINEER:
BUILDING PERMIT INFO
'
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
I Money afllrm that I am licenaced under previsions of Chapter 9 (commencing
with Section 70110) of Division 3 of the Business and Profeaaiuns Code, and my license Is
In full farce and effect. V2,_ 2
NEW CONDO -11371
License Class Lk.R
Comrecwr
ARCHTIECI'S DECLARATION
I underwml my plans shill W used as public records
Licensed Normal ... I
OWNER -BUILDER DECLARATION
I hereby affirm Nal I am exempt from the Contractor's License Law for the
following mason, (Section 703 1.5, Business and Professions Code: Any city or county
which requires a permit w cnnswci, alma improve. demolish, or repair any structure
$243738
prior m its issuance, also requires the applicant for such permit to File a signed su¢ment
Ft. Floor Area
Valuation
that W is licensed Putman, w to previsions of the Contractors LIcense Law (Chapter 9
Sq.
(commencing with Section 7000) of Division 3 of the Business and Professions Cade) or
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
3 RPIR MMIkir U J
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of
not mare than Bud hundred dollars (3300).
❑ 1, an owner of the property, m my employees with wages As Weir sole compenotion,
Required Inspections
will do the work and the structure B not intended or offered for salt (Sec. Busimer
And Prefessims Cade: The Conuaccres Umma Law does fat apply 0 an Owren of
9 P
property who bulldaar improvers Merton,end who doessuch work himselfor through hi[
own employees, provided thatsuch Improvements Me not intended warranted forsade. IL
however. the building m improvement is mid within out year of completion, the owner
builder will have the burden of pmving that he did not Wild or Improve for purpose of
.in I.
❑ 1, as owner of the property am exclusively contracting with licensed eontmcom to
construct the pmjm (Sec. 7044, Business and Protestors Code:) The Contractors U.
cense Isw does not apply to an owner of propm,Who Wilda or improv thereon, and
who contracts for such projects with a canlrattor(s) licensed purswnt to the Contractors
License Law.
❑ I am exempt under Sea. B k P C for this ..on
net Data
WORKER'S COMPENSA71ON DECLARATION
1 hereby aRMr under Pna ty of perjury ane of the following declammed:
❑ I have and will maintains Cen lesmCf Consent to selRinsure fm Workers Compere
astian, u provided for by Section 3700 of the Isbar Cade, fm the perfmorn. of the
L' for which this permit is issued.
❑ 1 haw and will maintain Worker's Compensation Insurance. as required by Section
3700 of the IsWr Cade, for the performance of the work for which this Permit is Issued.
My Workers Compensation Insurance cartier and Polity �q((qq\\"bQee a're:.-s
', 1
Cartier. �AA AAR Policy No.:h�/.f_.�.J..
CERTIFICATE OF EXEMPTI 0N FROM WWORKERS
COMPENSATION INSURANCE
(This section need not he completed If the permit Is loran. hundred dollars (SIM)
or loss.)
1 certify that In the performance of the work fm which this Permit is issued. I shall not
employ any person In my manner¢ as to hommcmbjecl to the Workers' Compensation
Laws of California. Dam
Applicant
NOTICE TO APPLICANT: If. after making this ceniticam or EMMPtion, you should
become subject to the Wod er's Compensation provisions of the Labor Code. you must
forthwith comply with such provisions or this Permit hall he deemed rooked.
CONSTRUCTION LENDING AGENCY
1 hereby 411rm that there is a construction Itnding agency for the performanm of
dm work for which this Permit is issued (Sec. 3097, Civ. C.)
Lender', Name
1<nders Address
1 cenify that I haw read this application and sum that ft salve infonnatlun Is
'
corn-- I gree to comply with tll City and county ordinances and sum laws elating to
building constructs ,and hereby authorise representative[ of this city to cruor upon 0e
aWw-mendunod petty forinspoe' purposes.
(Wc) q to save. indem ' Y keep harmmss the City Of Cupertino gains)
Iiabilidas,judg metsand purses hich may in any way aceree gains, said City
In consequent f the gramf this It.
APPLICA STA DS AN WI COMPLY WITH ALL NON -POINT
Issued by: Date - 20-46
SOURCE 10
Re -roofs
Type of Roof
-. o
Sign rundcontrm Dow
NAZARD0 S MATERIALS DISCLOSURE
Will the applicant or future Wilding aecupantatone Cr handle husAous material
I defined by the Cupenina Municipal Code. Chapter 9.11, and the Health and Safety
coe.Section :333a(a)7 /
All roofs shall be inspected prior to any roofing material being installed.
CYea 0Nd
If a roof is installed without first obtaining an inspection, I agree to remove
Will thc applicant Or fututo b Id Ps occupant use equipment or devices which
Ged May
mit havardous air contaminmts byArea Air Quality Management
all new materials for inspection.
istrict]
❑Yes ON.
16.ngKrk6.'nxAdaKi/1/
Ihavem NehmsrrgWs sura rlalsrequisemcnu under ChePmrh.95 of the Calltor
le Health A$e yCodc, fctictu7 3(13.23333 and 75334.1undattimdthatiftho Wilding
ors not curt Y ave mnmt, at It u my responsibility to notify the Occupant of the
quimme m them prior SswanceofaCmiRcamofoccupanry.
Signature of Applicant Date
— °� y0
All roof coverings to be Class "B" or better G
Dam