050801903UIQ
3
3 i
3q—
gLLti
x03
qyqyn
`p0
3g�
-Zi
Yi6
eFF
O C
� N
a>_
600. G
az
UO
OF
W
U
CITY OF CUPERTINO
� gUN=T TOR�INk`C>RMA.TIUN'��.
BUILDING DIVISION PERMIT
4 4i�' 'NtVi 7w Yd
BUILDING ADDRESS:
128 STEVENS QRK 4 211
PINN BROTHERS CONSTRUCTIO
�SMIT"x.05080190
ER's NAME:
1
PERMIT ISSUE DATE
PINN BROTHERS
1475 SARATOGA AVE
01/20/2006
ONE:
SANITARY NO. CONTROL NO.
(408)252-9131
ARCHITEC 11INGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MUCH
O O O O
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 beach, from Wmad(romm
t I am licensed e, provision of Chapter 9 cecing
withSection 700)) ofD n 3af the Buuneu aM Profrjyt'r Coda. and yliccncu
inranfoleandcfrccL'v
NEW CONDO -1117'
Lkcn Class Lk.g
Cam0
As DECLARA ION
shall use
I urtdenunJ my plans shall M used as public tttrrtls
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm Net 1 am exempt from the Comrseror's License Law for the
following reaun. (Section 703 1.5, Business and Prorcuiun Calc: Any cityar county
which requires a Pmmit to construct. alter. Impmve, demolla s. or repair any strucmro
$239451
prior m its issuance, also requires the APPlicant for such permit to file a signed su ement
Ft. Floor Area
Valuation
that he is licensed Folsom to the previsions of the Contractor'sLicense Law (Chapter 9
Sq.
(commencing with Section 7000) of Division 3 or the Business and Promminrs Code) or
Nat he is exempt therefrom and the bub fm the alleged exemption. Any viotadon of
r
Occupancy Type
Section 7031.3 by any applicant for a Permit subjects the applicant in a civil penalty of
not more than live hundred dollars (S300).
❑ I, as owner of the property, or my employcn with wages u their ule compensation,
Required Inspections
will do the work and the stroma Ismumanded or offered fo sid.(Sec. 7044, Business
and Prolamin. Code: The Connciafs License Law does not apply ban ower of
q P
property who build. orimprove thereon, and who doesauhwmit himself ar through his
own employcos, provided that each improvements sm not intended aroffered for sale. If.
however. the building or improvement is old within one year of completion, the owner -
build' will have the burden of proving that he did not build or improve for purpose of
sale.).
❑ 1. u awner of the propeny, .m exclusively... umo., with licensed centacmrt on
contract the projem (Sec. 7044. Business and Profession, Cade) The Communes Li-
ccese Law does not apply in an owner of property who builds or improv thereon. and,
who contracts for such projects with a ca^uacmr(s) licensed D'mam in the Contraatah
Lice"m Law.
\ 7
❑ I am exempt under Sec. . B & P C far the wan
r Dam
WORKER'S COMPENSATION DECLARATION
I hereby affirm under Penalty of perjury ane of the following declaration:
I Mm and will commin a CeNRatc of Consent to self -Wore f' WorliniCompcn-
more. as provided for by Section 3700 of the Labor Code. for the peefarmance of the
work for which this Permit is Wood.
❑ 1 have and will maintain Warkeri Compensation Imuran, u required by Section
3700 of die Labor Cede, for the performanc of the work for which this Permit is Wted.
My Works Compensatian Inumttce tartlet and Policy n41mW are:
^�df_
Cartier. tat-y7/net-< Poli.. N..: `
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thls section recd notbec'nplemd lithe patrol, is fm one hundred dollars (SIM)
or less.)
1 certify that in the performance of the work for which this Permit is issued, l shell not
employ any person In any manner as u w become subject to the Worker' Compensation
Laws of California. Data
Applicant
NOTICE TO APPLICANT: If. after making this Ccnincam of Exemption, you should
became su lied in de Worker's Compensation provisions of out L.h' Code, you mum
forthwith comply with such proviuons or this permit shall tic deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hemby affirm that them Is a construction lending agency for the perr.vaance of
the work for which this permit is issued (Sec. 3097, Ci, C.)
Lender's Name
lender's Address
I certify that 1 have read this application and sum that the above information is
'
correct. I agrte as comply with all City and county ordinances nd sum laws noting u
building construction. and hereby su badge mpresenutiv of this city in enter upon the
above-mentioned p party for Inspection purposes
We) as save. indemnify and keep ha,mless City of Cuptnide against
Ilabilitie,judC .emu Mdexpe which mayka yacrnc galut said Cay
in is reaft. 1-1
APPLICANT DERSis
TAN a AN WILL PLY WITH ALL NON -POINT
Issued by; Date
SOURCER
Re -roofs
Roof
Signatu A I' Can or DM
HAZARDOUS ATERIALS DISCLOSURE
Type or
WIII applicant or room building occupant mom orhendlc husNon material
u dtfin of by the Coastline, Manic pal Code. Chapter 9.13. and the Health and Safety
2553x4).
All roofs shall be inspected prior to an roofing material bei. installed.
P P Y g g
❑Yes Nu
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future Iding occupant use cyuipmcnt or devices which
hausrdous air contaminants defined by the Bay Arca Air Quality Management
all new materials for inspection.
ict?
Imq.iSection
❑Yea N.
I have shuardama mrlals vimmenuundcr Ch,pWr6.95oftheCalifor-
cS yCade,Sacdo 25515, 33and25534,1ummrsundthmifthc building
na that It i y Tea hility W redly the cccup., of the
hi. m.,I Indo, W .raCemneatcootcmp.ncy.
nt
Signature of Applicant Date
r :;2 ° -
All roof coverings to be Class "B" or better
O r arizcd agent Dom