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CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
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BUILDING ADDRESS:
PINN BROTHERS CONSTRUCTIO
g]MITNO.05080191
0128 STEVENS QRK # 212
Efts NAME:
PERMIT ISSUE DATE
PINN BROTHERS
1475 SARATOGA AVE
01/20/2006
ONE:
SANITARY NO. CONTROL NO.
(408)252-9131
ARCHITEC rENGINEER:
BUILDING PERMIT INFO
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LICENSED CONTRACTOR'S DECLARATION
o
Job Description
I hereby affirm Nat 1 am licensed under provision of Chapter 9 (commencing
p
with Section 7000) of Divi+lo¢lofdte Buvnw uW Ikofutlny Code,f)nd my license i+
in full forte t}�/S +O G
NEW CONDO -1117'
and effect. I
Liceuc Clue Lic N S
Date CunDECL-
RCHRECTS D
imbll me.,&
I understand my plena shall be used a puMlc mcorN
Licensed Perfusional
OWNER -BUILDER DECLARATION
I hereby afOrm that I am exempt from the Contractor's License Law for the
following moon. (Section 7113 t.5, Business and Professional Code: Any city or county
which reforms a permit to construct. Wes. improve, dcludel. or later my structure
$239451
prior m its ismance. also requires the applicant for well permit to file a signed statement
that he is licensed pursuant to the provisions of the Comruers License Law (Chaplet 9
Sq. Ft, Floor Area
Valuation
(commencing with Section 7000) of Division 3 of the Butmem and Profusion Code) or
Out he is exempt therefrom and the bels for the alleged exemption. Any vmlmlon of
f
Occupancy Type
Section 7031.5 by any i pplicam for is permit subjects the applicant to a civil penally of
not mom than five hundred dollsn (S7(10).
❑ 1, an owner of the property, or my employee with wage as their sole compensation,
Required Inspections
will do the work. and W instum isnot instead or offered lot man (Sm. 7Um, Business
and Prefesstona Code: The contaminates Licerue Law does not apply In m owrter of
q p
properly who build+ar Imprmes thereon, and w Ice daes+uch work himself or through his
ownemploycle, provided the such Improvements are nothrended oraffemd formic, if.
howeveq the building ar Improvement is mid within au year of completion. the owner
builder will have the harem of playing that M did not Wild or improve for purpose of
sale.).
❑ 1, a owner of the property, am exclusively contracting with liecmed cenumtom to
consumer the project (Sec. 7014, Business and Profession Cade:) The Cantuctar's B-
eene taw does not apply to an ower of property who Wilde or improve themen, and
who contacts for such projects with a comm cti licensed purwam in the Como ctoes
Liaise Law.
.BhPCferthi+aason
ser DasWORKER'S
COMPENSATION DECLARATION
1 hereby siDmt under pwlty of perjury am of Ne fallowing1
IlamexempuunduSec
have and will maimuin a Cenifieate of Consent to elf -inure forWorke6Compen-
an, u provided for by Section 37M of the labor Cade, for the performance of the
rk far which It. permit is issued.
1 have and will maintain Workers Compensation Insunna, o required by Section
0 of the Labor Cade, for the performance of Ne work forwhich Nis permit is issued.
Worker's Communaute.. lnsurence carrier and Policy number are:
Carrier. Et -4 Polley No.:
CERTI GTEOFEKEMPIONFROMWOR FRS'
COMPENSA71ON INSURANCE
(Thiswetion need not W completed tithe permit is foray hundred dollarm($100)
or less.)
1 aNfy that in the performance of the work for which this permit is issued, I .Nall not
employ any person In any mountain as to become subject to the Worker' CompeuWan
Laws of California. Das
Applicant
NOTICE TO APPLICANT: If. after making this Centiliter of Exemption, you should
become subject he the Worker's Compensation provisions of Nc Labor Code. you mute
forthwith amply with such proviEnu or this permit shall be decmed muted.
-
CONSTRUCTION LENDING AGENCY
1 hereby affirm that Nem is a eouuuctin r Lending agency for the Performance of
the work for which this permit Is issued (Sea 3097, Civ. C.)
'
laodces Name
Lender's Address
I unify that I ha mad this application us Nal Ne above information is
comet. 1 etre a comp with all city and Co. o inantta end state laws mlaling to
Wilding consu�Non, WrebywNaria mmn ive of Nis city to cnsrupon he
shove -mentioned pro y (or iopcesi n p s.
(We) agree to vex, edcmnify an p lee the rty of Cupenino against
Iiabilitiu,Judgmen ossa deapcnw hich me in an ay ecemc against mid City
in consequence of of this miL
APPLICANT U E D N WIL 0 Y WITH ALL NON -POINT
Issued by: Date — Za v
SOURCEREG )
Re -roofs
Signuurc Das
App ontrmtor
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applicant or future Wilding occupant store or handle huudou material
de0ned by the Construct Munici 1 Cade, Chapter 9.13. and the Heale and Safety
de. Sa25531(a)?
All roofs shall be inspected prior to any roofing material being installed.
❑ Yu utian
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or mere WI ing occupant use, equipment or devices which
mit hamrdau ail canuminanu as ned by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑Yus No
I have mad akmom ruisnu a menu underChapter S93ofthe Califon
nuHealthhSafn .Say 505.255 ate253N.l mdcrstuulOwif the Wilding
Jas not current] n a sena that It is m ulbility a nodfy tic occupant mf tic
rcyointmentsw miniorin' a Of aCenlncateofOccupancy.
Signature of Applicant Date
-0-20�
IBI'
All roof coverings to be Class or better
owe . hari d gent
C