05090099CITY OF CUPERTINO
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BUILDING DIVISION DIVISION PERNUT
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B t,ENDADDRESS:
PINN BROTHERS CONSTRUCTION
gRMITN0'05090099
2 128 ST VENS CREEK R1,
OWNER'S NAME:
PERMIT ISSUE DATE
PINN BROR. CONSTRUCTION
1475 SARATOG
4 2 05
E: -
SANITARY NO. CONTROL NO.
(408)252-9131
ARCHITECTIENGINEER:
BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
I� 0
LICENSED CONTRACTOR'S DECLARATION
o
Job Description
1 hereby afm that I am licensed under Provisions of Chapter 9 (commencing
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P
with Section 700rB of Division 3 of the Business and Professions Code, and my license Is
m full force aM et.
12
DEMO (E) BUILDING
License Crus U... Sr2%
Data -V, Contractor
AR HI ECTS DECLARATION
I undersand my plans shall he used a public recnNe
Licensed Professional
DECLARATION
Oat
I am cUII.DEfr
I hereby comm that 11..Bumps from d Canuacmh License law for de
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moon. 7o Business and r Code: Any city mcoumy
demll
whichfollowing
permit str improve,
which inquires • permit re cnnsuuct, alar. improve, dcermitt or mashned
'. �'"\ �'^^--. $30000
omens
requires theapions of for such Permit mfileasigned wumcm
prior wisocensedp pursuant
JpSectio TOM) ofDisionsnfde e8uacwM1lJamtaw(CNPur9
(comms (commencingn 3for of ac Cotte) or
andmpt
(cin asempth SectionTOM)and
Sq. FloorArea .i/'
�� /.✓1 {-,✓
�' �Val`t tion
basis alleged exaan. My
Nu he ts wempl therefrom and Ue buis for Ne allaeed esemptim. My vloladon .f
he is the
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(1 ),
(�
cGJ Type
Section 7031.5 by any, applicant per a permit wbjau the applicant to a civil pcelty of
not mom than five hundred dollars (5500).
❑ 1, u owner of Itis pmpeny, m my employes withwee u de4role c.mpemtion,
panty
(,� -+�
Required Inspect
Me uctum isnot lnandedaroffered foruk(Sea. 7014, Business
willdo the we.and m
and Protestant Code: The Conuacmes Licerue Law does not apply 0 an owner of
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pmpcny who Wilds orimpovea thereon,aed who doatuch work Mmxlfar through his
owemplayua, mevldal Nm such imprommonu see not int, or offered for sale If.
however, the building or Improvement 4 sold within one year ofcompletion, the owner.
Wilder will have the burden of proving that he did not build or improve fm purpose of
ala.).
❑ I, an owner of the property, am conclusively contracting with licemd contractors he
canstme Ne project (Sec. 7014, Baines and Professions Code:) The Cmuactm's U.
cove Law does not apply se an owner of property who build. or improves fastens. and
'
who contracts for such projects with a contruclm(O licensed pursuant to the Contractor'.
,
License law,
E] Iameaemptunder See .Bic PCfeth4resson
Owner Dace
WORKER'S COMPENSATION DECLARATION
I hereby alRm under penalty of perjury ane of t e following deductions:
1 have and will maimtln a Certificate of Comm to self-bsum for WorYer's Compen.
salon, u provided fo by Section 3700 of the later Code, for the performance of the
work for which this permit is Issued.
❑ I haw and will maintain Wastes Compensation Insurance, u required by Section
3700.17 the labor Code, for the performance of the work for which this permit is issued.
My Workcts Compeneetion Insunna artier and Polity n mher am: pp
i-�/li,C t Qty
Cartier. YS POLICY No.: 7
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
fids statim need an[ ft completed Edo permit is free= hundred &It=(SI00)
or less.)
1 certify that In the perfomancet of the work for which Nie Permit 4 issued. l shell not
employ any person in my manner so as b become subject to the Werkeri Compemtion
Laws of California. Dau
Applicant
NOTICE TO APPLICANT: If. after making this Ceniaate of Exemption, you should
become subject to the Worker's Compensation provisions of Ne Labor Code, you most
forthwith comply with such provision or Nis pcmit shall M doomed revoked.
CONSTRUCTION LENDING AGENCY
,
1 hereby alfnm that them Is a construction lending agency I'o Ne Performance of
_
the work for which this permit 4 issmd (Sec. 309'1. Civ. C.)
Leedcl. Name
,
Lender's Adders
1 «nify that I have red this application and Na that the aheve tnfomatim 4
coma I agree to comply with all city and county ardinuwes and aux law misting to
building construction, and hereby authorize representatives of this city to toter upon Ne
above-mentioned property fm idepeNon puryuxs
(We) sgnc to save, indemnify and keep harmless the City of Cupertino against
Ilabilides,judgm.nW cos expanse which may in any way acerin against aid City
1. so softhe
APPS RSTA DS AN WILL COMPLY WITH LN -POIor-NT
Issued by: Date
SOUR EGU A
Re -roofs
Type of Roof
Ev"b"'I'AWKsottCrAtiructor
HAZARDOUS MATERIALS DISCLOSURE Dau
WE Na applicant or forum building accupant store or handle harudoe material
ss dcOrtod by the CupeNna Municipal Code, ChsPar 9.13. and the Health and Safety
ado. Section z5533(a)7
Yes o
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 applicant or future building occupant use equipment or devices which
IWUNnua air cmuminants u dc0nad by Ne Bay Area Air Quality Management
all new materials for inspection.
mrict7
❑ Yet
I het read da h������eyyyyyyccc����c�c�c������tttmtttf maanabmquitemenis mderchmar6.95afthcGlifo-
niaHcalth atetyC ser 23503.75533 ux125334.1 mdcnuPd NSIfNa Wiluine
Joel rot end ve a u nL tht it is my mapomlbilityi�o trod y the occupmt of Ne
mqulm it nub me orwlno. afa Cc 10caa Occup ry.
Signature of Applicant Date
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All roof coverings to be Class "B" or better
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r.at ori ac Do.