06040111CITY OF CUPERTINO
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Ci1NTRACTOR INFORMATION
BUILDING DIVISION PERMIT
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BUILDING ADDRESS:
PINN BROTHERS CONSTRUCTIO
,;RM7N0-06040111
20128 STEVENS CREEKJ
OWNER'S NAME:
FE'RMIT ISSUE DATE
MANDELLA VICTOR M AND MARYTAYN147S.RARATOGA
AVE
05/08/2006
E:
SANITARY NO. CONTROL NO.
(408)252-9131
ARCHITECT/ENGINEEA:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job DCSCi1pClOn
1 Mmby allium that 1 am Banned under provisions of Chapter 9 (mmmoucing
ids Section 700(f) of Division 3 of the Business and Prof.m. Code, and my license is
m PoBTam..edaffan_ I r1/
REVISION. ORIGINAL PERMIT #005080164
License cl tic. g
Date 5.L_ComneWr
ARCHITECTS DECLARAn N
! I understand my plans shall W used as public records
Licensed Pmfcssionel
BUIIDER
mDECLARATION
Boll I a. taw for the
1 Mrthy .firm Not 1 vamp, from Ne COnunts My
/
Ca :
Calc: Any city or county
i 1. c
mown. (Saito Illi is. Business and
`may
. detium
whowing
which rtquim_s a permit w camwa, alter, impmve, demolish, in repair any strucWrt
V 0
+ prior Wits issuance. sew oval the applicant far Such permit as file a signed statement
Contrctor's liana, Law (Chap=9
Sq. Ft. Floor Area
Valuation
Nat he is licensed internal an the provisions of the
Section )000) Division 3 the Business and Professions Code) or
(commencing with of of
Nat he u esempt Wemfmm Sons the basis for IM alleged eumption. Any violation of
r U U
Occupancy Type
Section 7031.5 by any applicant fa a permit mbjecu the applicant to a civil penalty of
not mom Wan five handled dollars (SSW}
I, as owns, of the property, or an, employern with wages. Weir sale compenmtim,
ns Required Inspections
will da the wart. slid the SWnureu not intended Or Offered for sale(Sa. 7(M4. Butlrvs5
and Professlaru Cade: The Cmuazmr's License law docs let apply m an awmr of
q P
pmperty who builds or im prova Btereon, and who does such work himself or through his
own onPltyas, provded that such improvements am not intended w.ff..d for Sall If,
however. the building or improvement is Said within ane year of mmpleum, the owner.
builder will have the burden of proving that he did non build or improve for purpose Of
sale.).
❑ 1. as owner Of the property, am exclusively conuSo.sing wile licensed conuacnon m
cotisusas the project (Sec. 7044, BuSincv aha Pvfessiom Code:) The Comicu is U.
cense law does not apply in an owner of property who Wilds or improves thereon, and
who comment for such pmjeeu with a mrolacmr(s) licensed Parma., in lM COntnaor'5
Lica. Law.
1 am exempt undo See. . B d: P C for Wit mason
Owner Dam
WORKER'S COMPENSATION DECLARATION
I hereby affirm order Musty of perjury ane of We fallowing dalasatimu:
have and will maintain a CartiBate of Consent ro self-iosvm far WarkcYs Co sism.
setion, as provided for by Section 3700 of tite Labor Code. far Iha performance of Ba:
walk far which this permit is issued.
❑ 1 have and will maintain Worker's Compensation Inssmna, ar, required by Section
3700.1' Bm Labor Code, far the performame of Be work far which But permit is issued
'
My Worker's Compensation Insurvuz Curia Slid policybee art: q
I �
Carrier.. i PPolicyNo.:n l
CERT7Fl- -CATEOFE%FMFlON FROM WORKERS'
COMPENSATION INSURANCE
(Thu union reed not he completed if ted pomit IS forme, hundred dollars ($100)
a
or lass.)
1 certify IME in We perfom,use of the work far which this plena, is named. I Wall trot
employ any pawn in any manual an u to become subject m the WOrkers' COmpe dUlka
Lawa of Califomia Data
Applicant
NOTICE TO APPLICANT: If, aBe, making this Certificate of Exemption. you should
become Subject m the Worker', Compcnmtion provisions of the Labor Code, you most
r forthwith comply with Such Pravdsanm or Wu permit shell be domed revoked.
j CONSTRUCTION LENDING AGENCY
1 ber,by that thele is
30 lending agency for the perfunmana of
which
' the work for which Nis permit u issued (Sec. JW7. Civ. C.)
s ed (Sec.
Lender's Name
,soder'. Address
'
1 certify th.t 1 harc read Was application and SUM that the above information is
' comccn 1 agree to comply with all city and county ordinances and sate laws misting to
building construction. and hereby authority repmumtivrs of this city in cnmr upon Bic
I .hove-monuun pmpcny for issue ugroses.
(WO) a rte w save, Inde By an kap harmlea tM City of Cupertino i gunn t
j [is bilitia.ju mcnu,cosu and xpcnsa ppMich may in any way .lens againstfmd Gry
adds
in eonseguc ce of the goal of pcymit.
APPLICA UNDERDS AN WILL MPLY WI7N ALL NO POINT
Issued by: Date
SOUR
Re -roofs
Type of Roof
Sign n_ HAZARDOUS ALS DISCLOSURE Data
Uc appliaot m future Wilding mellow store or handle harardows material
as defined by the Cupenina Municipal Code. Chapter 9.13, and the Health and Safety
Carlo. $.Ban 25532(a)7
0Ya
roofs shall be inspected prior to any roofing material being installed.
_04All
If a roof is installed without first obtaining an inspection, I agree to
Will the applicant or future Wilding Occupant use equ itaentordevices; which
remove
IM sadme, sir contamimnu as &road by We Be, Arta Air Quality Managcmcm
all new materials for inspection.
Unic0
[3 year ryNu
'he`
'I'S mWe haraNaus mamrialsmquimmcnnt undcrChapmr 6.95o(tixCalifor-
maHealth 1011C 25505,25333an125534.1unummadWmiflW Wilding
does no nenBy c a ¢n L than it is. my responsibility m notify the meupant of the
rewire p' moa et riorwssuenm of. Cadfmam of OCeOp'"y'
Signature Of Applicant Date
� Jn
All roof coverings to be Class "B" or better
r uthtna es t �
Dam