06020168 CITY OF CUPERTINO tq * "T'7 t s —.77F,
BUILDING DIVISION PERMITyC. xg"y"�� rriYg'�'�p.vt .yv'
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BUILDING ADDRESS: PINN BROTHERS CONSTRUCTIO 9"i" .06020168
R'S NAME: PERMIT ISSUE DATE
PINN BROTHERS 1475 SARATOCA AVE
PHONE: SANITARY NO. CONTROL NO.
408 252-9131
ARCHITECTIENGINEER: BUILDING PERMIT INFO
9�LDG t
+Op LICENSED CONTRACTOR'S DECLARATION Job Description
U i hereby affirm that I am licensed untie,provisions of Chapter 9(commencing P
with Section 7M)of Division 3 of the Business and Profcuions Code,and my Ikense b
oy inrulirorccandelfectJ,9f.L LIC, REVISION-REVISE T FOUNDATION TO L FOOTING ON
ire? Licensc Clam so'
Dam Coouamor < C_Z,)1kf GRID LIVE 1, D, 8 & E
ARCHITECTS DECLARATION
f 6 Iunderstand myplans Shall beused aspublic recnrtls NO NEW PERMIT ISSUED/ORIG. 405080165
e G to Licensed Professional
`y5 OWNER-BUILDER DECLARATION
i i hereby aRrm Nu I am exempt from tic Cantru7aes License,Law far the
E o fallowing moan.(Satires 7(D 1.5.Business and Prorestiau Cade:Any city or county
which imin.a permit in cnnsmms4 sher,improve.demalW,Or repair any struclum
in prior w its isammucc,also required the Applicant for such permit to file a signed statement y,Ft. F1oorArea
< that heulicensed pollution10thepmviatomofdoContractor Licaruelaw(Chytmr9 S Valuation
?E $ (eommeWlncinsSuion70t10)ofMvision3oftheBusinuseMPmfeuionsCade)ser $0
L that bet.muvpl therefrom and the basis for the alleged esempUan.Any violation of
Section 7031.5 by my applicant for a Permit subjects the applicant w a civil penalty at APN Number Occupancy Type
not mom woo five hundred dollars(SS00).
❑Luowlmr of ase property.a my emplaym with wagesuthehsoleeempenutdon,
will do weirmt Nd themadam Is ran amended or offered laraalc(Sm.70M.Business -' Required Inspections
and Professions Code:The Countesses UR I.W duet set apply w an owner of 9 P
Property who beads ar improwa dtmeon.and who docs such walk himself or through his
even employees.provided that such improvements art notinanded oralfaW for aaa.U.
however,die building or improvement is sold witia one year of catupmtion.Oe Ovil
Wilder wiu have the burden of proving Wu he did nal build or improve for purpose of
sale.).
❑1.u awtmt or we Property.am exclusively contracting with Iicansed essm se on in
ecoatm,tha pmjm(Sec.7O1a,Buinev stet Profestlws Cade:)The Gamlacuses u.
come Law does cot apply in an awllar of property who Wilda of ImpmRs weman,and
whommmets for such projects with a mntramorts)Ikmtsed pursuant w Na Comeames
License L.W.
oro eaempl undo See ,Bl PCfarthbrcsmo
Dam
,0007 WORKER'S COMPENSATION DECLAM[ION
1 hereby aRrm under penalty of perjury m of the fallowing declwimu:
1 ham and will maintain aCmGftcam of Consent to self-invert fur Watknes Compen.
sation,as provided for by Section 3700 of the labor Code.for the perlmmance of do
wort for which this permit is issued.
hive and will maintain Worker's Compw
etion Insurance.u required by Section
77 oftha Labor Code.for We pefformaaceoftie work forwhich this permitbssuc
ld.
My Worker,Compevsatwo Insurance carni and Pal
iryn berate:
Carrier. iLPL17Fa -policyNo.: l t
CERTIFICATE OF E FMPnON FRO RKERS
COMPENSATION INSURANCE
I
(Thu aectlon need aothe completed atie permit 1s(wane hundred dollars($1001
or leu)
I certify that in live pmform.of tie work for which this perm11 is issued,)"I Our
employ anypenan in any mennerm u in become subject to we Worltms'Compeuuan
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Caaificare of EumMion,you should
become Subject in the Workers Compensation provisions of tic lahnr,Code,You muss
3 0 forlbwith amply with such provisions or was permit shall be doomed revoYcd.
zs NCONSTRUCTION LENDING AGENCY
(--t 1 hereby a(Rrm this there b a construNnn lending agency for the Performanoo of
I>;> the wort for which this permit ts issued(Sec.3097,Civ.C.)
WS Lenders Name
u
0 z Landees Addec
V O 1 certify that 1 have read this application and state this the above information is
Hcounsel.I agme in comply with all city and county oNinances and sun laws misting to
C) building construction,and hereby aut
horise mprN
escmaincs of this city to enter upon e,
W shove-mentioned p pony in iupecuon purposes V^�
O. (We,)ogre save,indemnify and keep harmless the City of Cupenino against
t,y fA lisbilitiu.)Wgm ,ensu and which mryin any nYattnm gains)mid City
V Z APPLICANT De RSTAnit
$Afilts WI COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REG ' ONC
c Re-roofs
Signature(VAI'VICAUCbritrilEtoDam
HAZAROor ATEMALS DISCLOSURE Type of Roof
Will dte applicant or run=building accupanlamm or handle huardous material
efined by 1M Cupertino Municipal Code.Chapter 9.13,mld the Health and Safely
Secdou 25532(.)? All roofs shall be inspected prior to any roofing material being installed.
[3 Yes j2 Nu
Will the applicant or future building Occupant use egoipmenl or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit huardnu air contaminants as deluged by tie Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes 2�Nu
I have rest use board
trueo anmrd.95ofthe Califor.
me Heal"$ yCad,Sectiy5.15533nJ21534.1umCrsu Liffe
building '
dam nal cune y have a tete we(ssrit u mY.N.ihillly w notify Ne=upanl of the
rcymwments M rep rwimaan .cOninc.maOccuanry. Signature of Applicant Date
Owncro decent DamAll roof coverings to be Class nBn or better