08010135 (2) CITY OF CUPERTINO gs.YC /�N��,�g'xlr fit ``
BUILDING DIVISION PERMIT zCVil l\1atiC(TO�� �! ^YlATII l�
IT NO.
BUILI]IIiG�QIFSN DE ANZA BLVD PINN BROTHERS CONSTRUCTIONS PERM08010135
1AIRCHITECT/EbIGTNEER:
NEERUS NAME: FEM417ISSUE DATE
BAY COLONY INVRS II INC 1475 SARATOGA AVE #250 02/15/2008
ONE: SANITARY NO. CONTROL NO.
(408) 252-9131
BUILDING PERMR INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONmAC10R'S DECLARATION Job Description
bowery affirm that 1 am Imam ni under provisions of Chapter 9(cammancing
.g withSecuan7IXMBofDivision3ofdmBusinemandProfcsa(anCode,awmyIt,---is REVISION—STRUCTURAL CAP OF REC RM(WEIGHT
n ,BI in full fares and effect. t
!taco Lie, LOAD)COMMON/EXERCISE ROOM—ORIG. 05100174—NO NEW
g DamCrs DECLARATION o PERMIT.
[understand my plans[hell W used u public record[
6
5 C Licensed Professional
OWNER-BUILDER DECLARATION
E I hereby affirm Not I am exempt from the Contra orr's License Lew for the
o O fallowing mason.(Section IID 1.5,Business and Profaaians Cade:Any city or county
$ which requires a permit to construct,alme narrow,demnllsh,or repair any macture -
iy prior W is issuance.a lm mquiral the applicant for such permit to rile aligned statement
zp
that Wis licensed purmantto the provisionsofthcConvector'sLicense,Law(Chapmr9 SG:FLFIOorArea Valuation
Cg (commencing with Section7000).(Division3ofUteBumeact ndProdead.usCM.)., $2000000
3 that be is exempt therefrom and the beau For the alleged marnp ton.Any vialation of
Somme,703E.5 by any applicant for a pandit mbjecu the applicant to a civil penalty of N Number Occupancy Type
nal mane Nm Sim hundred dollars(5300). 3 2 E 10 0 V aF
0 I,u Owner cribs property,or my employees with wages as their mle compenssdon,
will do the work and Utestructum is netmuniedoreffaeaimaam(Sec.7014,Ouivas Required Inspections
and Pmfensions Code:The Commutes License Lew dams not apply m ns an owner of 9 p
Property whobuilamimpmvee daerean,and whodoestuch want himselforthmugh his
own emplayeas,provided that such Improvements arc notimmnded ororfered fmssie.If.
ha onmr,the building or improvement is mid within ane year of compledon.the ower.
builder
wer-
builder will haw Um burden of proving that he did not build at improve for purpose of
.k.3.
0 1,as Owner of the property,am exelunuely connecting with licensed convacma to
mnstmct dae pmjcm(Sec.7044.Buintu and Pretensions Code:)The Con achans W-
an=Law docs not apply to an ownu of properly who builds or improves daemon.and.
who contracts for such projem with a contactor(s)licensed pursuant to that Contractor's
License law.
0 l ore exempt under Sea .B&PC for this coma.
nes Dam
WORKER'S COMPENSATION DECLARATION
1 hereby anion under penalty of perjury now of the following declan0om:
❑I ham and will maintain a Cenifcate of Causes'0 self-insum for WorkeresCompen-
sation,as provided for by Section 3700 of die labor Code,for the perfomtuoc of due
wort for which this permit is boom.
0 1 haw,and will maintain Worker's Compensation boatmen.as required by Section
3700 of the Mbar Code,for the performance of the work for which this perwak is Issued.
My We, nsation InauM.carman and Policy n sber are:
Grtitr: 'Polley No.:
CERTIFl ATEOFEXEMPDONFRO ORKE
COMPENSATION INSURANCE
(Thu se it.need Out W complomd Ease permit is faro..hundcoddaftem(SIW)
.r lcaa)
1 cardfy,that in to performance of the work for which this Permit is iuucd,l shall not
employ any person in any manner an as to become subject in the Worker'Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT.IL eller making this Gnificam of Eaemplion,you should
become subject or the Worker's Compensation prevision.of the Labor Code,you mum
.J 0 forthwith Comply with such proWsions or this permit Shull W deemed mwoked.
n'Z,vCONSTRUCTION LENDING AGENCY
In[—m I hereby error that them is a construction lending agency for the perfurmaue or
rL 7 the work for which this permit It issued(Sec.3097,Civ.C.)
W Q Lender'[Name
Z Under's Addcoss
U O I aurally dant 1 haw mad this application and sum that the atow information Is
4, U coma I agree m comply with all city and county ordinances and stare laws mlNng as
-0 building construction,and hereby aufhode:mprommstoms or this city a enter upon the
W [bore-mentianetl patient m inspection purposes
kEL
to aw, damnify and keep harmlets the City o(CupaOino against
liabi U u,cuu d expenses which maymany way eccrve agdwtsaid City t
V AP L C of
DER9TA DSof thrNce�ms OMPLY WITH ALL NON-POINT Issued by: Date
SO RC An0NS.
Re-roofs
Slgnamr VCmmi Dam
IAZARDOUS MATERIALS DISCLOSURE Type of Roof
ill the applicant or forms building occupant nom arbandle buueou material
ns de ed by the Cuperman Monte 1 Cade.Chapter 9.11,and dae Hcalth and Safety
a Section❑Yo15532(a)7 All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding Occupant sex equipment or deWces which If a roof is installed without first obtaining an inspection,,I agree to remove
emit hanrdau air canumiaents u fined by the Bay Area Air Quality Management all new materials for inspection.
Diwiet7
Yes u
1 ac mad the baurdr aterials rertmencm;under Chapter 6.95 of the Glifor.
ria I Safety Cade,Sec 25505. 175534.Iandeamnd that if0m Wilding
d at mly haw a we m my mapomibility to notify the gaup n,of the
ai w missuance onc ofr(jMks .�,�y SignatureofApplicant Date
0 cru wtharimdaganl Daa'CJ All roof coverings to be Class eBe or better