08070041 (2) CITY OF CUPERTINO rgt3dxs' x.»a'�Ee aefy°s `=`�"�`�' "
BUILDING DIVISION PERMIT .1CONTRACT'0IC1 FORMATION
BUIL41NG ADDRESS: PERMIT NO.
.L0745 N DE ANZA BLVD PINK BROTHERS CONSTRUCTION 08070041
'R'S NAME: MRMrr ISSUE DATE
BAY COLONY INVRS II INC 20132 STEVENS CREEK BLVD 07/10/2008
Me SANITARY NO. CONiBOL NO.
(408) 252-9131
ARCHMECT(ENGINEEIt: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
o o LICENSED CONTRACTOR'S DECLARATION Job Description
F 1 bachy,.Mirth than,I am li¢mW under provisions of Chapur 9(mmmencinb P
with saaon 7(101))or Division 7 of than Buenas and Prmmssmas Code.and my liceon is REVISE WELD CONNECTION @ A SUN SHADE ORIG
its i:n
fall rceiyderfea Lice #05100159 NO NEW PERMIT.
F p Dam Conlrsuor
q 7W ARCHITECTS DECLARA
WV 1 undcrsund my plans Nall d used as Public rtcoNs
g O Lkemued Pmfcseo^al
OWNER-BUILDER DECLARATION
i<E 1 hereby affirm that 1 am exempt from the Contractors license Law for tM
y O O following mason.(Section 7031.3,Bananas and Professions Codc:Any city or county
$ which requires a p arit to comanxt.ahcr.impmw.dcamish.Or repair any swctum
prior to its is.,also require the applicant for such permit to file.signed saument
pxx< that he is licensed pursuant to the pmvimmd of Ne Convenors Uunm Uw(Chapur9 Sq.Ft.Floor AreaValuation
t
yFg (cameuing with Sudan 7")at Division 3 at NBusiness and Businand Professions $Code)tar 0
— dot he Is cumin da mltatn and the nails for the a11egN exemption.My violation of
Section 7031.3 by any applicant for a permit subjects are applicant to a civil pcmdty ofN Number Occupancy
notm War five nandmddwma(swm 326-10-06 Penc Y Type
0 1,a ownu of llie pr p ny,a my employcea wiN"Ses u th mle compcmdon,
wits da the Wart and Neawnum b rotNadd ora w d docs
.1 apply
an Basi r Of
and Pmfadns Code:The Cantnnor. dwho Las door rot apply f an owner is Required Inspections
.rom Whos.proariroproveathereon,ahaants..atinworkende himmlfarthmugh his
Ww m.me Wilding
that such impmwmau art not,add umlfued for sale If.
however,Ne W e the
u improwmut 4s cold within oro yet of completion.due oromomr.
of
builder will have Ne buNa of pmvin6 dot he via rot NtiW m Improv for puryO¢err
sale.}
❑1.an an=clam property son enclasively contracting with Ikaurea conttactas as
construct the Inaj=(Sec.7044.Business and Prdreceans Cdc)The Caovaemra U.
nations Law doe not apply to an ownu of proper who builds or improv s demon,and,
who contact,far pmjecu with.coram mr(s)Iiamed panaam as the Con racme,
Lkena Law.
I oro amaitimdu Set ,B A P C far the moon
Data
WORKERS COMPENSATION DECLARATION
1 hemby aRrm under pantary or perjury ma of the fallowing decimations:
1 haw and will maintain a Cenifiamof Consent m salf-iaurt fm Wodxrs Coolant.
.urian,u proAdd for by Sutton 37M of the Labor Code,for the perrormutu of the
work for which this pmnit is island.
❑1 haw and Will maintain Workers Campemalian Instinct.,a mqulrta by S=coot
J700 of Ne lanor Code,fade pcRormarce of the work for which this permit u issued.
"W
huwmnct arriu and Polity number are:
Cartier: lyV[JL1N.�%k.�-s PolityNd.: '(31913(71cf I
CERTIFICATE Op EKEHP ION FROM WORKERS'
COMPENSATION INSURANCE
(nes secdm had rot N canplcted ifNc permit b forma,mrsdrd dollars(SIM)
or lora)
I unify Net in au performaroe of am wok for which this pmoit is ismad.I small no.
employ any panda in any manhar on a m b=come wbject to the Workus'Compcaation
Iowa of Califamia Data
Applicant
NOTICE TO APPLICANT:IL afar making this Cenifiam of Eaemplion,yon should
bamme subject m Nc Workers Canpcnsation provisions of Nc Libor Cdc you roup
C)'z forthwith comply with arch provisions aNb permit shall he dc,md nonsked.
z y CONMUCnON LENDING AGENCY
for
which
Rim Nat da i ba constocti 097,Cine aeenry far Nc laerldrmarcc of
C > the Wart far which Nis pemtit b islWA(Sri.]09'r,Civ.c)
Q LendaName
a z I<ndee.h Ansa_.•
U Q L mlify,Nati 1 Mw mad this apphkui^n and sae Nu the abmw information is
Is, calms,l 89mo m=amply wl aB city ad eounty adhlLutt ad sora i m rtladne b
0 Wilding consuuniom anal by auNorior mpresenutives ofNb city m=nur upon thc
Z in naarodproperf ira,amna which
F g1 ( e)agree m aw.i dcmnify ad kap harmless tie Cry of Cupertino against
ti h
Halt iia ments.cdsta dapensa which may in any WaY+=cmc against said City
V z m aseq Of Ne ganti g of Nu pum�l �
" AP IC NDERST SatNOl4ILI-COM LY w AL NON-POINT Issued by: Date ��/.-Z-e"
SO RCE
sienatert rAppliwnVCd tar DW
Re-roofs
x us MATERIALS Drscu uRE Type of Roof
Wi 1 the applicant a forum building occupant pore or Mndlc haallous maarial
fin=e by the Capart Municipal Cade.Chalon,9.13,and the Health and Surely
Y.
us3x(a>+ i'No All roofs shall be inspected prior to any roofing material being installed.
Will tie.applicant Or future Bain dm If a roof is installed without first obtaining an inspection,I agree to remove
PP �t ! pant tic equipment or dM2n& Which ,tra
Diwk,7 Nam air cmnuminanta defirad by de Bay Arta Air Quality Manaecmcnt all new materials for inspection.
❑m
1 hese mad the,ssarda s maeriab anpamm,nts under Oupur 6.95 of am Caliror.
.is N@SafnyCa Scctionstaws. j7aad.7{S3q.)ud,nwW Nyifyu nuilding
n cwmmly bar t-�I ilia my rapodbility at Mari do path Of ds
ta whi m at prior to issaman oft Card Signature Signature of Applicant Date
r v
ow 1 ..mord.deg=G Dan, All roof coverings to be Classor better