01070078 (2) CITY OF CUPERTINO
BUILDING DIVISIONPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
119979 STEVENS CRK PINN BROTHERS CONSTRUCTI NS01070078
OWNER'S NAME: APPLICATION SUB DATE
PINN BROS CONST. INC. 1475 SARATOGA AVE 07/18/2001
PHONE: SANITARY NO. CONTROL NO.
(408) 252-9131
°O ;ARCHITEC iENGINEER: BUILDING PERMIT INFO
m- BLDG ELECT PLUMB MECH
ai - CJ L.J L._7 CI
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'H z LICENSED CONTRACTOR'S DECLARATION - Job DescriptionZ
.�1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing'
�__° is in Sadoretand efect: on3 of lne Businasnnd Profcaions Cute.ane my license DEMOLITION.
I
is null tome end effect:
z m
License Class Lic.x
3 a t- Data - Contractor
ARCHITECT'S DECLARATION
t Ow I Understand my plans shall be used as public records
ed e,
p Y Licensed Profe.vsinnal
OWNER-BUILDER DECLARATION
a'-' 1 hereby mYlrm Ina 1 am exempt from the Contractor's License Law for Ne
t-. following reason.(Section 703 IS.Business and Professions Codc:Any city or county
I0 which requires a permit to construct. Iter,"mpr vat demolish repair any structure $50000
-
ua 3 .Prrmmus usuarce.alwreq rhe npPlrant(or conA Pemulm B4 sgrcJstammem. - - ._ _ __._._.._.. _
that he nleensed p-_ddduodlpm sons of Ne CmurecmfsLce.Law(Chnpmr 9 r t j�0f)kk55r.A a A I Valuation
Icamou cng wilh Sect 7")of Division 3 of the B.yne a ad Fortifier,Code) l tj•\� (3 @ fl�l�:UU .`3_11 tr.f.5y: ,
or(hot be is exempt therdioin 6rd the basis for the alleyeilexcm bm.An,vi.lmirn t
of Senion 9031.5 by env applicant Inn a pamtit mbjens the applicant to a civil pctuln
,gflnm more than live hundred dollar,($50)). NO INSPECT ONS' ' Occupancy Type
01,as owner of the property,or my employees with wages as their vote compensation, i
will do'the'work.and me structure,s not intended or offered for sale(Sec.7611. t,
'Business and Profession Code:The COOmvclOr's License Law docs not apply to an Required Inspections"
owner of propeny Who builds or improves thereon,and who docs such work himself 1
or through his own employees provided IM1a such improvements are not(mended or ------_ ___ ..._.. ._.._..
offered f 1 If howeim,doebulifing briciprorvernent is sold within dinccyciiirof
cninpletion,the ownscolismider will have the numbers of moving that he ea not Wild or „
rep or p T f ) 1
o wr of the Propcny. elusively contracting with licensed t sours to .. ... t• _ ..i i _ ..._....
construct the project(S 70k4 Business d Professions Code)The Comncmr's 1 ,., ,I. •L.
Li<ens<Law d�e�p n plyl owner ofp pery who bald o improvesIheteon } Q
.and who Comrac(for h, 1 rs won tmunrlsl licensed p 1 In, he . ..__. ..._.. ._. ..__.. ..l ,/\ -. ....... ...
Conus rs Liccnu
SIC V
�1 ❑la a pond 1 tB&PCfo this mown
1AY/W - Y
t wORXER'S COMP SATIO DECLARATION~
_ Ihereby affirm under.pcwlry Of perjury,ane ofthe following declarations:
❑ 1 have'and will maintain a Csrt ieum of Consent b self-i...re for Worker i
Compensation, as provided for by Section 37W of the Lahr Code, for the
_ 'performance of the work for which this permit is issued..
-_ _ ❑I have dad sill r Code n Workers Comance f Insurance,as rt ch thi by anion
3700 of the Lehui Cade,for the perforrcc rr eM1c work for which this permit in
sso'J My W k Is C rep. "i Insurance c nl Policy number arc -,
Curse t t I ria' d YN . + E .� ',' ... .,�,a. \ t, •uJtr
" CERTIFICATION'OF EXPEMPTIoON FROM'WORKLRS' •.r _ e1 s 1 I°v •-S S lr,•, }: 1�I,l�'
+ �.._ ....COMPENSATION INSURANCE'+ _._..-
""�flTis section need ndr be'romplemd if the permit is fm one hurMrcd dolls t ' ^('
1,
(SIfNlJ or lessl�, ,,,r„,
Icresfy.m It.Ute porn sof Ne okf hch Ihs pemut issued,P, + 1 1 p 1.11'+ '
shall not employ any person any b anner so a to oimn s b)ect.o the Workers
f m , .
Cq pe t L o Clf I DI
Applicant
NOTICETO APPLICANT If ft r making the Cer(fcate ofE pt y should'
'bee e
lh t i the Worker C pe . 1 p ort of Um LaborCod y,u m t
Q Q
Anl6livlf tiply wish lah provisions or this permit shall be deemed revoked
..rr.•,. 1•
y a N LENDING AGENCY ,
a;> ncd(Sec, lending agency f the performance'
� .�. CONSTRUCTION
(Sec.3097.Cis.CJ
co
I1ndc,,Address- Ifs -
I h eb firm that the s at
of the work which this ns
L Q 1snticr's Name' -
I rte.ihmlh er hal PPa 1' dsaumooc, b frena nnry
Li .b t r icumun. d bl t I n t d vs J t I rd tog
0 W to hu IJ n8< t cl d h ebp IM10 p 1 foe 'his 'ty m Pon
the ten' t_ d, pony f inspection P ren e. (�/J
fw)'b I s , Ude fly andkeep Imarademnae C'ry atCp ug'nsr,
(Ai Iiab 1 t tc judgnams, n 1 d expense hch y” any y ace g m. said
C.7 .Zn ,City n nuquentn of aming of lh pc 1 / 9
ADPL C 1T U,NDE N 5 AND W OM Y NITN ALL NO / Issued by: /+a_ Date
fY1d
'Signa rc pphcznuCm ser_ - Date Re-roofs
m fia' HAZARDOUS N
tA gaacuRIAIS DISCLOSURE 's Wit" �, . Type Of ROOF - •
W II he' lie t t rt bti(din mnt t hrnlle h N - ... .. _. ._ ... -
,os def ed by flacCuMmim MunicipalCade.ChapacrLiZ andthe Health ansiStificty .G' \
6 ❑Ye1 'a)?_i . I .. ... . . .......nk,4fl" 0'•, l :')*.
a;d� section sss3, 1 Iv,.,.,,.. All roofsshall.be inspected prior-to any.roofing material being.installed.. ._ . .__ .
Will the applicant or future building occupant use equipment or devices which If a roof is installed'without first obtaining an inspection, fame to remove
emit tarentos air contaminants as defined by me Bay Arca At,Quality Management
District!ve: [3 No -=' - - _ all.new materials for.inspection. Applicant understands and,will comply.with_
all non-point source regulations.
1 have read the huimlrgi materials requirements under Chapter 6.95 of the
'Culitorniu Headd&S tty Code,Sections 25505.25533 and 15534.1 undcrnmor that _
if the building ds; ole rtcndy have a tenant.that it is myrcspn,miIdy i,,nmifythe - -- -
,o2cvpa of Me ragmrc'ser which must he sen prior to issuance o a Cenificme of
7 �I�L. _ Signature of Applicant --' Date _- _ . ..
'r / All roof coverings to be Class "B" or better' '
Ihonzed a em .
OFFICE