06110056L It yr—
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
20128 STEVENS CREEK BLVD
'ER'S NAME:
PINN BROS
PHONE:
ARCHiTECTIENGINEER:
---
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
rith Section 7000) of Division 3 of the Business and Profess, Code. and y license is
a full force and effect. Lic. B til/ 2
,icensc lass
)arc � Conuactar
ARCHITECTS DECLARATION
I understand my plans shall he used as public records
'-iccnscd Professional
OWNER -BUILDER DECLARATION
i hereby affirm that I am exempt from the Contractors License Law for the
following reason. (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit to construct, alter, improve, demolish, or repair any structure
prior to its issuance, also requires the applicant for such permit to file a signed statement
that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
3 of the
(commencing with Section 7000) of Division Business and Professions Code) or
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars (5500).
I, as owner of !tie property. or my employees with wages as their sole compensation,
intended or offend for sale (Sec. 7044. Business
will do the work and the structure is not
and Professions Code: The Contractor's License Law does not apply to an owner of
property who builds or improves thereon, and who does such work himself or through his
own employees, provided that such improvements are not intended or offered for sale. If,
however, the building or improvement is sold within one year of completion, the owner -
builder will have the burden of proving that he did not build or improve for purpose of
sale )
— PERMIT NO.
TBD — TO BE DETERMINED 06110056
PERMIT ISSUE DATE
SANITARY No. CONTROL NO.
BUILDING PERMIT INFO
Job Description
REVISION ROOF TRUSS CALCULATION
ORIGINAL PERMIT #05080165 NO NEW PERMIT
36903001!
I, as owner of the property, am exclusively contracting with licensed rnntractors to
Cofistract the project (Sec. 7044. Business and Professions Code:) The Contractor s Li-
cense Law does not app to an owner of property who builds or improves thereon, and .
who contracts for such jects wi ntractor(s) licensed pursuant to the Contractor's
License Law. B & P C for this reason
0 I am exempt un
� Date
ter ATION DECLARATION
KER'
I here irm under penalty of perjury one of the following declarations:
0 1 have and will maintain a Certificate of Consent to self -insure for Worker's Compen-
sation, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
0 1 have and will maintain Worker's Compensation Insurance, as required by Section
3700 of the Labor Code, for the performance of the work for which this permit is issued.
My Workefs ompensation insurance carrier and Policy num arc: b
Carrier. Policy No.:
N FROM
CERTIFICATECOMPENSATION R SURANCEORKERS'
(This section need not he completed if the permit is for one hundred dollars (E 100)I
or less.)
I certify that in the performance of the work for which this permit is issued, f shall not
employ any person in any manner so as to become subject to the Workers Compensation
Laws of California. Date
ApplicantP You should
NOTICE TO APPLICANT: if, after making this Ccnificatc of Exemption, y
become subject to the Worker's Compensation provisions of the Labor Code, you must
Z forthwith comply with such provisions or this permit shall be deemed revoked.
Z CONSTRUCTION LENDING AGENCY
(� ►., 1 hereby affirm that there is a construction lending agency for the performance of
a > the work for which this permit is issued (Sec. 3097, Civ. C.)
W A Lender's Namc
:4 Lender's Address
I certify that I have read this application and state that the above information is
U C)correct. 1 agree to comply with all city and county ordinances and state laws relating to
(D U building construction, and hereby authorise representatives of this city to enter upon the
ahovc-mcnuunEIM
d r riy for inspection purposes.
(Wc) ave, indemnify at�d kapp harmless the City of Cupertino against
rA liabilities, judgstsandexpo whi may in any wayaccrue against said City
in consequcanting of s permit{/U Z APPI Ir'ANTND AND , L COMP WITH ALL NON -POINT
SOURCE RFquYYwnb/ L_. it V —d
q1,
Date
Signatu of IicanUCo..N.
HAZARDOUS MATE DISCLOSURE
' Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
ode, Section 25532(a)?
Yes �No
Will the applicant or future building occupant use equipment or devices which
emit hazardous air copLaminams as 0cfined by the Bay Area Air Quality Management
District?
0Yes f7 No
1 have read.the hazardous materi uircmcnts under Chapter 6.95 of the CaliCor-
nia Health & C dc, Sccuons 2 5.2 33 and 25534.1 understand that if the building
docs not cu y vc ten 4 at it isiny rcspons lity to nosily the ot:cupant of the
renuimmcnlsfWlti bcm prior wjsfuancc�Pa CcnifKam�o�(Occu�ajrt�
Dale
Issued by:
Re -roofs
Type of RJOf
oor Area
$0
Required Inspections
Occupancy 'lype
All roofs ihall be inspected prior to any roofing material being installed.
If a roof i; installed without first obtaining an inspection, I agree to remove
all new rr aterials for inspection.
Date
Signature of Applicant
All roof coverings to be Class "B" or better