04070055CITY OF CUPERTINO
BUILDING DIVISION PERMIT
CONTRACTOR INI+ORMATION
BUILDING ADDRESS:
J. M. O'NEILL, INC
PCRMIT NO. 04070055
ER'S NAME:
PERMrf ISSUE DATE
'NE:
-SANITARY OL NO,
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hcmby affirm us,1 am licensed under pmvmons of Chapter 9 (commencing
- P
with Seefion 7") of Divisi f Ne Busineas and Pr.fessium Code.and my he. is
Gicenow ?" � ¢4—
TI--REPAIR STAIR/BALCONY/HADRAIL
Dam contrctar
ORIG. #03040064 EXPIRED/REVISION-403090064
ARCHITECTS DECLARATION
I understand my plans shall W uxd aLpuyit mcards
i�
Ip
I^��pV■■AL&D
Licensed Professional
OWNER-BUILDER DECLARATION
1 hereby (firm 1 cxcmpe from Nc Conlranoo Law for Nc
Any
c
Com: Any city in county
on 1. :
reaso . ](IJL5,Business and
Following reason.
ennsw0. alter. improv, he
which requires a permit improve, demolish,
aroma or repair any swment
re ermit t
in ,r N s licensed issuance, alau on I. tW dro ismax or forthe such Conpermit m f le a signet autement
thathe Putmam mtW a Lkenxlaw (ChapterCode)
theehe
Sq. Ft. Floes Tea Valua[o4500
or Diviouaf Buacmr
or
mencCnJc)or
(commencing with section 70)(y) of Division) oftheeged
Any
that he is li and Nc bask for alleged exemption.Any violation of
be Beamt
1.56y anyreddolltfor permit subjecu Ne epplieuruo .civil penalty of
31.5 b any ap
APN Numb Occupancy Type
s(a
not mom man Eva nanama dollars (ssoo).
not mom than
1 r
❑I.ssa«nu or Ne proprsaY. or my employe. wuh wagasu their sok compewtlan.
32633103.00' • k
Required Inspections
will do Ne work and Ne,m mure is nos intended m.neral for aah, (Sec. ]04d, Business
and Pmfeuions Code: The C.ntracmrs License law does not apply to an owner of
pmpeny who builds or improves Nemon, and who doeesuch work himselfor Waugh his
own employers, provided that such improvements are not intended orolfetea for sales If.
however, the building or improvement is sold within ane year of completion, Ne mart.
builder will have the burden of proving Nat he did not Wild at improve for Fulgox of
sake.).
1. as owner of the peopeny, am Caeluslvely contracting wit licensed contractors t0
eonstmm Ne project (Sec. 7004, Business and Professions Code:) The Convaemr's Li
_
came Law docs not apply in an owner of properly who builds or improves themon, and
who contracts for such pmjecu with a canmactags) licensed purmem in W Conuacmrs
Lcense law.
I aexempt under See .B&P C far this ..a
m
cr Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following decumfions:
thaw and will maintain a Cmdfmwx of Cement o self-insure far Wurkcrs Cma ce.
cation, az provided for by Session J]00 of Ne labor Code. for the peRarmame of the
work for which this permit is issued.
1 Aave and will maintain Wader's Compensari.n Insurance, az required by Section
171 of thc labor Code, for Ne performance of the work for which this permit is issued.
My Workers Comperoati.n Insurance arrim and Policy number am:
z
Carrier.�� Policy .:R p���
`F
EKE
CERTIFICATE OF EXEMPTION FR WORKERS'
RTIF
COMPENSATIO%111 CE
(This actedneed nm W completed if t\k/Ircrmit is tar one hunch/ dollars (s1110)
or ksa.)
1 cmufy that in the perfosmanec of the work for which this permit IS issue., I shall not
.mploy any .an in any manner x az to become subject to W Winlen'' C"mpcnsmirm
Laws of Califomia. Dat,
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject to Ne Workcr's Compensation provisions of Na tabor Code, you muse
faMwith comply with such provisions or Nis Permit shall be lamed revoked.
CONSTRUCTION LENDING AGENCY
I hereby tm that Nene is lending agency Ito Nc performance of
which s ed (Section
Lies work for which Nis permit is issued (Sec. 7(197. Civ. C.)
Lender's Nmnc
/
lender's Address
1 ttnifyee Nn I hese this is
and sol¢ mat the .bow iws
city totaling
commit. 1 agree were all city and county nNinanm and sure laws redoing to
with and county
etcomply
ogand lforcbyauNomemprexnutivu of Nis City menter upon Nc
abovengcotioned a purposes.
above-mentioned property for im indemnify
(We) agree b save, indemnifyes keep may wyacep Capertonagainst/
j may in any way acrnu against said City
liabilities.judgments,ft
and expc"xcory
cgrsu
' uenea of Ne gran' is pc 11
1 APPLI ANT UND ANDS ND ILL OMPLY WITH ALL NON-POINT
Issued by: Date
CER G L
Re-roofs
Type of Roof
Signor of AppiicanVCon—,., r Data
HA]I�RDOUs MATERIALS DISCLOSURE
Will the applicant., future building occupant nam or handle bvudous material
az defined by one Cupenino Municipal Code. Chapter 9.13, and Ore Heald and Safety
e. Section 35532u)7
All roofs shall be inspected prior to an roofing material being installed.
P Y g
❑Yes Na
P g
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building accupant use equipmcm ar devices which
it havardo. air contaminants as deGn,d by Ne Bay Area Air Quality M.... cmcm
all new materials for inspection.
District?
❑Yes SU u
materials
1 have mail me emardous requirements under Chaplerh.95 of Jur Califon
nu fkalth&Safety Code. Sections 35505.35533 and 35534.1 undcmmnd thaifthe Wilding
Jyr+rrw �curscnI, Wveac mt. thm it my res'notilay�mnndfy me upan1 of on,kCyuimrtrdn
to at n mi asnccofsccm'frcTtg&fCca ry.
Signature of Applicant Date
1 \ 8to
All roof coverings to be Class "B" or better
own, N
raummi.dagam Dole