05020059 CITY OF CUPERTINO
BUILDING DIVISION PERMIT ',CONTRACTOR INFORMATION' ,
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BUILDINO ADDRESS: PERMITNO.
W E O'NEIL CONSTRUCTION 05020059
' OWNER'S NAME: PERMIT ISBUE DATE
ARY QatOL N0.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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LICENSED CONTRACOR'SDECLARATION JobDescri tion
1 Mrcby affirm Net 1 am licensed usurer provisions of Chapter 9(commencing P
with Soence md10)of Division Sol Ne Budnessand Prvfegaiuns Code,end my licence le
^ in full farm end effem
]'off Linenma Lk.g GARAGE STRUCTURE-FOUNDATION ONLY
Dim.Contractor ARCHYIECTSDECCLARATION UNDER PODIUM.
L$ 1 understand my plans their M used u public records
5C Lkensed Prof casinner
.OWNER-BUILDER DECLARATION
I hcrchy eUkm that 11. exempt from the Contractor's License taw for the
O o
which
ng mown. cant, 7031.5.Business and Rafessku Cade:Any city at county
which nqulma sentence,emso re cares the eller,improve,h per it t car repair any taroclme
prionniucensedalm requires the provisions
Of for such Penntuo s e Law statement
_< Nommeningwitpurbant u the pmWdonsOf Ne Conusiess (Chap=9 o,c)or Sq.Ft.Floor Area "236
$ (ca,W 1.exampt Sectionrn and the
Division ssur Of the al egad cared Prommion.Myons Cane)or
.. Nal he b aumpt Nenfrom end Ne bub fm the alleged exemptive.My violation of
Section 7031.5 by any applicant for a permit subject,the applicant to a civil penalty of APN Number Occupancy Type
not mom Nan five hundred dollars($500).
Di.u aweaa Of the Property,ar my employees with weses a a web nk eampenndae, 36940002 . 00
will do the work.md thestsuctu,b unstructured orolfend forum(See.7044,Bwbaeu Required Inspections
and Professions Code:The outhouses Limnk remr law does t apply to an owof q P
property who befitting improves thereon,and wha does such work himself or through his
Own employens,provided that such Improvements art not intended oroaered fmsak.If.
however,Ne building or Improvement Is sold within ore year of m nFlo0on,the owner- FIN
A
builder will have Ne Darden of proving Nhe at did not build or improve for puPurposePurposeor ��
builds u �\®�r/L''IB
I,u Owner of the property,em exclusively contracting with licensed contractors
cbutbet the project(Sea 7014.Badne ,and Profeasions Code)The communes Li-
I.w does bol eppl msj owRen ropeny who builds or Improves thereon,and,
who canasta fan %ai c tor(U licensed purbem m the Co.=t0es
Licence Law.
❑nem tae On c .BdsPG this u BUILDING J
Owner Dan ,IU° LDING
MPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following decimations:
haw and will maintain eCerdOcak of Covent k¢I6lasu ,for WodreetCampen-
btlon,u provided for by Section 3]00 0(die Labor Cada for Na per(ormancc of Nc
work for which Nis pumit Is issued.
❑1 ban and will maintain Worker's Comperm lon Wunnce,u required by Section
3700 of Ne labor Cade.far dee peemnownse of Ne work for which Nis permit is issued. _
My Worker's compensation Insurance carrier and Policy number w:
Cartier: Policy No.:
CERTIFICATE OF EXEMP ION FROM WORKERS'
COMPWSA71ON INSURANCE
(This section need not he completed If the Perot,Is foronahundmd dollars($100)
Or legs)
1 unify that In Ne performance of Ne work for which this permit Is issued.I shall not
employ any town In any manager an u b Is mmesubject to Ne Workers'L'ompenu len
Laws of Califsmie.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subjcn no the Workees Compensation previsions of Na tahm Code•you must
.,0 forthwith comply wide such provisions or Nb m permit shall be deemed Orked.
'Z'ti CONSTRUCTION LENDING AGENCY .
F (busby alrmn deet pen is a couuucunn lending agency for Ne pommumm or
Gv
the work far which this permit is issued(Sec.3097,Civ.C.)
WM Q lendces Name
a,z Lender's Mdmas .
Vt 1 ceNfy that I have rodage mm this application amm Nu the above infomuuun b
U correct.I agree to comply with all city and county ordinances and sure laws minting to
C7 building connotation,and hereby eulhotin representatives oftht,city in encu upon Orc
W above-mentiaoed pmPenY Ter iupenian Purymea
(We)agree to save,indemnify and keep bombast the City of Cupertino against
zy Ilebiliuu.judLmenLL.Inst,an4 expenseg which may in my way amue against said Cityin _
V^� of the granting of thrmit.
APPLICOUNDERSTANDS AaND
ANTWILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signature of ApplicanVCanDate
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building ouupanl stare or beware hevardons material
as;defined by the Cupertino Municipal Cade,Chapter 9.I2.and the HcdN and Safely
,MLCocm.S�Yeg �Nu aUea 25532(.)7 All roofs shall be inspected prior to any roofing material being installed.
>
Will the applicant or future building occupant use equipment or dcviceg which If a roof is installed without first obtaining an inspection,I agree to remove
it harmimm air contaminants u defined by the Bay Area Air Quality Management all new materials for Inspection.
Dustin?
❑Yes No
I have mad us N reek- em immenuundcr CTapkr6.97oftheCaliror-
Mcrmaid, S a Cade. 0 3end25534.1undcnunduWlflhe building
does not entl haw 4 t ny"4 my mapouibilhyy ratify dee a//cupan�nf Ne
Occur cn �lu"rlmut,sum I togs':�W Signature of Applicant Date
Own_ wCr� favlr6nmaeseN JCl/ Date All roof coverings to be Class"B"or better