06020031 CITY OF CAUPRETRTT.VINRO d'� ty ^'"
BUILDING DIVISION PERMIT ,COI�7TCT,O�tIN7QRMACION
STQNR R2
BUILDING ADDRESS: PERMIT NO.0602
0031
EWS NAME: PERMIT ISUE DATE
' SILVERSTONE 2006
NE: SANITARY NO. CONTROL NO,
ARCH= GINEER: BUILDING PERMIT INFO
BIS 0 PLUMS
l� t�
30o LICENSED CONTRACTOR'S DECLARATION Job Description
rd 1 hereby th
nation l am licensed under pon,mo r,of Chapter 9(commencing p
wiNSeclion7OM)ofDiviaion3ofthe Buri mUWProfcsdom Code.udmylicenmu
^ mfull roreearaAffect.
REVISION-MECHANICAL. PLAN-SILVERSTONE R2
LP,j? License ClwLte.g
s� Dam Contractor NO NEW PERMIT-ORIG #05030078
ARCHITECTS DECLARATION .
I understand my plans shall W used As public records
]4 O
a O Licensed Professional
g
OWNER-BUILDER DECLARATION
4�q I hereby aUirm that I am exempt from the Contractors License Law for the
0 o following moron.(SCctiun 7113 1.5,Business and Professiona Code:Any city or county
which requires a Permit to emwruct,alu r.improve.xmnluh,or repair any stmcture
prior in its issuance,also requires the applicant for such permit to file.signed ata.froM
zFF< that heulicensed pmsuantmthe provisions offtContractor's Liums,Law(Chapter 9 Sq. Ft. Floor Area Valuation 0
5� (commencing with Section 7000)of Division 3 of the Business and Pmfcadons Cook)or
3 Rut he is exempt Ihemfrom and We buss for Nn alleged cremption.My violation of
Section 7D31.5 by any applicant for a permit subjects the applicant in a civil penally of APN Number
Car mimman five hundred dollars($500). Occupancy TY
pe
01.as owner of ON,properly,Or my employees with wages As their sole compensation, 36940002 . 00
will do the work,and do, =,to.is not tnteMed or offered W.M.(See.7044,Business
.it Profmnana Cox:The Communes License Law does Cat apply m on owner of Required Inspections
property who builds or i m proves thereon,and who does such work Mmmlf or through his
own employm,provided thin such improvements are not intended crolfered for nate.If. �n
however,the building or improvement is sold within one you urcmmpledm.the owner. C_
ImHiker MR have the Wtaen of proving that be did not build or Improve for purpose of \
talc/,),� .(^
B 1,u owner of Rte propene am exclusively contracting with licensed canuamon to \V
construct the pmjm(Sec.7044,Business and Professions Code:)The Contrxmr's Lt- \\
cove Law data not apply m an owner of property who Wilds or Improve Rieman.and,
who comracu for such projects with aeomamor(O licensed pursuul in the Coronaries
Liccm Law.
❑lam emmpt unser See. ,Bk PCfa do on
me ?- /f
WORKERTCOMPIENSATION DOEARATION
I hereby aRhm under penalty of perjury one of the following dslantions: -
1 have snit will maintain a Certificate of Consent to self-Insum far Worker'. Ari
u provided mtics for by Section 37M of the Labor Code.for the pe fmaof the
cantle for which this permit a Issued.
❑1 have and will maintain Workers Compensation Insurance,u required by Section
3]00 of the Lamm Coda,for the performmee of the work fast which this permit is issued.
My Worker'.Cmnpeuetion Imunntt carrier and Policy number art:
Cartier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu acction need not W compleed If the permit is forms,hundred dollars(SIM)
or kat)
I unify that In the performance of the work for which this permit is tumid,I shall nm
employ anypersun in any many�er s�ulq l�mm subjecuo the Workers Compensation
Laws of Califar' Dam / / ff d /
Applicant /
NOTICE TO APPLICANT:If.after making this Ccnifica of Exemption,you mould
become subject to the Worker's Compensation provisions of the IsWr Code,you must
O forthwith Comply with such provisions or this permit shall W deemed revoked.
CONSTRUCTION LENDING AGENCY
'(•v.�-v I hereby affirm that them to a construction lending agency for the performance of
? the work fur which this permit Is issued(Sec.3097.Civ.C.)
Q finders Num
= z Lender'sAddress
U Q I certify that 1 have mad this application and sum mat the a Wve information is
correct.I agree to comply with all city and county ordinances and sum laws relating on
O building canswctma,esa hereby wilocrlve representatives alms;city to enter upon the
W above-mentioWd property for lupection purposes
py (We)agree to save,indemnify and keep harmless the City of Cupertino agaimo
y Ilabilities,judgmenu,emu and expenses which may in any way mm
es against mid City
[.)Z in consequence of me granting of this permit.
^� APPLICANT UNDERSTANDS AND WI OMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
�a� r ;n2-/f� 94 Re-roofs
Signuurt ofA canUCa umm tea¢
HAZARDOUS MATERI MCLOSURE Type of Roof
Will IM applicant or forum Wilding occupant mom orhandte huuaous material
As de0ned by the Cupertino Municipal Cade.Chapter 9.17.and the HCaW and Safety
Section 255320)? All roofs shall be inspected prior to any roofing material being installed.
❑Yca
Will the applicmt if furore W' ing occupant us,equipment or devises which If a roof is installed without first obtaining an inspection,I agree to remove
I hexarorus air conuminanu ,fund by tiro Bay Area Air Quality Management all new materials for inspection.
ic17
❑Yea Nu
lhavmesd thehuArdmsmamrlall mquimmenuunxr Clupter6.95ofine Califor-
ni.HealthhSatelyGed0.Sectlous255D5.25533.d25534.Iummound thatifthe Wilding /
doss not currenly haw a mnem,Rut II u my neo ma. ty in notify the p¢upant of Are -
requirementswhichmustbnmelpoorwt u eafaCcrulicamofoccupNCy. SlgnatUr of Applicant Date '
2 f All roof coverings to be Class"B" or better
caner ar estb sdagcnl p