06050004 CITY OF CUPERTINO
BUILDING DIVISION PERMIT ..,CU I'TI2�iGT(TR�TI 'owmq,ION
`i54i0, " P av 3S •row„ a4V!?
BUILDING ADDRESS: W E O'NEIL CONSTRUCTION PERMIT N006050004
DE ANZA SILVERSTON
OWNER'S NAME: PERMIT ISSUE DATE
SILVERSTONE DEVELOPMENT 5245 PACIFIC CONCOURSZ_DIUVE 06/16/2006
Et SANITARY NO. CONTROL NO.
(510) 385-0121
ARCHITEC?ENGINEER: BUILDING PERMIT INFO
BO EQ PLUMB MEOCH
X00 LICENSED CONTRACTOR'S DECLARATION lob Description
u I hereby IMM Nn 1 am licensed under provisions of Chapter 9(comme Cing
+�
IN Section 701111)of Division 3 of the Business and Pro(culon,Code,and my(kens Is mmnmrceamaffect. REVISION-STRUCTURAL .AT STAIR #4
301: ownteanss tractor ORIGINAL PERMIT #05030078-NO NEW PERMIT
DflARCHITECTS DECLARATION
1 understand my plans shall be used as public records
58 Licensed Pmfcnionsl
OWNER-BUILDER DECLARATION
CS I hereby affirm that I am exempt From Ne Contrxmrs License Law far the
0 O fallowing reaann.(Section 7031.5,Bumnues and Profevioes Cade:My city ter only
which requires a permit in contract,alar,improve,demolish,or repair any sbamare
_Z to prior err its issuance.sun requires ft applicant(ormrch permit to file aligned matee
mm
<
that heisllmnsedpunuenttoNepmvisiova(dsContractor'sLicenslsw(CTapter9 Sq.Ft. Floor Area Valuation 0
�th (commencing with Section 7000)of Division 3 o(the Busineuand Professions Code)Or
drat be Is esempl tbemfmm and the bull fm the alleged uemption.My iolumm of ppN N Qt
Section 7031.5 by any applicant for a permit subjects the applicant m a civil penalty of 3 6 9§0�U r 0 0 Occupancy T)pe
mart than an five bundmd dollars($500).
❑I,uOwner of de pmpmy.ter my wplOyca with wgau Nev sic eampevadon,
will do the work and Nestntnum b nelkteMed oranerad farde(Sm.70th,Busiws Required Inspections
and Profeulans Code:The Conumelor's Liens Law ciao Out apply m e an Owner of 9 P
propenywhO Wildsorimprems,th ncen,and whodoessuchwarkhiauelfor through his
awn employes¢,provided Cast such improvements are nollntanded oraQered(orde if.
however. building origin of imentlsmlde didOneycar orweplefarps. uowe r.
of /J \
buedar will have 11e burden of proving that bo did Out WIW or Improv fm purpose of
ask.). r•�
❑1.a owner of du Property,am exclusively contraning with licensed co oactam in
constroc7 the project(See.7014.Business and Professions Code:)The Contractors U. V r�
Lic cLa
ave Law does not apply m an owner o(proper y,who Wills ter Improwa thereon,and, `+
wic rnnwcu(ter ouch projects MN a contranor(a)Iianmdpunesm m the Convsetora
ense w. V
❑lam exwpt undo gee .08 PC(m Gds won
a
-case-
WORKERS
meWORKER'S COMPENSATION DECLARATION
I hereby a0km under penalty of Perjury arc of the following dcclasNmte:
❑I haw and will msinuina CaliOese o(Caesentm self-WurtforWorkoraCompm-
saUan,a provided for by Section 37M of the IJWr Cade.for the performance of lam
work for which this permit is issued.
❑1 have and will maintain Workers Compensation Insurance,as required by Section
3700 of the Lobar Cade.for the peRamra ofthe work for which this permit 4 issued.
My Workers COmpemation Intron artier and Policy number are:
Calver: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS*
COMPENSATION INSURANCE
mussNon need net becmnplemd iflhe permit Is(ma a huvdm l do uds($100)
or Ins)
1 certify Not in the perform.of tbe work for which this permit is issued,l shall not
employ any person in any manner to as to became su*ct in the Worken'CompemNan
Lewy of Califoda.Data,
Applicant
NOTICE TO APPLICANT.If.after making this Certificate of Exemption,you amid
become subject in the Workers Compensation provisions of Na Lader Code,you mut
z forthwith comply with such provisions or this permit shall W deemed revAked.
z` CONSTRUCTION LENDING AGENCY
E~ (hereby vition that Cert is a Construction lending agency for dm performance of
CL the wark for which this pencil is issued(See 3097,CN.C.)
W A Lenders Name
Z)z I<ndOes Md.
U O 1 ceN(y,that 1 haw read this application and sou that the above information 4
j, F correct 1 agree to comply with all city and county ordinances and sum laws relming to
0 U Wilding Construction,and hereby authorise represemativa of this city to enter upon the
W shave-mcnduncd property for inspection purposes
(We)xsrce mart,indemnify and keep harmless the,City of Cupertino against
ij"ly fA liabilida.judgments,casts and camouea which may in any way secret,against cid City
in
U rZr APPuence of the grenting of this permit.
LICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signature of AppBandCom DO Dau Ty of Roof
HAZARDOUS MATERIALS DISCLOSURE Type
WIII the a Cupertino
or future building occupantemre w handle h eardoanmaterial
u deRned by the CupeNne Murdcipal Cade.Chapter 9.12.and the Health and Safely
aae•sectionx55324)7 All roofs shall be inspected prior to any roofing material being installed.
Ora 13 No
Will the applicant or future building occupant us equipment Or devices which If a roof is installed without first obtaining an inspection,I agree to remove
Anvil haysrdoes air cestamim nu u defined by the Bay Ara Air Quality Management all new materials for inspection.
District?
❑Yes ONO
I have mad the hnarGwmucrWs requirensents under Chapterd.95 ofthe Cali(ar-
nb HcefO&SAfety Cada•Sccdons25505.25533and2553A.lundenundthui(Ne Wilding
dao not emmmly have a tetra,Cut it u rey ompodhility a mdfy tie occupant of civ:
requiremcnuwhich mum be met pdorm issuance ofa Certificate of0c"pancy. Signature Of Applicant - Date
Owner err sulhorircdagent Data All roof coverings to be Class nBn or better