06050131 CITY OF CUPERTINO �a,�� x-'j+��rYp�sa �,' f� �`'�° y-'��'� "BUILDING DIVISION PERMIT �OA\'`iltIAG 01R' N'F4,L�1 A TO
BUILDINGADDRESS: W E OINEIL CONSTRUCTION PERT"ND'06050131
DE ANZA SILVERSTONE R2
ER'S NAME: PE MIT ISSUE DATE
A
SILVERSTONE COMMUNITIES 5245 PACIFIC
E: SANITARY NO. CONTROL NO.
(510) 385-0121
ARCHRECTrENGINEER: BUILDING PERMIT INFO
BLDG ELECT O PLO MECH
O
ioij LICENSED CONTRACTOR'S DECLARATION Job Description
i U I hereby sairse done I Am licensed under Provide"of Chapter 9(commencing P
With Section 700D)of Division 3 of the Business and Prefeteivn Code,and my license is
in full forte and effect. REVISION-TITLE 24 CALCS FOR R2-R13 SOME WALLS
i License Class Lk.g
Dam Contractor ORIGINAL PERMIT #05030078 NO NEW PERMIT
1 ARCHITECTS DECLARATION
i 1 undersand my plans atoll he used as public records
ie.0 Licensed Pmfcssimnal
y Oe[I AM cU olt from
DECLARATION
I a I heaby.(Rem on I nm ucmpl arum W QOndmrora e:Any c Law for the
-p o following aason.(Section 703 1.5,Budnesa roti Ren.demol Cade:Any city '=lure•$ which requires a permit re cores deb alter.hnprow,demdNh,or mash ed mucus
prior u its Issuance,alsorequiresW On the inoumf for such Cmarsemitwicome file a AW(Chapter
s Q
that
ommencoseucdpSectmtuDePmWiomuithe eBuhahlxcnselaw sCode)9 Sq.F[.Floor Area Valuation 0
$
(commencing excwlthhecdon]0DO)of andPaDrvbion3 of theeged exemton.Any
Code)or
hart ha le sumps Ikferrom and doe buts it We ctsSeO eaempts us Anal violation of pp+�)T yA�,]tJtpb� •�
Sections 103I.5 by fin
appLLesn(for a permit subjects the Applicants ro e civil prmlty of 3 6 9 Y V U U 2 T 0 0 Occupancy 'J'Pe
Am mart dont Rw hundred dmllus(5500).
1,u awnv ofuw property,or coal wPloym wIU wages u Heir vele eompenaetion.
will do the work and Red mavu ,is Was uulded or offered far sake(Sec.7014,Bnarcas Required Inspections
and Professions Cade.The Contractors License n LAW dom1 apply 10 an owner or q P
property who build,or improve dream,and who doss such work hiwelf or through his
own employou,provided that such improvements arc not In"MM or offered for We If,
however.the building or Improvement i,sold within one year ofcompledon,the owner,
builder WILL haw the soden of proving that he did cot build or Improve for purpose of
sat.).
co Las owner of the property,am
Business
and Professing with licensedcontractorsi.
Prnuuv site project(Ser.toed,Boer of and property
Profession Cade:)The Covdsemra rad \
cone law does cot apply u to owner of property who sedda v improves doertm,and,
wM.Lace for auc4 projects with semuumdU licensed punwnt u On Contractors '
0 14M Law. \
❑lam esempt undo See .BBPCfor this Mason
v Date-
WORKERS
auWORKERS COMPENSATION DECLARATION
1 thereby affirm under penalty u(pe0ury one of the following desciamdom:
OIhave and ode for
by
37M of the Labor
Cof fe,teWortmanceopen-
wlm, r which
this
(or by Section 3]00 a(ate labor Cade.fo W peAoemaoa,(doe
wale for which Nis permit it(sued.
O I have and will maintain Workers Compensndon Insurance,As festooned by Section
3]110 ofute labor Code.for use perfovmaoa clubs wart for which do$permit ts lowed. '
My Worker,Compensation buurmcc carrier and Policy number art:
Carrier Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS ,
COMPENSATION INSURANCE
(This motion Med nolM completed If ate permit Is foone hundred&It—(5100)
or lets)
1 anify that in the performance of the work for which this Permit is Wood.I shall no
employ any person In my mmnerso As At become subject to the Worker Compensation
Laws of California.Dau
Appuont
NOTICE TO APPLICANT:If.after making thin CenlBcae of Exemption.you should
biome mbjev to the Wormej Compensation provision of the Labor Coda you most
.,O forthwith comply with such provision or Nis permit shall k named eed.
vok
'Z y CONSTRUCTION LENDING AGENCY
(—t Iheaby.M.Wl them lsaconmuetion lending agency for the per(urm.uf
C> the work for which this permit Is issued(Sec 3097,Or.C.)
�^n• Landers Name
a z Lenders Address
U C 1 anify that I haw road this application AM sue done the show information Is
U.P correct 1 atme of Comply with all city and cowry oNinmea And sass IaW%reladng to
DU Wilding construction.and hereby authority mpresenariva of this city to cnmr upon the
W •hove-otmioned property for inspection purposes.
gy
(We)agree a saw,indemnify and cep harmlw dw City of Cupcnino against
liabilities,judgments,costs and expenses which may in my my mane against add City
U Z to consequence of the Standing of this PermiL
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: �6iDate
SOURCE REGULATIONS,
Re-roofs
Sigouurc of App1lcmVCaDate
HAZARDOUS
S MATERIALS DISCLOSURE Type of Roof
Will Oso o Cupertino
o future building oanpmterme arhaMlc hassAoese
as defined by ate Cupertino Municipal Code.Chapter 9.13,and the Health rotid Safety
1.
Section 35533(4)] All roofs shall be inspected prior to any roofing material being installed.
❑Yes ON.
Will to applicant or future building occupant sec equipment or dMm Which If a roof is installed without first obtaining an inspection,I agree to remove
emit hanrdoua,ir contaminants u defined by the Bay Arca Air Quality Management all new materials for inspection.
District?
❑Yes ONO
I have read the hamdws materials aquioments under chapter 195 ofdte Califio•
nia Health&SafctyCM,Secdon35SO5,35533md25534.1un r=WNetiNc building
does not currently haw a tenant that it is my responsibility to wiry the occupant of the
requirements which most be cost prior Of Issuance a(A Cotifcaw of Occupancy, SlgnatU Of Applicant Date
Owner or anO.n.dagent Dow I I All roof coverings to be Class"B"or better