05060209 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CUI�ITRACETQRNFO�MA ,ION,
BUILDING ADDRESS: W E O'NEIL CONSTRUCTION PERMIT NG'05060209
10281 PARK GREEN LN
WNER'S NAME: PERMIT ISSUE DAM
SILVERSTONE DEVELOPMENT 5245 PACIFI 2005
NE: SANITARY NO. CONTROL NO.
(510) 385-0121
ARCHI'IECUPNGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONfRACI'OWSDECLARATION Job Descri tion
I 1 hereby affirm that I am licensed under previsions of Chapter 9(commencing P
with Section 7010)o(DlvWon Sof the Russians orad Pro(wl..Code,and my license is
InfuEmresAddirect. 2 STORY TOWNHOME 1441 '
Uanse Clens Lie.# Lf 'I lel 03 1
Data Conlmelor Li L' O.✓E/L
ARCHITECTS DECLARATION
Q 1 understand my plans shall to used at public menrds
G Licensed Professional
OWNER-BUILDER DECLARATION
1 hereby mora .(Sere that 11. exempt from the Contractor's :License law for the
p O following inaren. Permit(Section contract.
Business and Rofuuons Cade:Any oily or county
$(4s which its h u•a permit ro ennmvet.alter,Improve,fors,h permit
i ri mash any .lecture $166810
-iiprior m its i ens d r shou main to t e the applicant far such permit u file•signed mumenl
(Oat In Is commecttnsWputaant7000)ofDivisiooftheeBuinessalanselaw(Code)or Sq.FL Floor Area Valuation
(cat he Is log with Sectionm and of Division 3 of the Business and Proon.Any
lad,w or
that he u uempt therefrom and the buss fm the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to s civil perully of Occupancy Type
trot mom than pian hundred dollars($300).
❑1,u owner of the property,or my employcu with"gas as their sale compensation,
will do the work and the structure is not intended or offered far e.I.(Sec.7044,Business Required Inspections
and Prefusuns Cade:The Cormacror's License Law dos ret apply b e an owner of q P
propeny w ho builds ar(mprem thereon,and who data such work h(msel f o through his
own employees,provided Nail such improvements art not Intended monitored fmsale I(.
however,Ne building or improvement is mid within mu year of cempletion.the owner
builder will lave the burden of proving Na he did not build or Improve for purpose of
aau.).
❑1.as awmr of the propery,am uclusively cormorm,with licensed contractors in
construct the project(Sec.70th.Business and Preftaslons Cade:)Th Comolaun's Lt.
cense Law it=not apply in an owner of pretWay who builds or imprum demon,and,
who contracts for such projects with a contracron s)licensed pursuant to the Centradoe.
License Law.
❑1 am uempt under Sec. .B k P C for this reason
Dau
WORKERS COMPENSATION DECLARATION
I hereby affirm m under penalty of perjury am of the following declarations:
*'1 ve and will maintain a Cenifimuaf Consent to self-imam(ea Wmkcr's Compcm.
snion.u provided far by Section 3700 of the labor Code.for the perfomunsc of the
weak for which this parsed it Wood.
❑I have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code.for the performance of the work fmwhich this permit is Wised.
My Worker's Compenmtim Inwnntt cattier and Policy number art:
Cartier.EyfQyul /t^^C7Q/e4^� Policy No.: wt+ 3x73/03 OS-
CERTIFICATE OF PXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu satin need maloccanpkud Kull,permit is finesse,huWmdder.($10()
or less.)
1 cenify Not in Ne performance of the work for which this Permit is Issued,l thall not
employ any permn in any manmrsn as in become subject to the Warkeri Compensation
Laws ar California.Date
APplicam
NOnCS TO APPLICANT:If.after making this Certificate of Exemption,you should
become subject to Ne Worker.Compensation previsions of the labor Code,you moat
wJ O forthwith comply with such provisions or this permit shall be deemed invoked.
Z^ CONSTRUCTION LENDING AGENCY
[+ Ihereby a?rm Oat Nein is a construction lending agency far the performance of
ai 7 de work for which this permit Is issued(Sec.3097,ON.C.)
QLender's Name
gLz landeis Addreu
U Q 1 canary dent 1 have read this application and suss that the above information is
corms I agree an
comply with all city and county ordinances and suss laws mining m
0 building transaction,and hereby authorise representatives of this city to enter upon the
{il abuve-mentioned property for inspection purposes.
gy (We)agree to save.indemnify and keep harmless the City of Cupertino against
in lisbilided.judgments,touts and expanse which may In my any attmc against said City
V 7 in consequence of the granting of this permit.
F7 APPLICANT UNDERSTANQS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE RECO TIONS
-W — i 96440 S Re-roofs
Sgma fAPpBcanuCmftacIm am
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Ne applicam or future building Occupant tom or handle hsardous material
as de0ned by the Cupenlm Municipal Code.Chapter 9.12.and the Heald and Safety
otic.Section 2ss32(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yea J u
WIII the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
1111 t hicardnus air contaminants u denmd by the Bay Area Air Quality Management all new materials for inspection.
DiNict7
❑Yes Nu
1 have mad the hvatdmsmateruhroquiintnamb under Chape r6.95oflhe Califor.
nil Hcalth B:SafctyCude,Secdom25505,25 33 and 25534.1 der undthadthc building
data not curendy hove a norm,that it 4 y responsibility to notify the occupant mf the
require nu which menu be mttptior ounce ah Ccrtincau of Oc Signature of Applicant Date
L23Z ��O r All roof coverings to be Class"B"or better
Owner ter— a�ent Dau