05060210 CITY OF CUPERTINO " '<w.`"'r
BUILDING DIVISION PERMIT ,,, URA.��TQR I�NFORMAT.I�ON ;g
BUILDING ADDRESS: W E O'NEIL CONSTRUCTION FEpMITNo'05 O 6 O 210
10283' PARK GREEN LN
OWNER'S NAME: PERMIT ISSUE DAM
RNSILVERSTONE DEVELOPMENT 5245 PACIFIC 08/29/200S
E: SANITARY NO. CONTROL NO.
(510) 385-0121
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�oo LICENSED CONTRACTOR'S DECLARATION Job Description
ldc 1 herby affum that 1 am licensed under provisions of Chapter 9(commencing
with Section 7001)of DNWon 3af die Butane and prefuWans Cade,and my lie..is
+� infallfaceaneert—ey " / �— 2 STORY TOWNHOME 1441 '
. f llfCw tae.« N44 03/
DaW Co0llamnr
e ARCKr ECrS DECLARATION
1 understand my plan shall W umd As public records
3
O y I.ieented PN(ClYaMI
3 OWNER-BUILDER DECLARATION
qy I herchy.(Sero that 11. exempt from Ho Connector's License Law for the
follo`p o
which
massa.permit
U Ln LS,BIISIR99 and ProlaminesdcovAI C.or:Any shy or actum,
$� which rcyvima•permit m enowet.sites Improve,dcmnlbh,or repair any swdure $166810
_Zu, prior W its Waseca.al.mquiro He applicant faMMh permit m Dle asignW.tatemcnl
that he is llcenrad paranaal W We provisions of ftConowuWe license Law(Chapter 9 Sq.Ft.Floor Area Valuation
$ (commencing with Section 7000)a(Division 3 of the Business and Professions Cade)or
that k Is exempt therefrom and the basis for the alleged exemption.Any violWon of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of Occupancy Type
not more Nan five hundred dollars(5300).
o1.uownerofthepopery,amyemployeewhhwguut 4mlec wnudon,
will do die work,artd wasuaaure is not Intended or offered foaale(See 70m,Business Required Inspections
and Profusions Code:The Contractor's License Lew does net apply W an owner of q P
property who builds or ,i mpery r,thereon.and who does such work himself or through his
Own employces,provided Wlsuch imp awments an,notimended oroffered for We.IL
however.the building or improvement is mid within new you of mmpledan.the owner-
builder will As.the burden of proving Nat he did not build or improve for purpose of
Asia.).
❑I.as owner of the property.am exclusively caressing with licensed connadars to
construct the project(Sec.7014,Buineas and Prowstlons Code:)The Comae ear's LI-
cense law does non apply W an owner of property who builds or improve Hereon,and,
who comer eta for such projects with a conuaeums)licensed pvaunl W the CMtrmlor's
License law.
❑l am exempt under See. B d:P C fm this moon
eDau
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penally of perjury out,of the following declaw lona:
❑I haveand will maintain•Cerdnccwteof C.nunt W self-urate far Worker'.Compcn-
Wion,as provided for by Seeton 3700 of the labor Cade.fm to performance of He
work for which this permit is issued. -
❑1 have and will maintain Weakeri Compensation Insurance,As required by Secton
3701 of the Labor Code,for the performance of the work for which this permit is issued,
My Worker's Compensation Insures artier and Policy number are:
Cartier.,ZVKICN �pull iryNo.: TVG3533103-0
CERTIFICATE OF EKEMP ION FROM WORKERS'
COMPENSATION INSURANCE
Crhis section reed notbucomplewd If to Permit is fmanchundred dollars(SIM)
or less.)
1 certify that in the performance of the wart for which this permit is WOOL.I shall not
employ any person In my manner an As W became subject to the Worker'Gampersadan
Laws of California.Dow
Applicant
NOTICE TO APPLICANT.IL after maltng this Ceniaate of Exemption,you should
become sobjm W He Worker's CompeMaunn provisions of t e labor Cade,YOU mar
,JO forthwith Comply with such Produced Of His Permit shall hmroo
e deemed ranked.
zy CONSTRUCTION LENDING AGENCY
(..,.. 1 hereby arum Het glare is a consioctnn lending agency far the performance of
pYi m7 to wank fur Which that permit u issued(Sec.3097,CH.C.)
W Q Lemler's Nam.
7 z Lender's Address
U O 1 codify Hat 1 have mad this application and state that the above infoanmen b
It,Fcamel.I agree to comply with sal city and county ordinances and sou law miming to
QU building construction.and hereby authodm repreaenmives of this city W eoer upon the
W above-mentoned property for inspection purposes.
pry (We)agree W save,indemnify and keep harmieo the City or Cupertino against
VI liabilities,judgmems.com andexpenses which may in anyway accuse against old City
U incoAPPLICANT UNDEofthe RSTANDS I D WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOU CEREGULAn NS.
2 Re-roofs
Signatu ApplicanUConuamor Da
HAZARDOUS MA ALS DISCLOSURE Type of Roof
Will die applicant nr future Wilding=pan[Tore or handle hvudaus material
As donned by the Cuperdno Municipal Code,Chapter 9.13,and the Health and Safety
Cede,SCcton 35333(a)7 All roofs shall be inspected prior to any roofing material being installed.
[3 Yes elaa
Will the applicant or filum building occupant ase equipment of devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit harudnus air commumanu as cicnecd by the Bay Area Air Quality Management all new materials for inspection.
Dimicm7
❑Ya doll
I have mad the WiMmsmateualsmquimmenuundcr Chapwr6.95 af the Califer-
out Health BSafctyCode,Sectiurg235D5,25533 sm129334.1 ualcumaid teati(de building
docs not cwou my hew a tenant.UW It u my respnnswal ty to redly to occupmt of the
myui v wb ichmusmbcme orWLuunmofaceirmaworocmpmey. Signature of Applicant Date
3` All roof coverings to be Class"B"or better
Owner orf homsd ager t Dau
L