05060208 CITY OF CUPERTINO t
BUILDING DIVISION PERMIT i�CONTRACTORA DIZMATION
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BUILDING ADDRESS: W E O'NEIL CONSTRUCTION PERMITNo05060208
OWNER'S NAME: PERMIT ISSUE DATE
SILVERSTONt DEVELOPMENT 5245 PACIFIC! 08/29/2005
E; SANITARY NO, CONTROL NO.
(510) 385-0121
ELECT
ARCHITECT/ENGINEER: BUILDING PER
INFO
BOLOG O PD O
Y0M LICENSED CONTRACTOR'S DECLARATION Job Description
1 boreby affirm that l am licensed under provisions of Chapter 9(commencing
with Section 7000)of Division Sof the Buenwand Profcsslnns Code,amy license is
In murarteandeffam. and 2 STORY TOWNHOME 1306 '
Z Lkenm CI Lk.1 . 41 ImLo3l�
Dam Gonuxcnl - N
ARCHITECTS DECURAT N
�i 1 understand my plan shall W used u while reeada
3 y Licensed Professional
p
OWN ET-BUILDER DECLARATION
40 1 normal.
on 11. acmpl from the Cssions o License Law for me
a C following rcuoa(Semon 7031.5,Business and improve,
de un Code:My city or aunty
$ which requires
su n permit to construct,alcor.Improve,dcmollah,or repair any structure $151182
s-Z� thatprior1. its issnmcaalw rt uinnotI.the
tie Applicant for enCoitp en's 0k aSigned mem,m
ggggSFFa Natmenclicensed pSenmt lathe provision of of Ca usines'and Pro law(C ode)or Sq.Ft.Floor Area Valuation
3$ (commencing mull of Division the
theeged exempt PromotionCode)of
B than he k eaempl Ummfmm cent the,bun for Ibe cell,{W exemption.My Ho1Won of
Section 7031.5 by any applicant for a permit subjects the applicant In a dvil penalty of Occupancy Type
not more than fee hundred dollars(SSM
1,u owner of the property,or my employees with wages u their sok composition.
will do the work,and themewlum In not ntended or offered formic(Sec.7044,Business Required Inspections
and Professions Code:The Com ucer's License taw does not apply n e an owner of q P
property who builds orimproves theroan,and who doesanh work himselfor Woo&h his ,
own employ=.provided that such Improvem<nu are nothmended oraRered for We.If.
however.the building or improvement is mid within one year of completion.the owner
builder will haw:the When of proving that W did not Mid or Improve for purpose of
❑1.u comer of the property am exclusively connecting wish licensed contractors in
contract the project(Sec.7044,Business and Prefnsion Code:)The Conume's U.
cense law does not apply to an owner of property who Wilde or improves thereon,and
who conwcu for such pmjecm with a contractor(s)licensed pursuant to the Contractors
License Law.
❑I am aempl under Set ,B k PC fm this rtuon
nu Data
WORKER'S COMPENSATION DECLARATION
1 hemby than under penalty of perjury one of she following decluuian: -
❑I haw and will maintain aCertinase of Consent be self-insure for WorkefaCompen-
ution,as provided for by Section 3700 of the Labor Code.for the performance of the
work for which this permit is issued.
0 I have and will maintain Worker's Compensation Insurm o,u required by Section
3700 of the Labor Code,for this Performance of the were:for which this permit is instead.
My Worker's Compensation maunnce carrier and Policy number art:
Cartier. 2aRyCN A-,rAj4A1ftIm,Na: f. r 3533109 -7
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Tiodsmenum need not W compound Bute permit is forme,hundred dollen($11)(0
nrlua)
I certify Nat in me performance of me work for which this Permit Is honed,I shall not
employ any person in my manner an u n become subject to tin Workers'CamPenaOon
LAws of California.Dam
Applkant
NOTICE TO APPLICANT:If, no,making Nis Cenifiate of Evemption,you should
become subject as men Worker's Compenstion provisions of she la W,Cade,you mute
0Z forthwith comply wim inch provision or this permit Mail W deemed revoked.
ZCONSTRUCTION LENDING AGENCY
y
(~ I hembyaiGrm that mere Is emabtection lending agency for the performance of
ai> me work for which thie permit Is issued(Sec.3097.Clv.Cd '
W�Q Lenders Name
v7 z LendeYa Addom
U0 I certify mat I have read his application anbo
d mule that the ave information k
U,U correct.I agree a comply with all city and county ordinances and min law reining n
O Wilding canswctum.and hereby mmarise mpruentuiwa of this city a emu upon Ue
above-mendaned property,for humecbon purposes
1f-y a (We)agree to on.indemnify and keep humleu the City of Cupertino against
In liabilities,jedgmeess.comts and espomes which may in anyway aceme against said City
V 7 In conmegnnec of the¬ing of this permit.
f+ APPLICANT UNDERSTANDS ND WILL COMPLY WITH ALL NON-POINT Issued by:3 Date
SOURCE REGULATIONS,
a,2q�OS Re-roofs
Signets of ApplicanuConmcher Dare
HAZARDOUS PATERIALS DISCLOSURE Type of Roof
Will she applicant or future Wilding occupant nam or handle besudous material
u denncd by the Cupenim Municipal Code.Chapter 9.12.and Our Health and Safety
ala.Section 255324)7 yy�� All roofs shall be inspected prior to any roofing material being installed.
❑Yes L]ao
Will the applicant or future building MCUPam um equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as dented by the Bay Arca Air Quality Management all new materials for inspection.
Dinrict7
❑Yea Nu
1 have rent the huudnn romod.k requirements underCMper 6.95 of she Califor-
meHealth kSafsy Code,Secbon 25505,25533 ant 25534.1 understood this lftW Wilding
docs net currentlY haw a Imanl. t k my responsibility to nodry the occupant of Use
ont.mm,nn which Wmet r e Issuanceser a Certificate 0racopancy./ Signature of Applicant Date
.fir � 9��9/et All roof coverings to be Class"B"or better
Own fur hones �r '..ctl agent � Don
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