05030239 *eCITY OF CUPERTINO .eaa " v
BUILDING DIVISION PEST ± CONTRACTU' INFORMATION
BUILDING ADDRESS: W E O'NEIL CONSTRUCTION PEIIMITNGfl5030239
W;R'S NAME: PERMIT ISSUE DATE
SIVLERSTONE DEVET40PMENT 5245 P 5
PHONE: SANITARY NO. CONTROL NO.
(510) 385-0121
ARCHITECOENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0
30p LICENSED CONTRACTOR'S DECLARATION
I hereby arE,m that I am licensed unster provisions of Chapter 9(commencing Job Description
with Section 7010)of Division 3 or Ne Busher and Pro(esalomn Code.edl my license is
mfIli amanddit NEW CONDOMINIUM
Lieeua Ci Lie.I H9y1
J
Dula comanr a E O. /� 743 SQ. FT. LIVING SPACE
ARCHITECTS DECLARATION
1 understand my plans shall m used an public rectum,
is Licensed Professional
5 OWNER-BUILDER DECLARATION
i I hereby.(Sere that 11. exempt Imre the Contractor's : c Law for the
E O o following moon. emit t 71131.3,construct,
ohm and Pro.demons Code:My ally or county
5$ which rtquirus issuance.permit m mires a sue improve,demolish,m repair any ned tatement
_Z> poor toatNis enpurzoamgothe Me of for Cohpumi'mfile+,Law(Chlamanl
o NathetsciagwieSectammduProvisions3of eBasin r'alJcenselaw(Cboca)M Sq.Ft.Floor Area Valu$®6009
$ (core a is exe pt therefron om
and the
basis n 3 Badu Buinoo and Proregirm.My vi Code)or
—
that M ts exempt Nue(mm and Ne bats for Ne alleged essmptim.My violation of
Section 7031.5 by my applicant for a permit subjects the applicant m,Civil penalty of APN Number Occupancy Type
not mom than five hundred doll.(3500). 36940002 . 00
wi I,uownerofthe pamnect r mycm ermin withened aNei(solee .Business
will do Newons Code, he Comeman's uicamse aw does rukpply 70 N,Business Required Inspections
and property
ons Codm The ConuecmY,License law dans not apply f rt owner is q P
property who buildsarlmpmt such i m r andwM do not ended bim,alf ed Waugh his
two a er,Meso,pmvidr idui such improvements ars notyear
ofintended deorfond forMe Own if.
builder,Ne buildinghu improvement ismid(within aro year of mproe far Ne Owner.
builder haw the human of proving that he did not ddld u Improve far purpose of
uleJ.
0 1.as owner of the property,am exclusively contracting with lummul mmnedon to
construct the prejen(Sec.7044,Business and Profusions Cade:)The Contractors LI-
cepa Law doss not apply in an owner of property who build,or improves tiureon,sed,
who contracts for such projects with a convector(s)licensed pursuant to Ne Con arm S
License law.
I
am exempt under Sm. .B&P C for
Nu mown
r Dau
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury am of the following decioolonst
01 haveard will maintain aCenifium or Car ent to self-insure far Workena Conten.
when,an provided for by Section 3700 or Ne labor Code.for the perfcaromm of Ne
were for which Ni,permit is mood.
0 1 have mm will maintain Worker's Compensation Imurance.u required by Section
3700 of du Labor Code,fu du performance of the work for which Nks permit is Isaned.
My Workets Compensation Ia n ronce curia and Policy number ala:
Carrier.?t IIGTjt,±- Ilcy No,:I-C-71-3,3103-0 Nsrt
E actiMMON FROM WORKERS'
COMPENSATION INSURANCE
(Thissection need ant W complelad if the permit It forma hundred dollars(SIM)
or less.)
1 unify the,in Ne performance of tie,work for which this permit is Wood.I,hall net
employ any person in any manner an as m become subject O Nc Wdekers'Compensation
Laws Of California Dau
Applicant
NOTICE TO APPLICANT:If.after making this Canificau of Exemption,you should
become abject in Ne Worku's Compensation provisions of the Tabor Code,you mum
,J 0 ronhwith comply with such provisions or Nu Permit shall M deemed revoked.
„z„► CONSTRUCTION LENDING AGENCY
(—m I hereby affirm that Nem is a combustion lending agency Its Ne Performance of
tY the wank fa,which this permit 6 Load(Sm 3097.Civ.C.)
WLenders Name
�
D Z Iandrfs Addass
t.)Q 1 modify that T have reed this application and sum Nam Ne above ieformadm Is
mkt
attract.I agme to comply with all city and county ordinances and once issue mlating to
0 building construction,and hereby malmdm Cap WAmtivm of Nis City to color upon Ne
437 ,hove-mentioned property for inspection Panorama,
pyt (We)agree to sive.indemnify and keep harmless the City of Cupertino against
m,w 4n liabilities,judgments,cuts and expenses which may In any way tiered against aid City
V 7 in consequence of the,granting of this permit.
G APPLICANT UNDERSTANDS WILL COMPLY WITH ALL NON-POINT Issued by:9 Date
SOURCE REGULATIONS.
Re-roofs
Signaturi,aff ApPlieumConmetor Dam
HAZARDOUS MOERIALS DISCLOSURE Type of Roof
Will Ne applicant ur future building mdupant smm u handle hamodous malarial
fined by tits Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
.Section 23532()? All roofs shall be inspected prior to any roofing material being installed.
D Yen GfNd—
Will 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
emit mordants air cmuminanu as defined by Ne Bay Area Air Quality Management all new materials for inspection.
District? ��
0Ycs L4490
1 haw mad the haarduusmaterulsmquimments under Chapter6.95of theCelifor-
nlaHmIm&Safety Code,Sodom 25505.35533 send 25534.1 understand than Klhe building
dans Out currently hew a unanL Nu t' y responsibility n nodfy the Occupant of on
mqulaements which mum bomeI pn meanm a r.Cenifie,la Car Qmpanry. Signature of Applicant Date
1Ph%b All roof coverings to be Class"B"or better
Owner, defied de ager Dalo
G