05030243 7-77
CITY OF CUPERTINO ;77 m'; 7 77",
BUILDING DIVISION
PERMIT
BUILDING ADDRESS: W E O'NEIL CONSTRUCTION PERMITNO.05030243
20500 TOWN CENTER LN # 171
R'S NAME: PERMIT ISSUE DATE
SIVLERSTONE DEVELOPMENT 5245 PACIFIC CONCOURSE DR VE 08/29/2005
PHONE: SANITARY NO. CONTROL NO.
(510) 385-0121 1
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
.00 LICENSED CONTRACTOR'S DECLARATION
W M I humby am.mat I am licensed under sumvink,"of Chapter 9(commencing Job Description
Re Seemor 70010)of Division 3 ofine Business Mad Professions Code.and MY licence,Is
infullfomer"cicifecL JZ NEW CONDOMINIUM
Lc..cause I
D= A Co..-- 743 SQ. FT. LIVING SPACE
MCW ARCHITECTS DECLARATION
U I understand my plans shall be used w public mcmd,
IC
,u.
0 Licensed Professional OWNER-BUIWER DECLARATION
�I I hereby aMm that I am exempt from ft Cone acmes License Law for the
OE following mason.soctiun 103 1.5,Business and Professions Code:Any city of county
u2 which mquim or.Permit construct.aIle,improve,demolish,or repairmy structure
Prior to its issuance,also requires Re,applicant for such remit On file a signed statement
this he I.licensed pursuant to the PrOVISMOS of the Contractor's Uccone Law chapter 9 Sq.Ft. Floor Area Valu AI]Bik 0 0 9
(commencing with Section 7000)of Division 3 of me Business and Professions Cc&)or
mat he is exempt therefrom and man basis for the alleged exemption.Any violamon of
Section 7031.5 by my applicant for a permit subjects the Applicant W a civil Pc"&IIY Of ANN Number Occupancy Type
not more Man five hundred dollars($500). 36 40002 . 00
0 1,as owner Of the property,or my employees with wagon ar their sold compeamealker,
will do the work and the structure I.not intended or offered formic(Sec.70".Business
d Profesdarts Code:The Commodes Liam Law does,not apply W an Owner of Required Inspections
an
property who build,orimpromeademon,and who does such work himself or through his
we cropeloym,provided thatsuch Improvements are not intended oroffered for We.If.
however,the building or improvement Is sold within one you of completion.the Owner-
builder will hame the burden of pmving that he did rum Wild or improve for purpose of
sal..).
C]1,as Mawr of me propeny,am exclusively contracting with Heart contractors to
construct the project(See.7044.Business and Professions CM10 The Constaxwes Lt.
come Law dos not apply at an owner of properly who build,or improm themon,and
who contracts for such prejects with a commenor(A)licensed pormarl In the Ctrotmetuxes
License Law.
❑I am exempt under Sec. .,B&P C for this moonr Data—
WORKERS COMPENSATION DECLARATION
I thereby aftlim under penalty of perjury one of the following declarations:
0 1aveaWwiilm4inWn,Ce rimofCowntionit-issumfarWab .Compen-
sation.as pmvi&d for by Section 3700 of the Labor Code.for me Performance of the
work for which this permit is bound.
[]I have and will mainuum weakees compenomflon brommocc.an required by Section
3700 of the labor Cotic.for the pandencesurce of the wait for which mis permit is issued.
My Worker's Campectuadon Immetracc caries and Policy number are:
canw.7,uAj0-A. e_k(GAp.Iic,Nd.:we_33-33 hi3-aS'
CEKnFICATE OF EXEMPTION FROM WORKERS*
COMPENSATION INSURANCE
Crab seethen neent rompecompleped ifthe permit Isforone hundred dollars($IM)
nr less)
I certify that In ft performance of the work for which this Permit is issued.I shall not
employ any person in my mannerso as W become summl to the Workers Compormalmon
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject M me Worker's Compensation provisions or me Labor code,you mum
Oforthwith comply with such provisions or this porroltmall to,counted invoice.
CONSTRUCTION LENDING AGENCY
1 thereby millmot that them Is a construction lending agency for me ptcriomnarec of
the.,it for which this Permit is issued(Soc.3097,Civ.C.)
Undoes Name
] z Lender's Add.
U0 I cartify that I have read this application and Sam that me also.information I,
Lks y with all city and county onfirouncel and mom laws mialing to
nstru
0 building coction,and hereby Authorms,mprosentatim of this city to crum ft upon
come"I agree 0 comp,
above-mentioned property for Inapecdom purposes.
(We)agree to sett,indemnify and keep hancelear,the City Of Cupertino against
C,i liabilities,judipmema,costs and expenses which may in any my acerae
againalsmiCity
mcmunquenceormcgonum of NisPermit.
APPLICANT UNDERSTA S AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULAMO
-41 , */7- Re-roofs (�7
SI{ erpre of APplianVConue
F Date'
HAZARDOUS DISCLOSURE Type of Roof
Will the applicant or future building Occupant am or ander hareardous material
0 fined by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
,SoetiMn 25532m3? All roofs shall be inspected prior to any roofing material being installed.
f 0y. 6<
Will the applicant or future building=U"nL MC cquiarmal or devices,which If a roof is installed without first obtaining an inspection,I agree to remove
comi,hoxaminus.1,coesurninants as defined by me Bay Area Air Quality Management all new materials for inspection.
District?
0 yeut 66W.
—
I have road the Warrimmaterals roxittinuccummultuChapic,15,95.fdo call(..
W.Real SafixyCMIc.Sectlem,25505.25533 and!25534.1 command mallifthe WWi.t
does ret currently have.tertam,mm)/ismy surponothuhy m Madly tier occupant Of me
nottuharramu,which mu to mel W.."Munce.f.Certificate of Occupatv Signature of Applicant Date
Owner or hThomsed agent a All roof coverings to be Class"B"or better