05030244 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONS RA-OXINE0 SAT-10-N
BUILDING ADDRESS: W E OINEIL CONSTRUCTION """"005030244
Z0500 TOWN CENTER LN # 173
•R'S NAME: PERMIT ISSUE DATE
SIVLERSTONE DEVELOPMENT 5245 PACIFIC CO E 08/29/2005
PHONE: SANITARY NO. CONTROL NO.
(510) 385-0121
ARCH[=/ENGINEER: BUILDING PERMIT INFO
BLDOO ELECT O PLUMB O MECHO
; LICENSED CONTRACTORS DECLARATION 7obDescription
I hereby affirm that 1 am licensed under pmMom siof Chapter 9(commencing
zl with Section 701)(1)of DM sum 3 of the Business orb Profession Code.and my licroste is
j, mflifwm.ndeBea. NEW CONDOMINIUM
z tineas c Lt..a N 9 92 I
Dae Conhacusr L.b o a eyl. 743 SQ. FT. LIVING SPACE
ARCHr1ECrS DECLARATION
1 understand my plans"I W used as public records
s G AS Licensed pmfeuional
5 OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt fmm the Contractors License Law for the
o o following mann.(Semon 713 t. ss 5,Busineand Profession.,Code:Any city or county
$ which requ(rea a Permit to comsat,alter,bnprove,demolish,or repair any structure
_iy prior Lo its Issuance.also requires the applicant for such Fermit in fde a signed staemem
O that he is licensed pursuant to the Provisions of the Cmtrwwr'z License Law(Chapter 9 Sq.Ft. Floor Area Valu 1)6009
(commencing with Section 7000)of Division 3 of the Busines and Profession Code)or
that be Is wampt tlurtfrom and the basis fes the alleged exemptlan.Any violation of
Section 7031.5 by any applicant for a permit subjecta Use applicant W.civil penity ofAPN Number Occupancy Type
outmode than nes hundred dollen(M). 36940002 . 00
❑I,aownw ofthe property,or my employers with wages as then sole compensation,
will do Use work and the structure isnotinumded wartued forsak(Sec.70/4.11usmas
and Profession Cade:The Colossuses Limnse Law does Out apply man owner of Required Inspections
property who Wlldsorimpmwa duccon.and whoam mmitwwk himielfwthedugh his -
own employees,provided that such improvements was not Intended oraEered for sale.If,
however,the building or improvement is sold within one yew of completion.0e owner-
Wilder will have de burden of proving that he did not bald Or Improve for purpose of
.in).
❑1,as Owner of the property ma exclusively contracting with licensed conmcusn to
construct the pmject(Sec.7044,Baines and Professions,Code:)The Contractees U.
arse law does not apply to an owner of property who Wilds or improv demon.and
who contracts for such projects with a conoacmr(s)licensed Furman,m the COntneto's
License Law.
O l am e.empt under See. ,B&P C for this reason
Dam
WORKERS COMPENSATION DECLARATION
1 bereby affirm under Featly of Fury One of the following drslwioa: .
❑1 ham and will maintain a Certificate of Consent to self-Wure fes WOrkeeaCompen-
smon,as provided for by Section 3700 of dan labor Code,fes the performance of the
work for which this permit is issued.
❑I have and will maintain Workees Compensation Iruwenm,u required by Section
3700 of the labor Code,for die performanceof Ne work for which this permit is issued. '
My Worker's Compensation Insurance camicr and Policy number are:
carnia w!1& A-eai(A✓PaRey No.:Iy/G 3 r331e_
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Obis secdon need notbecomplowd firm,permit Is lwone hundred dollars($100)
orl ss.)
1 anify that in the pwformaree of the work far which this permit is issued,l shall nes
employ any person in any mwxrso a to become mbject to IM Wa lmri COmpensadon
laws of California.Dam
Applicant
NOTICE TO APPLICANT:If.after making this CcniOcau of Exemption,you should
become subject to the Wohers Compct.,atien provisions of the labor Code,you must
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forthwith comply with such provision or this permit he deemed revoked.
z y CONSTRUCTION LENDING AGENCY
[.r I herebyalTum that there its construction lending agency lot the Performance of
LYi the work for which this permit is issued(Sec.3097.Civ,C.)
6Wi Q lender's Name
Z)z London's Address
U Q I cmdfy that I have read this application and sou that the above information is
t.4 E' COMCL 1 at=to comply with all city and county eminences and rots laws relating m
O V building construction,and hereby mthonnrepresentatly of this city w enter upon the
W aWve-mentioned property foriupection purposes
fi
(We)agme,o saw,indemnify and keep homeless the City of Cupertino against
y liabilities,judpnmus.comaand e.penv which may In my my accrue against Fid City
U 7 in consequence of the granting of this Permit.
r� APPLICANT UNDERSTAN94okND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
�. , �� 6.
esu fAppliaro'contrecon / Dem Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant w forum building Occupant port or handle hazardous material
fined by the Cupsdno Municipal Code,Chapter 9.13.and the Health and Safety
Section 25532(x)? All roofs shall be inspected prior to any roofing material being installed.
Ya W.
Will the applicant or future Wilding Occupant an equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
cmh haxamoa.1,conuminantt ax defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yea �Pu
1 have read the hwamoas mauriais requirements under Chaper 6.95 of the Califor-
nts Health&SafetyCOde.Sections 25505.15533 tib 25534.I undoo and du,if t e Wilding
does not currently have a Owns.111111 i my resPOU Nllty us oddly the ma:upent of the
requirements which mum the met wW rme or ac mm am of Occupancy. Signature Of Applicant Date
L S
'Owne authorized agent m All roof coverings to be Class "B"or better
v