05030246 CITY OF CUPERTINO 7_771.�� kI=-
BUILDING DIVISION PERMIT
BUILDING ADDRESS: W E O'NEIL CONSTRUCTION PFRMITNOID 5 0 3 0 24 6
2D500 TOWN CENTER LN 4 177
R'S NAME: PERMIT ISSUE DATE
SIVLERSTONE DEVELOPMENT 5245 PACIFIC CONCOURSE DRIVE 08/29/2005
PHONE: SANITARY NO. CONTROL NO.
(510) 385-0121
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BUNG ELECT PLUMB MECH
jOp LICENSED CONTRACTOR'S DECLARATION ob Description
Ida I hereby afflum that I am licensed sonar provisions of Chapter 9(commencing
PNNmSection 7000)of Diviclom 3 of ma Business and Ptalcouslons Code.and my item,is
in full in=and effect. NEW CONDOMINIUM
L,
D:mxa�'. Contractor 743 SQ. FT. LIVING SPACE
ARCHITECrS DECLARATION
1 understand my pitns that k used as public nucords
M!u
snap Licensed Pmf..i...I OWNER-BUILDER DECLARATION
I hereby affiran that I am exempt from the Contractor's License Law for the
following....(Section 7031.5.Bummus and Pordleadons Coon:My city or county
Which requires s Permit to construct.Otey
hupsoun.doomflish.or miss any Wromma
print M its Women.Alm routine;flux.,pliCAM Watch FCMIL W Jim a signed statement
Lam W is licensed pUMAnL st Me prowfismas of Me Cmumente.Lt..I..(Claximas 9 Sq.Ft. Floor Area Valu4tB)6 0 0 9
(ccurnmeracing with Section 7")of Division 3 of Me Budams sad Phomas
Coac)or
mod,im a exempt muchufferat and the basis for the alleged murroupdon.My vlolNan of
atone
by my applicant far a per
objects dom Applicant to A civil Penalty Of APN Number Occupancy Tpe
Out.then R.hundred dollars($5M 36940002 . 00
0 I.athrow ofthe property,mmyemploymwith mtuutheir=Lc=pc=Oon,
willde,the wars,and Me straboure isruotiftentleat hoOfficarad(Waste(Sec.70".Business
and Profearums Code:The Chalmette,License Law does Out only W an owner of Required Inspections
property who buildsarimpraws therecam,andsrha domsuch warklornselfor through his
now employees,provided thatexach improwments see not Intended aroffered lonsiale.It.
hansawr.she Wilding or improwmem Is mid within am year ofoompIctlem,the Owner.
build,'will Im.the burden of proving that he did am Mid or Improve far purpose of
sale.).
[:j 1,as morear Of the propurry.ma exclusively commacting,with licensed courtureastans W
commuss the pmjm(Sec.7044.Business and Profusions ColJO)The Conrustooes Ll-
cove Law does not apply in an owner of property who holds or Improws Ounce,and,
who corourbout for such projects with a cormustorm)licamamd pursomr,to the Consomme.
License Law.
❑I am exempt under Sec. 'a&P C for this Mason
r Dau
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of Perjury am of the following declaralimar.
1 hew and will
Mof Covent
sum
saticurt,a provided for by Sued..37M of the Labor Code.for the performars.of the
work for Which this parraft is Wood.
[]I how and Will maintain WorlmrA Compmestation Insurance,as required by Section
3700 of the Labor Code,far the perfammunce of the work for which this permit is heard.
My Waraces Compensation Insurance carrier and Policy number are:
carder.11!64)CH-AeV11,1 L 4 daHey No.:L-/C 3 5')3 IL13
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This=ties need moloccompletud If the parrult Is fortune hundraddiallam(3100)
.,less.)
I certify Oat In the Incaformanco of the work for which this permit is issued,I shall not
employ any person in any meaner an as in become subject to the Workers Compensation
Laws Of CliffoutaiR.DIM
Applicant
NOTICE TO APPLICANT.If.after making this Coolness,of Exemption,you should
become subject in Me Worker's Compensation provision,of the Labor Code,you must
0 z forthwith comply With such forty sons Or this Permit shall the Mounted hawked.
CONSTRUCTION LENDING AGENCY
I houckuy.1fron that ft.I.s conalso,do.I.rdirl.gacy I.,Me pd.ramuncecd
Cvi> the work for which this permit it issued(Sm.3097.Civ.C.)
I.Who's Name
1 certify that I have mad this application and sum Oat ft show information is
COMCL I agree to comply with all city and county ordinamcss and zone laws resting an,
DU Wilding construction.and hereby mthorha mp=nmdm of this city to color upon the
above-ancrummed property for Inspection purposes /7
(We)agree to sanc,indemnify and amp luxordes,the City of Cupertino against
Co� liabilidesJudgamus,cute and expenses which may In any Way a,com'Jil.assidCly
In consequence of the granting of this North.
APPLICANT UNDERSTAND AND WILL COMPLY WITH ALL NON-POINT Issued by:9102� Date
SOURCEREGU�
Sx=gt>�__ 9 Re-roofs
ignsum,961'ApplicautlComosclor ,r- I
HAZARDOUAATERIALS DISCLOSURE . Type of Roof
Will the applicant or future Wilding occupant am orhandle lossublours astud.1
Ined by the Cupertino Municipal Code.Chapter 9.12,and ft Health and Safety
Sectio.M32(.)7 All roofs shall be inspected prior to any roofing material being installed.F[:]Yet dw.,
Will the applicant or[,I..Wilding Occupant use,equip cum or doelcm,Which If a roof is installed without first obtaining an inspection,I agree to remove
Omit lootolums a!,coacurnift d by ft Bay Area Air Quality Management all new materials for inspection.
District?
C]Yes ;rw
I how rosal the havardaus,materials requirements,under Chapter 6.95 of the Califor.
M.Hula&S.Im'Codc.Sections
11.10 Iml III
ift2� and
h,y1undentandlismitmet building
dm Out currently haw to bodify the occupant ormc
requirements which mutt be met pd muanceofaccmflcawotoca S ignature of Applicant Date
All roof coverings to be Class"B"or better
OwnerDAe3