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05030248 CITY OF CUPERTINOa s �'� BUILDING DIVISION PERMIT CU 1;T,1teS.C.eTQT� ANT`UR'1V�r1'T.T�1 BUILDING ADDRESS: W E O'NEIL CONSTRUCTION 1ERMITNo.05030248 OWNER'S NAME: FERMITMUBDATE 2005 E: SANITARY NO. CONTROL NO. (510) 385-0121 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH �fOp LICENSED CONTRACTOR'S DECLARATION Job Description 1 hereby affirm No al 1 em licensed under previsions of Chapter 9(commencing wlN Section 701W)ofDiH,non lar Ne Buainessand Pro(ceians Code.and mylicense is Intel farce end eRett j�� Lkenx Cl Lk.g L(7�7 L NEW CONDOMINIUM Date c�nta or ✓t a E/f. 743 SQ. FT. LIVING SPACE ARCHITECTS DECLARATION Iundcmund my plans Shall Ito wed upublic recnrN BMR UNIT/ NO CONSTRUCTION TAX og 3 c Licensed Professional Oat I am exempt from DECLARATION E I hereby.(Sere that 1 1. uusin Imre the Conions Co License Law for tire ,a O O fallowing moan.(Section 71131.3,Business and Profession Code:Any tiny or county v$ which requires a permit m construct,aalcor.Improve.demolish, fi repair any street= prior itsiesed pursuant tto restW spions of forsook < that he lalicenedpunuenitothe provinionnfthe CanlrecmisLicenelaw(Chapter 9 Sq.Ft.Floor Area Valuation (commencing with Section 7000)of Division 3 of the Business and Profceions Cade)or $86009 that he 4 exempt Nexfrom and the bub for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of APN Number Occupancy Type not more than Ove hundred dollen($500). ❑1,as owner of the property,or my employees with wages as Unchaste compensation. Mill do the work,and NeaWclut,knot intended or offered forsale(Sec.7014,Business Re uired Inspections and Profeadmis Code:The Contractor's License Law dace icon apply w an owner of q P property,who builds ar improve,Nercon,end who does such work himsel r or through his own employees,provitlrA that well Improvements art not ween kd!muttered fmsale.If, however.the building or Improvement is mid within one year of completion,the owner. Wildu will have the burden of proving that M did not build or improv for purpose of salt.). ❑I,u owner of the property,am exclusively contracting with licensed contractors to concoct the project(Sec.7W,Business and Profession Cade:)The Comment'Li. came Taw does not apply w in owner of property who Wilda or improves thereon,and, who conuxcts for such projects with a contractor(s)licensed puravent w the Conmcwfa License Law. ❑1 am exempt undo See. ,B&P C for this reason Owner Dam WORKER'S COMPENSATION DECLARATION 410 I hemby affirm unc kr penally of perjury one of tie following dalantion: ❑Ihan and will mainuina CenrimwofConwntwxlGluum far Worker's Compere anion,as provided for by Section 3700 of the labor Cade,fer the performance of the work for which this permit is issued. ❑I have and will maintain Worker's Compensation Insurance,as wgaired by Section 3700 of dee Labor Code,for the performance of tiro work for which this permit is issued. My Worker's Compensation Instance carrier and Policy number am: Cartier.�l/A!4& ,el--*CAV Policy N.A: C-�S�3I0 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not W completed If Ne permit i,forane,hundred dollars($100) In Ices.) 1 ce,dfy that in the performance of the work for which this permit is Wend.I shall not employ any ponsm in my mwner an as w become subject in tie Warkeri Compensation Laws of Celifomia,Dew Applicant NOTICE TO APPLICANT:If,after making this Ccnificate of Exemption,you should become subject w the Worker's Comp romon provisions of the IaWr Code,you moat .J O forthwith comply with such provision or this permit shall be deemed revoked. ,zt y CONSTRUCTION LENDING AGENCY p.a I hereby affirm that New its construction lending agency for the performance of I5:s7 the work for which this psmut is issued(Se:.3097,Civ.C.) ALender's Nuns Z)z Lender's Add. u Q 1 certify that 1 have mad this application and slaw that the above information IS IT„U correct.l ague to comply with all city and county ordinances and sere laws relating in C) building eonsimction,and hereby mNariae representatives of this city to enter upon dm W aborm-numdonc0 property for Inspection purposes. (Wc)agree w save,indemnify and keep humleu the City of Cuperina against a,y Taj) liabllities,Judgmenla.case and ex which may in my my Seems agelnnuid City U In consequence of the/ranting of fhb rmil. APPLICANT UNDERSTAND D WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGUL ONS. Z A S` Re-roofs Sigat of Aypliea t,Contrxctar list, HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will tie applicant or fucose building occupant now orhandle haukous material as defined by the Cupertino Mural ipaI Code.Chapter 9.13,and the Health and Safely Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. [:J Yes u Will the applicant or future Wilding occupant use equipment or device,which If a roof is installed without first obtaining an inspection,I agree to remove mit hazardous air emarrinnu do ed by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yea 9W I have mad Ne h®ardrws mawrlaismquimmenu underChapwr6.95af the Califon nia Hcalth ikSafeyCodc,Section 25505.25533 and 25534.1 undemand IAetif tits Wilding Ones not curently have a wnan4 that it my reapouihilly to tify t c oximant of the requirements which must W met ' r ieumccoracemncawarojapaney. Signature of Applicant Date t "� $/ Zq/� All roof coverings to be Class"B"or better Own, Na—t egcnl G CITY OF CUPERTINOa s �'� BUILDING DIVISION PERMIT CU 1;T,1teS.C.eTQT� ANT`UR'1V�r1'T.T�1 BUILDING ADDRESS: W E O'NEIL CONSTRUCTION 1ERMITNo.05030248 OWNER'S NAME: FERMITMUBDATE 2005 E: SANITARY NO. CONTROL NO. (510) 385-0121 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH �fOp LICENSED CONTRACTOR'S DECLARATION Job Description 1 hereby affirm No al 1 em licensed under previsions of Chapter 9(commencing wlN Section 701W)ofDiH,non lar Ne Buainessand Pro(ceians Code.and mylicense is Intel farce end eRett j�� Lkenx Cl Lk.g L(7�7 L NEW CONDOMINIUM Date c�nta or ✓t a E/f. 743 SQ. FT. LIVING SPACE ARCHITECTS DECLARATION Iundcmund my plans Shall Ito wed upublic recnrN BMR UNIT/ NO CONSTRUCTION TAX og 3 c Licensed Professional Oat I am exempt from DECLARATION E I hereby.(Sere that 1 1. uusin Imre the Conions Co License Law for tire ,a O O fallowing moan.(Section 71131.3,Business and Profession Code:Any tiny or county v$ which requires a permit m construct,aalcor.Improve.demolish, fi repair any street= prior itsiesed pursuant tto restW spions of forsook < that he lalicenedpunuenitothe provinionnfthe CanlrecmisLicenelaw(Chapter 9 Sq.Ft.Floor Area Valuation (commencing with Section 7000)of Division 3 of the Business and Profceions Cade)or $86009 that he 4 exempt Nexfrom and the bub for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of APN Number Occupancy Type not more than Ove hundred dollen($500). ❑1,as owner of the property,or my employees with wages as Unchaste compensation. Mill do the work,and NeaWclut,knot intended or offered forsale(Sec.7014,Business Re uired Inspections and Profeadmis Code:The Contractor's License Law dace icon apply w an owner of q P property,who builds ar improve,Nercon,end who does such work himsel r or through his own employees,provitlrA that well Improvements art not ween kd!muttered fmsale.If, however.the building or Improvement is mid within one year of completion,the owner. Wildu will have the burden of proving that M did not build or improv for purpose of salt.). ❑I,u owner of the property,am exclusively contracting with licensed contractors to concoct the project(Sec.7W,Business and Profession Cade:)The Comment'Li. came Taw does not apply w in owner of property who Wilda or improves thereon,and, who conuxcts for such projects with a contractor(s)licensed puravent w the Conmcwfa License Law. ❑1 am exempt undo See. ,B&P C for this reason Owner Dam WORKER'S COMPENSATION DECLARATION 410 I hemby affirm unc kr penally of perjury one of tie following dalantion: ❑Ihan and will mainuina CenrimwofConwntwxlGluum far Worker's Compere anion,as provided for by Section 3700 of the labor Cade,fer the performance of the work for which this permit is issued. ❑I have and will maintain Worker's Compensation Insurance,as wgaired by Section 3700 of dee Labor Code,for the performance of tiro work for which this permit is issued. My Worker's Compensation Instance carrier and Policy number am: Cartier.�l/A!4& ,el--*CAV Policy N.A: C-�S�3I0 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not W completed If Ne permit i,forane,hundred dollars($100) In Ices.) 1 ce,dfy that in the performance of the work for which this permit is Wend.I shall not employ any ponsm in my mwner an as w become subject in tie Warkeri Compensation Laws of Celifomia,Dew Applicant NOTICE TO APPLICANT:If,after making this Ccnificate of Exemption,you should become subject w the Worker's Comp romon provisions of the IaWr Code,you moat .J O forthwith comply with such provision or this permit shall be deemed revoked. ,zt y CONSTRUCTION LENDING AGENCY p.a I hereby affirm that New its construction lending agency for the performance of I5:s7 the work for which this psmut is issued(Se:.3097,Civ.C.) ALender's Nuns Z)z Lender's Add. u Q 1 certify that 1 have mad this application and slaw that the above information IS IT„U correct.l ague to comply with all city and county ordinances and sere laws relating in C) building eonsimction,and hereby mNariae representatives of this city to enter upon dm W aborm-numdonc0 property for Inspection purposes. (Wc)agree w save,indemnify and keep humleu the City of Cuperina against a,y Taj) liabllities,Judgmenla.case and ex which may in my my Seems agelnnuid City U In consequence of the/ranting of fhb rmil. APPLICANT UNDERSTAND D WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGUL ONS. Z A S` Re-roofs Sigat of Aypliea t,Contrxctar list, HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will tie applicant or fucose building occupant now orhandle haukous material as defined by the Cupertino Mural ipaI Code.Chapter 9.13,and the Health and Safely Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. [:J Yes u Will the applicant or future Wilding occupant use equipment or device,which If a roof is installed without first obtaining an inspection,I agree to remove mit hazardous air emarrinnu do ed by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yea 9W I have mad Ne h®ardrws mawrlaismquimmenu underChapwr6.95af the Califon nia Hcalth ikSafeyCodc,Section 25505.25533 and 25534.1 undemand IAetif tits Wilding Ones not curently have a wnan4 that it my reapouihilly to tify t c oximant of the requirements which must W met ' r ieumccoracemncawarojapaney. Signature of Applicant Date t "� $/ Zq/� All roof coverings to be Class"B"or better Own, Na—t egcnl G