05030249 CITY OF CUPERTINO eta '4 7", 745,17
BUILDING DIVISION pE$MI'I' COIN'TRA ZTORjINFORMATION" '
a3..e 'z
BUILDING ADDRESS: W E O'NEIL CONSTRUCTION PERMITND'05030249
2nc;no TOWN CENTER IN 4 96-A
OWNER'S NAME: PERMIT ISSUE DATE
2005
E; SANITARY NO. CONTROL NO.
(510) 385-0121
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
a o o LICENSED CONTRACTOR'S DECLARATION
rkd F 1 lereby afOrm Net l am licensed under providence of Chapter 9(commencing Job Description
i0 Section 7000)of Division 3 o the Business and Professions Code,and my license is
in full force and effect.
�Z License s Lk.g 4y 03 r NEW CONDOMINIUM
F�IiF-- Dem Come Wr_ L-c N 743 SQ. FT. LIVING SPACE
,ffypQ ARCHITECTS DECLARATION
Y p���Zuu CCyy� I understood my plans shall M used u public mcnrds
c Licensed Professional
OWNER-BUILDER DECLARATION
I 1 hereby affirm that I am exempt from the Contractor's License Law for the
02 fallowing moon.(Section 7031.5.Business and Professions Code:Any city or county
$ which requlres•permit to Construct,alcor,improve,demolish,or repair an,structure
Fiy prior m its in....also r or=the applicant fmsech permit to file a signed statement
FF < thethetshanedpmwanttotheprovisionsoftboContracWYsLicenaelaw(Chaptm9 Sq.Ft.Floor Area Valu 1$16009
(commencing with Section 7")of Division 3 of the Beat.and Professions Conti)or
`t$ that he is exempt tierefrom and the basis fm the alleged exemption.My violation of
Section 7031.5 by arty applicant for a Permitsubjem the applicanuo a civil penally of APN Number Occupancy Type
not mom than five hundred dalhn($M 36940002 . 00
0 1,m owns of the pmpeny.m my employees wiM wags u lheirmle eompenutian,
MH do the work and Nesneum is not Invaded moffered Wish,(See 7044,Bunions Required Inspections
and Professions Codd:The Commmer's License Law does trot apply W e an owner of q P
property who builds or improves demon,a nd who does such work himself or thmugh his
own employee,provided Nat such improvements And,not Inletted moffesed for Wn If.
however.the building or improvement is mid within one year of completion,the owner-
builder will love the holden of proving that he did nd MW or improve for purpose of
sale.).
0 I,As owner of tie property,assn exclusimly contracting with licensed contractors W
comroct Oe pmjm(Sec.7044.Badness and Profusions Code)The ConlnmaM1 Li-
cense law door not apply W an owner of property who bolds or improves thereon.and,
who contracts for such pmjem with a con=wr(q licensed pursuant W the Conuaator's
License Law,
O l oro exempt under Sec. ,B&.P C for this moon
owner Dau
WORKER'S COMPENSATION DECLARATION
410 1 hcmhy in.under penalty of perjury am of the following hclamtlou:
0 1 haw and will maintain a CeNfnam of Consent m self-Insure fmWorter'a Comfort.
notion.as provided for by Section 3700 of the labor Code.for the perfonname of the
wart for which this permit is issued.
0 1 have and will maintain Wurkm's Compensation Widens ce,as required by Section
3700 of the Labor Code,for the performance of Ne writ,for which this permit h issued.
My Worbkee,Compensation insurance carrier and Policy number art:
n
C. 1er:F(*ICN- CA4614.-Policy No.:L✓L 3S-?3I J L-0-7
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
CITU secdon need not bo completed If the permit u Torun hundred dollars($100)
or kis.)
1 cutify deet in the Performance of site work for which this Permit is issued.l shall not
employ any person in my manner in u an become subject W theWmkeri Compensation
Laws of Callform a.Dam
Applicant
NOTICE TO APPLICANT.If.Ann,making this Cendnam of Exemption,you should
become Subject to the Woher's Compensation provisions of the Labor Code.you most
0 0 forthwith comply with such provisions m thio permit shall bo darned rooked.
.ZoeCONSTRUCTION LENDING AGENCY
[r vVl-r I hereby alarm that there is construction lending agency for due perfurmmcc of
a
the work for which this permit is Issued(Sec.3097,Cl,.C.)
W�Q lander',Name
Z Lender's Add.
CJ Q I anify that 1 haw read this application and sum met the.bore information is
IL comm I acme m comply with all city and county ordinances W suss lows relating m
O building construction.and hereby autharine representatives of thin city W enter upon the
LV aborc-mendomd Property for lasPenian PugnnseL
M tWcl ago W ave.indemnify and keep hom iess the City of Cupertino ignites
cn liabilities,judgments,costs and expenses which may in my way amine against aid City
U z in consequence of the granting of this Pe it
APPLICANT UNDERSTANDS N WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE RECUL ONS. /y'f/er
Signator APPIIorm
nJConctor paw Re-roofs
HAZARDOUS 111144TIERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant stare orhandle haurdous material
As defined by the Cupertino Municipa ode.Chapter 9.13.and the Health and Safety
code.Section 25533(.)7 All roofs shall be inspected prior to any roofing material being installed.
40 ❑Yu o
Will the applicant or future building occupant u¢equipment ser devices which If a roof is installed without first obtaining an inspection,I agree to remove
cml,hauedou air contaminants as de0mcd by the Bay Am.All Quality Management all new materials for inspection.
District?
0 Ycs u
I have mad the hasatnusmawrlahom uimments under Chopmr6.95 of site Collin,
nialiealthk Safely Cade.Section,35503.3 533 and35534.1 undersund thmdfthe building
dace not cuncmly have a tenon,that It y rcsponsihility m ratify the uccupant of the
m cnuwInxed agenbcmct ' r umccofaccnirc.cofoc Y. Signature of Applicant Date
8 All roof coverings to be Class"B"or better
Owner utharit te
e