05030250 CITY OF CUPERTINO
BUILDING DIVISION PERMITCC1iTRAC'Tl?'R INF'OtMATIO.N r'`.
BUILDING ADDRESS: W E O'NEIL CONSTRUCTION PERM"NO.
05030250
15 ER'S NAME: PERMIT ISSUE DATE
SIVLERSTONE DEVELOPMENT 5245 5
PHONE: SANITARY NO. CONTROL NO.
(510) 385-0121
ARCHf1ECT/FNGINEER: BUILDING PERMIT INFO
BLDG ELECT p O O PLUMB MECH
O O
Y G j LICENSED CONTRACTOR'S DECLARATION Job Description
I hereby M.Nee l am licensed under provisions of Chapter 9(commencing P
with Sadao 7000)of Division 3 of the Business and Professions Cade,and my license u
in fall rorce andeffect. gagy C j NEW CONDOMINIUM
j License Cl Ide.
Continuant �hOle-( 743 SQ. FT. LIVING SPACE ,
Y ARCHITECT'S DECLARATION
Y 1 understand my plans dull M taxa u public raarN
3p Licensed Professional
m OWNER-BUILDER DECLARATION
1 hereby affirm Nal I am exempt from the Convaclor's License Law for the
00 following mason.(Section 7031.5,Business and Pmfeasinm Cade:Any city or county
S:
S E! which requires a permit m construct.altar,Improve,demolish or repair any structure
prior of is issuance,also acquires the applicant for such permit in file a signed statement
that M is licensed pursuant to the pw'vislmu of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valua$&6009
(commencing with Section 7000)of Division S of the Business and Profession,Coct or
3 that he Is exempt themfwm and the bub far the alleged exemption.Any vi.lNon of
Section 7031.5 by any applicant fa a permit subjects the applicant m a civil penalty of APN Number Occupancy Type
not mom than five hundmd delta.($500), 36940002 . 00
❑I,u owner oftie property,army amployeawith waguuNeir role compere.tion.
will do the workanl the ..to.isnot lmendetlaraRemd forule(Seo.704,1,Business Required Inspections
and Profusions Code:The Comrwtues Llcenee Law awes Out apply m e ns an Owner of q P
propeny who builds or im proves thereon,and who does such work himself ser through his
own employee,provided dot such Improvements are not Intended or offered foreale.IT,
however,the building or improvement is Sold within one year of Completion.the owner.
builder will have tits burden of graving that be did am build oe Improve fa purpose of
Add.).
I]1,AS owner or the progeny,am exclusively contracting with licensed conuaeron So
construct the project(Sec.7044,Business and Professions Code:)The Contractors Li.
«taus law does not apply to an sumer of ropen,who guilds or Improves thereon.and,
who contracts for such pmacts with a conuactor(s)licensed pursuant in the contractors
License law.
❑i am exempt under Sec. .B k P C fm this reaSon
Data
WORKER'S COMPENSATION DECLARATION
I hereby AM.under penalty of perjury me of the following doclandm s:
❑1 haw and will maintain a C.Nfiemof Consem Soself-insuze for WorkeesComper-
.tion,u provided fm by Section 3700 of the labor Code.far the perfertuce of the
work fm which this permit is issued.
❑1 have and will maintain Worker's Compensation Laurance,as required by Secdon
3700 of the labor Code,for the performance or the work for which this permit is laved.
My Worker,Compensation Insurance prier and Policy number Are:
Ca.ler!16D0t/(,/ AmeAi *,l Policy Na.C-e-3377/03 ALF
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need nathucompleted If the permit bforanc hundred dollen(SIM)
or less.)
I certify that in the performance of Ne work for which this permit b issued,l shall not
employ any person In any manner So As on become subject in the Wergerr Compensation
Laws of California.Dau
Applicant
NOTICE TO APPLICANT:If.after making this Ceniftcate of Exemption,you should
become subject Of the Workers Compensation provisions of the Lahr Code,you mut
,J O forthwith comply with such previsions of Nis permit shall So demand mucked.
?` CONSTRUCTION LENDING AGENCY
F-I I hereby affirm that Nen is a construction lending agency for the performance of
ai the work for which Of,permit is issued(Sue.3097,Civ.C.)
0 Lenders Name
z Lenders Address
U0 1 coolly that 1 haw read this application and tate thus the Show information b
{s.P comer.I agree to comply with all city and county ominsnces and state brat relating m
0 building construction.and hereby authorize represenutiws of this city IS enter upas the
W ,bow-mentioned properly for UupecOon NOPatea 117 /1.
6. (WO)Sgtce to saw,indemnify sed kap hmmkss the City of Cupertino agai=
rA liabilities,judgmena.eotu and expenses which may in Any way accrue agsimtssidCity
U Z in consequence of the granting of this permit.
^ APPLICANT UNDERSTANDS NO WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
8 QS Re-roofs
Signs of Appli.nUCaan' Dam
HAZARDOU ATERIALS DISCLOSURE Type of Roof
Will the applicator or furan Wilding Occupant none or handle hnallou material
defined by tie Cottonton Municipal Code,Chapter 9.13,and the Health and Safety
Sector,25532(.)7 � All roofs shall be inspected prior to any roofing material being installed.
Q Y.,
Wilt the applicant or future building=upset ue compound at dcvims which If a roof is installed without first obtaining an inspection,I agree to remove
cmh hazardous air conaminana u darned by the Bay AmaAir Quality Management all new materials for inspection.
District? 1
❑Yes Qrvu
I have mad the h.esrdoumaterialarequlrcmenu underChap er6.95af the Califor.
niaHmW&SaletyCoda,Section,25375,35533 And 25534.1 undersand thatiflhe building
does not currently how a moan,Nat It 100ah,responsibility So nodry the..Pam of the
requirements which must be met p o Ana ser.Ccmfi.. ar7pancy, Signature of Applicant Date
c ° All roof coverings to be Class"B"or better
Owner honyedagent Crate
G