05030252 CITY OF CUPERTINO 4"'4r•"'-,
BUILDING DIVISION PERMIT z � NTRAG,TORIN�"ORMA'TIOI ,
BUILDING ADDRESS: W E O'NEIL CONSTRUCTION PERMITND'05030252
2P500 TOWN CENTER IN ;� 273
ER'S NAME: PERMIT ISSUE DATE
SIVLERSTONE DEVELOPMENT 5245 PACIF 5
PHONE: SANITARY NO. CONTROL NO.
(510) 385-0121
ARCHITECIENGINEER:
BLDG BUILDING PERMIT INFO
ELEC7 PLUMB MECH
E= I�
30o
LICENSED CONIRACIOWSDECLARATION Job Description
`u 1 hereby afOm that 1 sec licensed under provisions of Chapter 9(commuting
IN section 70M)of Division Sof the Business and Profusions Code,and my license is
i0 fallfarceandercen. `' NEW CONDOMINIUM
HIM Lmeme CI Lt.g N9Y ? .
FFFF Date ComMor Wr. ONS/L 743 SQ. FT. LIVING SPACE
ell ARCHITECTS DECLARATION
i I understand my plans"I le used as public mcnNs
Licensed Profess mal
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt farm the Contractors License Law for the
OO following mason.(Section 703 1.5,Business and Professions Code:My city or county
S$2 which requires a parfait to conswcL alter.Improve,demolish,or-pelf soy structure
i oo prior to its issuance.also requires the applicant for uch poral m 01e a signed stammers
gg
that he Is licensed pursuant in the provisions of the Contractor's License Law(Clexpla,9 Sq.Ft.Floor Area Valu$86009
q�0 (cmnfaoncing with Sutton 7000)of Division 3 of the Business and Profcasiont Code)Or
any $ that he Is exempt the efmm and the basis for Me alleged exemption.Any violation of
Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
notmomthan0vehundreddollgn(M). - 36940002 . 00
❑I.uawms of the propry.osmy employees with mgesas Nelr anm compensation,
willdo thcwork.and me mussun u not intended or ortartA(Orane ISee.7044.Bushes Required Inspections
and Pmfenlans Cade:The Connors License Law aces,tout apply to sat Owner Of q P
pmpwy who bui Ids or improves Mercer.end who does tush work himself or through his
own employees,pmvided Nat such improvements ue notinmMed un@red for sale.If,
however,Ne building or improvement is told within Can year of cempleson.the owmr-
builder will have Me hard.of proving this he did rot build or Improve far purpose of
cam.),
❑1,as owner of the property,am exclusively canvacting with licensed contra ems W
Construct the project(Sec.7014,Business and Professions Code:)The Canmattors U-
ca-e Law does not apply an an owner of property who builds or improves Marmon,and.
who convects for such ejects with acomancior(O licensed pursuant W the contractors
License law.
❑I Om exempt under See. ,B&PC far Nu mason
r Data
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of Perjury am or the following declautiostc
❑1 bow and will maintain aCeniOam of Co-enttoself4faumforWarkee,Compen-
astion,as provided fm by Section 57M of Me labor Code.far We perfomence of the
work for which this permit is Issued.
❑1 have and will maintain Workers Compensation Insurance,as required by Section
37M of the labor Code.for We ptfamance of the work for which this permit is issued.
My Worker's Compensation lasurance�carrier
and Policy number am:
Cericr?(/Af,4/ No.: t4413r
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
('ITissectlnn need notbecomplemd lithe Permit R foram hundred dollars(SIM)
or ma.)
1 certify Not in than performance of the work for which this Permit a iswed,l shall not
employ any person in any manner se as 0 became subject to the Warkari ComputsaMm
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this CcnlRne of Exemption,you should
become subject to Ne Worker's Compwtion provisions of use labor Code.you menu
z forthwith comply with such provision of thin Permit NWI be domed revoked.
Zy CACONSTRUCTION LENDING AGENCY
F•n Ihereby affirm that them is a consumctlnn lendtng4emy far Me Performance of
0.i 7 the work for which thin permit a issued(Sec.3097,CO.C.)
W Q Lender's Name
z Lender's Address
U O 1 cenify that 1 have read this application and sum that the above information is
ly coarct.l agree to comply with all city and county Ordinances and mum laws relating th
0 U buildingcomuuctier,andhembyauthorimmpmmenutivnofthit cltytocnmr OPnnte
W above-mentioned property for impaction purposes.
gy (We)agree in eve,indemnify and hep hmnleu Me City of Cupertino 81116-1
in liabilities.judgments,costs and..Khan which may in any way accrue agai-1 said City
U7 In consequence of the granting of Nis iL
F7 APPLICANT UNDERSTANDS A WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCEREGULA ONS.
g 2q a Re-roofs
Signau ApphcanKonuacm, am a of Roof
HAZARDOUS ALS DISCLOSURE Type
Will Me applicant or future building Occupant Tom or handle lamolOas material
dented by the Cupertino Municipal Code.Chapter 9.11,and the Health and Safety
Section 25531(a)7 All roofs shall be inspected prior to any roofing material being installed.
ri Yen
Will the applicant of future building occupant use equipment m dcvim which If a roof is installed without first obtaining an inspection,I agree to remove
emit hasardovs air conteminmu as defend by the Bay Area Air Quality Management all new materials for inspection.
District? /
❑Yos �f16
I have read the huallo s materials requirements under CMpmr 6.95 of Me Califao-
ns.Health&SafmyCodn.Sectio-25505.25533 uW 2553/.I undcoaand Mm if Me Wilding
does not cmromly hew s mnane the t' my map-Imlity to anally Me occupant of Me
requlmmenu which must be met mmmmc afa CerMfeam of Occupancy. Signature of Applicant Date
,A!z. 4-._4 A Al2- /6.11�_
y All roof coverings to be Class nBn Or better
Ownsauthonmd agent DOW