05030254 CITY OF CUPERTINO
BUILDING DIVISION PERMIT ,CONTRACTORINFURMA'riON,
BUILDING ADDRESS: W E O'NEIL CONSTRUCTION PERMIT NO.05030254
0500 TOWN CENTER LN 4 275
R'S NAME: PERMIT ISSUE DATE
SIVLERSTONE DEVELOPMENT 5245 PACIFIC 0S
PHONE: SANITARY NO. CONTROL NO.
(510) 365-0121
ARCHIEC IFNGINEER: BUILDING PERMIT INFO
BLDGO ELECT PLUMS
MECH
O
j o p LICENSED CONTRACTOR'S DECLARATION Job Description
1 ty I Wwby M.that I am licensed and.,provialons of Chapter 9(enmm uct.1 P
with Section 7010)of Division 3 of No Business and Pro(esalons Code.and my license is
+� in mRraRenderreel. / /' NEW CONDOMINIUM
Z Lice I Lie.0
3k DaeContractor tr t 0nfdn L 743 SQ. FT. LIVING SPACE
'3<+ ARCHITECTS DECLARATION
I understand my plans shell its,hand as public mmr& -
y
0 Licensed Professional
OWNER-exempt R DECLARATION
Cervant
i 0 I hereby,(firm that 11. exempt frena the Cervantes License Law far Use
O O which
reason.(Section 703 1.5,Bustlers and Improve,
de ons Code:My city or stain
5$ unty
� which requires•permit m cores tax Blur.improve,h Fernot t ore a sig end suu,wm
�Sa poor mane its issuance,
nsedpursu stureqn tenbo applicant forthe sucCo mutiuofdcatl aw(Chi ned mem
�< lhatheueingwitpursuant 7Wthe)of Division
iatom Of the Commmr's Lianulaw(Cltspter9 Sq.Ft.Floor Area Valu$06 009
$ that M is erg with Sectioncan and she
D alis for of the Business and orofMy Professions Cade)or
out k ts cutnpt Nerefw and 0u buts for Nc allcgW eaempthm.My NoWim of
Schon 7031.5 by any applicant fee,permit subjects the applicant to a CMI penalty of APN Number Occupancy Type
nut more Nan Rw hundred dollars(5500). 36940002 . 00
❑1.as no,of the property,or my employ.with wages u their sale compensation,
will do the work,and the awcmte is not Intended err offered fonale(Sm.7044,Business Required Inspections
and Profeeslons Code:The Convectors License Law don not apply m e ns an owner of q P
property who builds or i mperom thsmn,and who don such work himself or auough his
awn employees,proNdW thuauh Improvements are Out inunded croffaed for asks.U.
however,the building or improvement is sold within aro year of completion.the awmr.
builder will haw the boaden of proving that he did not Wild or Impacts:fm purpose of
salo).
❑1,as Owner of des property,am exclusively conu¢ting with licensed antrammra in
monsuhct the project(Sec.7014,Business and profcsaiam Code:)The Cmuecum's U.
cense Law doh not apply m an owner of property who Wilda or improm Norton.and,
who contracts for soon projects with a eanuanor(s)licensed pommon m the Conteanofa
Llenm law.
❑Ism exempt under See ,B k P C fm this wan
Dam
W ORKER9 COMPENSATION DECLARATION
I hereby alllrm under pemlry of pe*,..of the following declandom:
❑1 have and will maintain.CeniMtes of canent an self-imhre for WormesCompen-
station,as provided for by Smaten 3700 of the labor Cade,for the performance of Ne
work for which this permit is lased.
t-I 1 haw and will mainumn Workees CompensNan Insursocc,m required by Section
37M of tho labor Code.for the perfomnuweof Ne wan forwhich this work Is issued.
My Wmkefa Compensation huhu me artier and Poli,number ate:
Cartier.'LUA&jV-,tv"14*4t,f+�Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(rats scam mod an,W completed Lima permit is foronc hundred dollen(SIM)
or less)
I certify,that In to performance of the work for which this permit is Issued.I atoll not
employ any penin in any manmrso as to became subject to de Workers'Compcnmdon
Laws of Califamla.Dau
Applicant
NOTICE TO APPLICANT:IL after making Nis Certificate of Exemption,you should
become subject m the Worker's Compensation provision of Ne labor Code,you mica
.J QM
fowiN n comply with such provisions;at Nu Permit Mdomed revoked.
Mall he oked.
'y rrACONSTRUCTION LENDING AGENCY
[r Ihereby affirm Nat Nem Is a construction lending agency the perfarmanco of
Di r7 thn work far which this permit is Issued(See.3097,Civ.C.)
Lendces Name
z Iendeh Address
U O i canary that I Mw and this applicWm and mm Na the above information is
V,r"'! carnia 1 agree an comply with all city and county onlinaoaund aura laws misting to
O`rJ' building construction,and hereby authorise representatives of this city m enter upon Ne
(i1 above-mentioned property for Inspection purposes
(We)agree an caw,indemnify aM keep hurtles the City of Cupertino against
„w fan liabilities.judgmen0.eests and expo.which may In my way eceem agaimuaid City
U 7 in consrgmnee of Ne gmdng of Nis permit.
F7 APPLICANT UNDERSTANDS AW WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONSr - j . 1; %
oee� Re-roofs
Ap ncan✓Conusctor
xA7ARno[Mh IAISDISCLOSURE�� Type of Roof
Will the applicants or future building oaupant M.orhand).huudon mmmial
WMed by tie Caperton Municipal Cade,Chapter 9.13,and the Health and Safety
e.Sector,23533(a)T Dull roofs shall be inspected prior to any roofing material being installed.
❑You
Will the applicant or fmum Wilding Occupant um equipment m devices which If a roof is installed without firs[obtaining an inspection,I agree to remove
emit hanrdnus air conumimnu as dc0md by the Bay Area Air Quality Management all new materials for inspection.
Dsuictl /
❑Yes Qtly
I have mW thehandnnmatedals requirements under Chapter6.93 orate Cailn
niaHmlth&Safety Cade,Same.25505,35533 and 35334,1 understand thatiff a Wilding
don not currently haw a maxim,Nat i s respomlhiiby m ratify the uceupant or the
requirements which mica be met pct uuws Ofa CcmJfcma.f Oc c5'. Signature of Applicant Date
owns,:.50
nthadsa ,Beat 9 ,�� All roof coverings to be Class"B"or better
L