05030263 CITY OF CUPERTINO %" � a
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BUILDING DIVISION PERMIT ;CON§TRACTOR INFORMATION '
BUILDING ADDRESS: W E O'NEIL CONSTRUCTION PERMIT NG.05030263
WS NAME: PERMTT ISSUE DATE
SILVERSTONE DEVELOPMENT 5245 PACIFIC 2005
PHONE: SANITARY NO. CONTROL NO,
510) 385-0121
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
jo0 LICENSED CONTRACTORS DECLARATION Job Description
F1 Mmby affirm that 1 am licensed under provision,of Chapter 9(mmmencin{
^� with Section 7000)Of Division 3 of to Business ad!Profession Coda,and my license is
in full force and effect. NEW CONDOMINIUM
? j Llan.Claaa Lie.0 N9f/ e 3 i
- Cotact, L/ adea 1193 SQ. FT. LIVING AREA
2 ACTS DECLARATION
S I understand my plana shall W used as public award,
56
Licensed professional
OWNER-BUILDER mDECLARATION
C<O hereby.(foss that 11. exempt from da Contractor's :My c Law for the
p o following mason.(Section 7(D 1.5, t,alter,and Pm.de oli Cade:My city or county
3$� which myuims a permit m construct,alter,impmve,hmol,h,or repair any structure
prior In its issuance.also mquims the applicant for such permit Or III.asi,r dwmncnr
< that k u Iicased Pursuant lithe Provialons of dk Commuter's Uearw Law(Chapter 9 Sq.Ft. Floor Area Val�aTl'DB 101
gm
(commencing with Session 700D)ofDivision 3 of the Business and Profoctions Coda)a
I' $ that M,exempt demfrom and the has,for the alleged osemploa.My violiahm of
Sermon 7071.5 by any applicant for a permit subjects the applicant An a ciml penalty Of APN Number Occupancy Type
oat mom than fes hundred dollar(M). 36940002 . 00
0 I,as owner of the property,Or my employees with wage,as their Able compensation,
will do thewmk.and the mucmm h not intended or opened foude(Sec.7044,Braine„ Required Inspections
ad Profaosions Code:The Contractor's License Law doe,not apply u e an owner or q P
Property who builds or i mproma to cum.and who does such wait himself or through h,
awn employes,prOvidal Wt such improvements Am notimaded connived for do.If.
however.the building or Wnprommem is mid within ora)eta of completion.the owner•
builder will have the burdan of proving that W did cwt Wild or improve for puryom of
ask.).
0 1,as Owner of the property,an exclusively contracting with licensed cmntranurs in
comma the project(See 70",Business and Praessioru Cade:)The COntrmurs Lb
cam law does AN Apply in an Owner of property who builds or Interim themon.and,
who contracts forweh projects with a euntruter(A)licensed pursuant to dw COntractara
License Law.
0❑mearnpladm Sec. ,B&PCforthl8ma0a
Dau
WORKER'S COMPENSATION DECLARATION
1 hereby&Man under penalty of perjury am urine following decimations:
0 1 ham and will maintain a Cennrcateof Consent to self-insum for WOrkef,Canpen-
sation,as provided fm by Scalia 3700 of the Labor Cade,for the performance of the
work for which this permit,issued.
0 1 haw and will maintain Warkees Compensation Immace,use Lural by Section
3700 Of the Law Code.for the pewormam a or the work forwbich this permit la Issued.
My Workee,Compensation Inm snce carrier and Policy number see:
carder:�4/RIGN-.a.nt�yf-1 GA-¢Dory No.:k�G?S33�o3-os
CERTIFICATE OF Ei(EMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Th,acWan need not W compleud if the permit Is fmoachundred dollus(5100)
Or leu.
1 cmif-v that in the perfarmanee of the work for which this pamit is,aed.I shall not
employ any person in my reamer a a to become subject a the Worked Compensation
Laws of California.Dau
Applicant
NOTICE TO APPLICANT:If.afar making this Cau ftcete of Earaption,you amid
become mbjem An the Woherl Compomalan proviams of the Labor Code,you muse
,J 0 forthwith comply with such provisions at this permit shallmm
W dooed wked. -
'Zti'ti CONSTRUCTION LENDING AGENCY
[-r Iberchy affirm that were is a construction lending agency for the performance of
ai 7 the work fur which this permit is issued(Sec.3097,Civ.C.)
1[7 Q Landers Name
M z Landers Address
y C 1 certify that 1 haw read this application ad wa that the whom inform"Ima,
U,E+ caned.I apes u,amply with all city ad county oNiames and sure law mlating or
0Wilding construction.a ad hereby Authorizempresmutims of this city to enter upon the
W construction.above-mentionaA property fes Inspection purposes.
(We)Agree to na.indemnify ad keep harmless the City of Cupertino Apinst
(4'q Ilabilimajudimenu,costs andea cress which may in my way mean,against aid City
U in Conuence of the s rent.
APPLICANT UNDERSTANDS Aof rND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUR/CB REGUTIONL � y�/r
IG Re-roofs
Si{nuuryA AppinuCcustrator
HAZA DOOUS MATERIALS DISCLOSURE —D� Type of Roof
Will the applicant or future building accupsot were m handle hazardous material
road by the Cupertino Municipal Cath.Chapur 9.12,ad the Health ad Safety
Section 25532(.)7 All roofs shall be inspected prior to any roofing material being installed.
0y. Own
Will the Applicant or comm Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit haysrdous of,cor uminmu As defined by the Bay Area Air Quality Mmegemenr all new materials for inspection.
District?
0 Yea L7 u
I have read the huardommeurwhrequhements underChaparli.95 aNr.Califory
n,Health&SafctyCme,Secdons25.7.15,25533 and 25534.1 understood thatlfthe Wilding
dun not currently hew s tenant,dist It, y rcaponslbillty in notify sec occupant of the
rcyulrcmcnu which mustbemet prior cora Ccnific.a of Oce agcy. Signature of Applicant Date
Owner ser dad,gem Dow
All roof coverings to be Class"B"or better
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