05030265 CITY OF CUPERTINO �,uAs•m�T^^ '.
BUILDING DIVISION PERMITCONTRACTOR.INFORMATIO .
BUILDING ADDRESS: W E OINEIL CONSTRUCTION PER1vlITNO05030265
0500 TOWN CENTER LN 4 186
EWS NAME: PERMIT ISUB DATE
SILVERSTONE DEVELOPMENT 5245 PACIFIC C 2005
PHONE: SANITARY NO. CONTROL NO.
(510) 385-0121
ARCHITECT/ENGINEER: BUILDING PERMIT
BLDG ELECT PLUMS PLUMB MECH
Io0 LICENSED CONTRACTOR'S DECLARATION Job Description
I hereby anbm that 1 am licensed under provilm"of Chapter 9(aemencing
n'1
with Section 701110 of Dividon Sof me Barin stand Pro(o limn,Code.and et,icense is I.Fall force and en"L NEW CONDOMINIUM
��Z Licemc CI Lk.R y 9 I 92 z It
a. D,l Comrmmr f✓E o �EyL 1193 SQ. FT. LIVING AREA
5ss ARCHTfECr3 DECLARATION
Q 5y�n I mmermnd my Ilam ah ll he need se public records
C
W sad Licensed Proem enal
OWNER BUILDER DECLARATION
I hereby rowen ofnrm that 11. exempt from dm Profession,snuacmh Licenm Law for the
O�off, which re rcama(SeNor 7(131.4 B.alteL atd ve,de Code:My City at county
which its issuance.
a Permit m candmbee do alter,improve,demolish..nr repair any structuweeram
_ hathchsiemsedprsumavothe"alpl oadtrat reuchfascue" nlealigned summem Vaaydt1378101
ZF< Nat(commencing
nand puemon101 P Disiomof mCContedoess l3ceme 6w(C oule). Sq.F[. Floor Area 'Y
6� that he is
pthhecoen7andthe basis
the
exempt Professions Cnde)m
It Net he h exempl therefrom and the baso fm Ne allayed exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
net mom than fin hundred dollars($500). 36940002 . 00
❑1,as owner of the Property,or my employcu with wagm We their sole eompenudon,
will do thew art and the muctum boot intended OraQemd far a*(Sm.70M,Bualiteu Required Inspections
and PropelCade:The Cunnee mes L.hense Law docs not apply m an owner of q P
property who builds or i mprevns d u coon.and who does such wank himself Or through his
awn emplayens,provided thllsuch Improvements art not Intended ar offered formic.If,
however,the building or improvement is mid within one year of completion.the own".
Wildm wIR Tuve the bucket of proving thm On did ant Wild or Improv fm Purpose of
sal.).
❑1,as Owner of die property,am exclusively Connecting with licensed amractnn to
construct the project(See.7044,Business and Profmalans Code:)The Commutes Li.
cause law docs not apply m an owner of property who builds or hansom men m,and
who Contracts for such pmjects MN a conumtor(s)licensed pursuant m die Contractor's
Licenm law.
❑Ism mmap,under See. ,B h PC for this mason
Data
WORKER'S COMPENSATION DECLARATION
1 humbly affman under Penalty of perjury arc of the following de Tical mte:
❑1 here end will malnuin a Cemnamaf Conant mtel(-imuro for W"ketBComp"-
coon.as,provided for by Section 3700 of the Taber Code,fm the performance of me
work for which this permit is bound.
❑1 have and will maintain Workces Compensation Insurance,As requited by Schon
3700 of the Labor Code,for be Performance of Be work for which this permit is issued.
My Workefs Compensation We pace rimer and Policy number am:
carrier.'uiJfk /I-LLw414/�PencyN.;% 3.(33/05-6
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
rlTl account need mtbccompleted Bthe Permit Is foronahundmd dORats(SIM)
m leu)
1 anify that in No perfosmencn of the wart for which this permit is issued,l mall not
employ any person in my manner an all in become subject to the Worimrs'Compenndon
Laws of California.Dem
Applicant
NOTICE TO APPLICANT:If,of or making this Cenifrats of Exemption,you should
bocmne subject to the Worms,Compenndon provision of Rin Lahr Cal.you most
O forthwith Comply with such pravidons m Nis permit Mall be deemed rovokrd.
y CONSTRUCTION LENDING AGENCY
[ti I hereby alarm mat more Is consurwulnn lendingagency l'nr the Performance of
a Cite wank for which this permit b laved(Sec.3097,Civ,C.)
W Q Iendeh Name
a z lender's Addrta
U O I comfy that 1 have road this application and sum that the above information Is
D. COMCL I agree m comply with all city and county onlinanaund sue laws relating to
0 building construction.and hereby sort mpreaenntim of this City to enter upon the
W above-nammo ed Property for Wpection Purposes
(We)alta to ave,indemnify and kap hsnnlea Ute City of Cupertino against
y liabilities.judgmOme.costs andexpensns which may in any way acme qal.,said City
V7 in conmgance of the snoring of this parents.
F7 APPLICANT UNDERSTANDS AND W MPLY WITH ALL NON-POINT Issued by:S toz Date
SOURCE REGULATION
1 241
Re-roofs
siywwe pplian onbmmr Deal
a Type of Roof
HAZARDOUS MA773R DISCLOSURE
WIII me applicant m fumm building uommarm snort"handle haasdous material
deRacd by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
.Schen 25532(.)? All roofs shall be inspected prior to any roofing material being installed.
❑ens Nu
Will the applicant or future building oaupant use equipment Or aYvitea which If a roof is installed without first obtaining an inspection,I agree to remove
emit haxamous air comminants a defined by me Bay Area Air Quality Management all new materials for inspection.
District? `/
Owe 695
1 ban mad the harodnw materials rtquimments order Chapter 695 of rix Calif".
nb Hulth&Safmy Code,Seclimts2s505.75533aW25534.iwdcnundmmifthe building
dam am cuoentiy have a tenant,mwill pons ihiliiy m nodfy mo occupant of the
mqulrtmcnu which must be met Into unncofa CeniBcateof Oce may. Signature of Applicant Date
8 2 All roof coverings to be Class"B"or better
Owner or uthomed agent Mae
Q
CITY OF CUPERTINO �,uAs•m�T^^ '.
BUILDING DIVISION PERMITCONTRACTOR.INFORMATIO .
BUILDING ADDRESS: W E OINEIL CONSTRUCTION PER1vlITNO05030265
0500 TOWN CENTER LN 4 186
EWS NAME: PERMIT ISUB DATE
SILVERSTONE DEVELOPMENT 5245 PACIFIC C 2005
PHONE: SANITARY NO. CONTROL NO.
(510) 385-0121
ARCHITECT/ENGINEER: BUILDING PERMIT
BLDG ELECT PLUMS PLUMB MECH
Io0 LICENSED CONTRACTOR'S DECLARATION Job Description
I hereby anbm that 1 am licensed under provilm"of Chapter 9(aemencing
n'1
with Section 701110 of Dividon Sof me Barin stand Pro(o limn,Code.and et,icense is I.Fall force and en"L NEW CONDOMINIUM
��Z Licemc CI Lk.R y 9 I 92 z It
a. D,l Comrmmr f✓E o �EyL 1193 SQ. FT. LIVING AREA
5ss ARCHTfECr3 DECLARATION
Q 5y�n I mmermnd my Ilam ah ll he need se public records
C
W sad Licensed Proem enal
OWNER BUILDER DECLARATION
I hereby rowen ofnrm that 11. exempt from dm Profession,snuacmh Licenm Law for the
O�off, which re rcama(SeNor 7(131.4 B.alteL atd ve,de Code:My City at county
which its issuance.
a Permit m candmbee do alter,improve,demolish..nr repair any structuweeram
_ hathchsiemsedprsumavothe"alpl oadtrat reuchfascue" nlealigned summem Vaaydt1378101
ZF< Nat(commencing
nand puemon101 P Disiomof mCContedoess l3ceme 6w(C oule). Sq.F[. Floor Area 'Y
6� that he is
pthhecoen7andthe basis
the
exempt Professions Cnde)m
It Net he h exempl therefrom and the baso fm Ne allayed exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
net mom than fin hundred dollars($500). 36940002 . 00
❑1,as owner of the Property,or my employcu with wagm We their sole eompenudon,
will do thew art and the muctum boot intended OraQemd far a*(Sm.70M,Bualiteu Required Inspections
and PropelCade:The Cunnee mes L.hense Law docs not apply m an owner of q P
property who builds or i mprevns d u coon.and who does such wank himself Or through his
awn emplayens,provided thllsuch Improvements art not Intended ar offered formic.If,
however,the building or improvement is mid within one year of completion.the own".
Wildm wIR Tuve the bucket of proving thm On did ant Wild or Improv fm Purpose of
sal.).
❑1,as Owner of die property,am exclusively Connecting with licensed amractnn to
construct the project(See.7044,Business and Profmalans Code:)The Commutes Li.
cause law docs not apply m an owner of property who builds or hansom men m,and
who Contracts for such pmjects MN a conumtor(s)licensed pursuant m die Contractor's
Licenm law.
❑Ism mmap,under See. ,B h PC for this mason
Data
WORKER'S COMPENSATION DECLARATION
1 humbly affman under Penalty of perjury arc of the following de Tical mte:
❑1 here end will malnuin a Cemnamaf Conant mtel(-imuro for W"ketBComp"-
coon.as,provided for by Section 3700 of the Taber Code,fm the performance of me
work for which this permit is bound.
❑1 have and will maintain Workces Compensation Insurance,As requited by Schon
3700 of the Labor Code,for be Performance of Be work for which this permit is issued.
My Workefs Compensation We pace rimer and Policy number am:
carrier.'uiJfk /I-LLw414/�PencyN.;% 3.(33/05-6
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
rlTl account need mtbccompleted Bthe Permit Is foronahundmd dORats(SIM)
m leu)
1 anify that in No perfosmencn of the wart for which this permit is issued,l mall not
employ any person in my manner an all in become subject to the Worimrs'Compenndon
Laws of California.Dem
Applicant
NOTICE TO APPLICANT:If,of or making this Cenifrats of Exemption,you should
bocmne subject to the Worms,Compenndon provision of Rin Lahr Cal.you most
O forthwith Comply with such pravidons m Nis permit Mall be deemed rovokrd.
y CONSTRUCTION LENDING AGENCY
[ti I hereby alarm mat more Is consurwulnn lendingagency l'nr the Performance of
a Cite wank for which this permit b laved(Sec.3097,Civ,C.)
W Q Iendeh Name
a z lender's Addrta
U O I comfy that 1 have road this application and sum that the above information Is
D. COMCL I agree m comply with all city and county onlinanaund sue laws relating to
0 building construction.and hereby sort mpreaenntim of this City to enter upon the
W above-nammo ed Property for Wpection Purposes
(We)alta to ave,indemnify and kap hsnnlea Ute City of Cupertino against
y liabilities.judgmOme.costs andexpensns which may in any way acme qal.,said City
V7 in conmgance of the snoring of this parents.
F7 APPLICANT UNDERSTANDS AND W MPLY WITH ALL NON-POINT Issued by:S toz Date
SOURCE REGULATION
1 241
Re-roofs
siywwe pplian onbmmr Deal
a Type of Roof
HAZARDOUS MA773R DISCLOSURE
WIII me applicant m fumm building uommarm snort"handle haasdous material
deRacd by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
.Schen 25532(.)? All roofs shall be inspected prior to any roofing material being installed.
❑ens Nu
Will the applicant or future building oaupant use equipment Or aYvitea which If a roof is installed without first obtaining an inspection,I agree to remove
emit haxamous air comminants a defined by me Bay Area Air Quality Management all new materials for inspection.
District? `/
Owe 695
1 ban mad the harodnw materials rtquimments order Chapter 695 of rix Calif".
nb Hulth&Safmy Code,Seclimts2s505.75533aW25534.iwdcnundmmifthe building
dam am cuoentiy have a tenant,mwill pons ihiliiy m nodfy mo occupant of the
mqulrtmcnu which must be met Into unncofa CeniBcateof Oce may. Signature of Applicant Date
8 2 All roof coverings to be Class"B"or better
Owner or uthomed agent Mae
Q