05030270 CITY OF CUPERTINO
BUILDING DIVISION PERMIT gC0NTIUCTORA NF,ORMATION
BUILDING ADDRESS: W E O'NEIL CONSTRUCTION Pum"No'05030270
29500 TOWN CENTER LN 9 276
R'S NAME: PERMIT ISSUE DATE
SILVERSTONE DEVELOPMENT 5245 PACIFIC 05
PHONE: SANITARY NO. CONTROL NO.
(510) 385-0121
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB 0MECH
loo
LICENSED CONTRACTOR'S DECLARATION Job Description
r6(Y I kreby affirm that 1 am licensed under previsions of Chapter 9(commencing
wird Section 70(10)of Division 3 of pm Business an profession,Code,and my license is
in m�foreearrdeffect. y / q NEW CONDOMINIUM
Z Ucenha Clu !Y.g 4 9'! Elf
?Fg oath cowacter L/C ObCIL— 1193 SQ. FT. LIVING AREA
ARCHITECTS DECLARATION
I underatand my plans shall be used u public records
50 Licensed Professional
OWNER-BUILDER DECLARATION
I hereby affirm on 11. exempt from the Comas Co License Law fou Ik
O O following meson ouch,o 7(131.5.Business and ve.de ten Code:My city or mum,
S$ which its i ms a permit re cores tan alcor,impmsc,h Permit he
or mash any utmmon,
thatWor iniuiensedpa4ant tone pression of the for aechpermr's Licumsigned(Chapter
Valt $101
pp < Natkucirgwid SectiotlotkpfDivision
iviomafof6.Butionsa UcenmiswalCoden9 Sq.Ft. Floor Area
Y�O (mmne Is exempt SeNmn70W)of basis s,3 oftheBninessmton.M vi Code)or
$ that k V exempt Ikmfrom and the bun for Um alleged exemption.My viotatian of "
Section 7031.5 by any applicant for a Permit subjects the applicant to a civil Penalty of APN Number Occupancy Type
not mom than five hundred dollars($500). 36940002 . 00
0 I,as owner of the property,m my employees with wages w their sale compensation,
will do thework,and theatroclme b notinunded oroRered for We(Sm.7001.Business Required Inspections
and Pmfehaian Code:The Contractors License law don trot apply to e an ow.of q P
property who buildsor improwa Uwas ,andwhat doessech work himselfor through his
awn employer;preNded that such Improwmas,u atm not intended poQend forme.If.
hwevu,dm building or hnprowmant is sold within ane year ref compledm.me owner-
builder will have the Wrden of pris,g that k did comm build or improv fee purpom of
pie.).
0 1.as Owner of the property,am exclusively contracting with licensed contractions to
construct the project(See.7004,Business and Profusion Cade:)Tk Conuasetara Li-
cense Law docs not apply to an Own of property who builds or improves themon,and
who comracu for such pmjecu with s contractor(s)licensed punctual to the Canaxt0el
License Law.
0 I am uempt undo Sec. .B h P C for this mases,
r Data
WORKER'S COMPENSATION DECLARATION
I bemby affirm under penalty of perjury one of the following declarations:
0 1 have and will maintain aCeArich orCmuent to half-insum for Workees Compsm.
nation,an provided for by Section 3700 of Ik labor Code.for the performance of the
work for which this permit is Issued.
0 1 leve and will maintain Workers Compensation Wheranm.as required by Section
3700 of the labor Code.for the performance of the work for which this permit Is tuned.
My Workers Compensation Insurance sari.and Paltry number are:
Caner.2041C&-A-«a,446t' Policy No.:4V-3f33103-o-
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(T essectlnn aced act kcompleted Iffix,pormh Is forom hundred dollars($100)
or less.)
1 sentry that in the performance of dm work for which this permit U issued.I shall not
employ any person in any manner an as an become abject to the Workus'Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this CerdOcau of Exemption,you should
become subject to the Worker's ComPenadon provision of the labor Code,you muat
7.7. 0 forAwnh comply with such provelioes or thin permit shall k deemed method.
q y CONSTRUCTION LENDING AGENCY
I-a Ilumby.111.that men iso comtrnedon lendingagcecy,for the performe.of
ori > the work for which this permit is issued(Sec.3097.CO.C.)
6W.Q Tandem Name
z lender's Address
U 0 I certify that 1 have match this application and stns thn tln above informaitun V
{in^ correct.I agree to comply with all city and county ordinances and one lave relating to
O SU' building construction,and hereby authorirc representatives ofdtis citymenlu upon the
W above-mentioned property for Inspection purposes.
(We)agree to have,Indemnify and keep humleu the City of C9POVIO0 against
nor 0 IIabIlldes,Judgments,eras and expenses which may In my wry accrue against said City
in APPLICANT UNDEuence of the RSTANDS ANDof COMPLY
w COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATINS.
8�2 7�S Re-roofs
Sitna of Applicantocmuractor am
HAZARDOUS MA LS DISCLOSURE Type of Roof
Will the applicant or future Wilding uccupent store or handle havallous material
Va.defood by the Cupertiva Municipal Code,Chapter 9.13.and the Health and Safety
Section 35533(x)7 All roofs shall be inspected prior to any roofing material being installed.
[2 Yes &h_
Will the applicant or future Wilding occupant one equipment or IIcvi=which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air comsmimnu an defiacd by the Bay Area Air Quality Management all new materials for inspection.
Disuic"
❑Yes mJe�
I have mad the hoardnn materials requirements under Chapter 6.95 ofthe Califor.
nia Hot"Safety Cade.Section 35305.35533 and 75534.1 undemand that lithe Wilding
does not currently haw a anent,that It isy responllett,y he wtify Gs,occupant of thc
requiremcnuwhichmunbeuch uencMC,ZcatcofOc Signature of Applicant Date
Z All roof coverings to be Class"B"or better
Ownu ptboriacdagem m
L