05030272 CITY OF CUPERTINO ' ''�' -`
BUILDING DIVISION PERMIT ;MTkACTk6R TNVORMMAT ON,
BUILDING ADDRESS: W E OINEIL CONSTRUCTION PERMITNG.05030272
20500
OWNER'S NAME: PERMIT ISSUE DATE
SILVERSTONE DEVELOPMENT 5245 PACIFIC 08/29/2005
Ee SANITARY NO. CONTROL NO.
(510) 385-0121
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDGO O PLUMB MECHO
lo
LICENSED
o JobDescri tion
0 1 Wrcby Lohse Nat 1 em licensed under provisions of Chapim 9(commencing P
]j� with Stctlon]IXgq of Dlvielon3of NC BudneaaaM Profuainm Code.and mylkenseis
�a LflifaRandeffen / J NEW CONDOMINIUM
Llcenm Class Lic.0
Data 6f1t Contractor ova 1193 SQ. FT. LIVING AREA
5e Q ARCHITECTS DECLARATION
i eyyF77 I uMersund my plans shall he Land u public mends
yJ .
cJ LWcnntl Pmfcoionai
Oat I am exempt
fat DECLARATION
Coo hereby.(Seto that 11. excmps from the Caston Co License Law for the
O O following mason. arch(Section RD str Busmen and ere.r1mom Code:My oily or county
Coo
K which acquires;•tennis to construct.aloe Wprow,demolish,or repair any suucmm
_ �^ prior to its issuance,also requires the applicant for such permit to role signed statement
Nat he ie licensed pursuant to Ne provisions of the Contractor's LICOnse Law(Chapter 9 Sq.Ft.Floor Area Va a]tfm8101
$ (commencing with Session 10)(B d Divalon3 oftbe Business and Professiam Codd or
— that baa exempt therefrom and the basis fa the alleged exemption.My violadaa of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
net mom Wen Ove hundred dollars(5500). 36940002 . 00
❑1,Is owner of the property.or my employees with wages as deb tole compensation,
willdothewotk.and Wepmnumlsnai.w edmaffemdforsale(SW.70W.BWme, Required Inspections
and Professions Cade:The Communes Lieense Law des onot apply W In owner of 9 P
property who builds or i m proves thereon,and who does a uch work himanlf or through his
awn employes,provided that such improvements art nut intended araRered for oak.IL
however.the building arhnp uveneent is said within arc year of eempleu se.We owocr-
buildcr will have the burden of Leaving out W did ant Wim m improw for purpose of
sale*.
❑1,u Owner of the propany.Lou exclusively contracting wish licensed contractors to
construct the Project(Sm 7014,Business and Pm@adam Cade*The COntracta"Li-
cense law docs not apply to an awrer of property who Wilds or Improves thereon,and.
who contracts for Such projects with a contramor(s)liansad pursuant to the CanVacmr's
License Law.
❑I am exempt under Sec. .B&P C far this reason
Owner Dau
WORKER'S COMPENSATION DECLARATION
411 I hereby affirm under pemlly of perjuryarc of t e fallowing decla stimoc
❑I ham and will maintain a Certificate of Com rdtoself-losenefarWafer'sCOmpcn-
sation,as provided for by Section 3700 of We labor Code,for the perform acc of the
were for which this permit is issued. ,
❑1 haw ata will maintain Worker's Compensation Insurance•u required by Section
37W of the labor Code.fes the perforname t of We wants for which this permit is Issued.
My Worker's Compensation Insurance caniu and Policy number am:
ca bn2u2/eN- policy No.:G��.3s73(g3-oJ
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(rho section need Out becompleud Brie Permit is foronchundoed dollen($100)
or leu)
I Unify that in We performance of ase work for which this permit ts bound.1 andl nm
employ any person in any manner an u W become subject sa tW WOrkcn'Compcnnlion
Laws of California.Dau
Applicant
NOTICE TO APPLICANT:If,after making this CertiOcare of Exemption•you shwld
became Subject to she Worker's Compensation provisions of the Labor Code,you most
,JO forthwith comply with such previsions m this Permitmail be doomed evoked.
z ti CONSTRUCTION LENDING AGENCY
EI hereby affirm that dem is a construction lendinSagenry for the performance of
> the work for which this permit is Issued(Sec.7077.Civ.C.)
dQ Lender's Name
.7. z Lender's Add.
C)0 I attify thus 1 haft mad this application and sum that the aWve information Is
F corset.I agree to comply with all city and county ordinances and sate laws mining to
0 U building convection,and hereby autharia mpresentialm of this city to cnur upon the
{$) above-mentioned property,for inspection parpoas
g1. (We)agree to save,indemnify and keep homieo the City of Cupertino against
y liabilities,judgments,eau and expenses which may In any way ancmo against said City
C.)7 in consequaux of the Starting of this permit.
F7 APPLICANT UNDERSTANDS NO WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGUL TIONS.
8�17�dT Re-roofs
signets afApplicaHAZARDO of Roof
HAZARDOUS Wilding
AI.SDISCIASURE Type
WIII tie e,Appliems Camden forum Wilding oaupant atom mad t e bondoua d aurid
III MOned by the Cupenian Municipal Code,Chapter 9.11.and the Hcelth and Safety
Cork,section 15531(07 All roofs shall be inspected prior to any roofing material being installed.
V.
Will ft applicant or mare Wilding occupant use equipment or dcviaa which If a roof is installed without first obtaining an inspection,I agree to remove
emiI hazardous air contaminants as defiwd by the Day Area Air Quality Management all new materials for inspection.
District?
0
Ya L4M�
I have Lead the hazardous materials requirements under Chapter 6.95 of the Califor.
nia Health&Safely,Cocz,Sections 25505,15533 and 35534.1 undersand due ifthe building
does toes currently hew a suede austo my responsibility to notify use occupans of the
requirements which moa bemel arm oIs certificate of Signature of Applicant Date
9'' 8ja r All roof coverings to be Class"B"or better
Owner a0kahorived.gart Dau
G-