05030273 CITY OF CUPERTINO
BUILDING DIVISION PERMIT 4CONTY2ACTOR INFOR�ATIDN s
BUILDING ADDRESS: W E O'NEIL CONSTRUCTION PFRMITND'05030273
20500 TOWN CENTER LN it 996
OWNER'S NAME: PERMIT ISSUE DATE
SILVERSTONE DEVELOPMENT 5245 PACIFIC CONCOURhE DR VR 08/29/200S
E: SANITARY NO. CONTROL NO.
(510) 385-0121
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
j86 LICENSED CONTRACTOR'S DECLARATION Job Descri tion
I buttery affirm this 1 ace,liamed under pmvWaM of Chapter 9(mmmcnclog P
iNSxtlon7OM).f DIvW n 3 of the Business,and ha na Professions Code,amy liaI-
full �9�/ C?� NEW CONDOMINIUM
?gt-' o:mm` 1 c Vater tit �E/L 1193 SQ. FT. LIVING AREA
WARCHITECTS DECLARATION
�a+ I undenund my plana Mail M mod as public records
5� Licensed Professional
OWNER-BUILDER m the RATION
oommu
00 1 hereby.('firm that I am exempt from the CanBnetarl :My c Law for the
a O which ng reason.(Sadao T(13 s r t,Business and ere.denim Cade:My city or county
$un which rtyuirta a permit re construct,alae Improv,h permit t m repair any mrucmm
_ice that he its licensed i p also mquit a Me applicant for sucCon permit to UO, hamoment 18101
RG (comma cingputsaon70M)ofDiviomofdie ofamB sinessalianalaw(Clupm9 Sq.Ft.Floor Area Vdl
$ (commencing with Section 7000)x(Division]af Ne Business aha Pmfeuiana Cadet or
i Nat he is aempt therefrom and de basis for the alleged nemp0on.My violNon of
Section 7031.5 by any appliam for a permit subjects the applicant to a Civil penalty of APN Number Occupancy Type
nut more than five hundred dollars(550107. 36940002 . 00
❑1,u owner or Ne property,or my employ=with wages"detrmle campevadon,
will do the work,md the structure m notinendedmoffemd(mind.(Sec.70",Business Required Inspections
and Professions Code:The ConuncNrs Licerue Law does not apply to an owner of q P
property whobutIdscarImprove.thereon,and whodices such workhimselfar though his
own employee,pmvmud that such improvements art not intended or offered for sale.11.
however.the building or imp rewound Is sold within one year of completion,the owner.
builder will haw the humen of proving that he did not build or improve for purpose of
sale.).
❑1,as owner of Ne property,am exclusively contracting with IIcesW contraction,to
construct the project(Sec.7010.Bnai.aha Profeados Cade:)The Contractors LI-
ecru,Law dans not appy to an owner of property who bmWs or improves thereon.and,
who contracts for such projects with a eonummr(s)licensed puosnt N the Contractors
License law.
I am exempt under See. ,B&P C for this won
nee Dare
WORKERS COMPENSATION DECLARATION
I hereby affirm under Penalty of perjury aro of Oe following ammunitions:
I baa and will maintain aCertifiate of Consent to self-Naum(s Workers Compen.
sadon,u provided for by Section 3700 of the labor Code.for Ne perfor mann of 0e
west for which this permit is issued.
D 1 have and will maintain Woftes Compensation Insurance,u required by Section
7700 of the labor Code.fs the performance of de work far which Nu Tenni,is bound.
My Wafers Compensation Inaurana artier and Policy number art:
Gnnc,.? yl0u/A�r7't-/-A.-Policy blw(IC,7Sj3y r
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu sada need notbccompleed time rem 1,Isfaonehundreddollan(3100)
or Ica.)
I Cerl Net in the performance of the work for which this permit is laced.I shall not
employ any person in any manner an u On became subjecu0 de Warken'ComPm31aOR
Laws of California.Date
Applicant
NOTICE TO APPLICANT:IL after making this CenlOate of Exemption,you should
become subject m Ne Workers Compunction provisions of Ne labor Code.you most
.J O raMwith comply with such provisions or this permit shall be deemvok
ed reed.
„Z,rCONSrRUCrION LENDING AGENCY
=
Eve I hmairalfinn Nat Nem tax constroNnn modingageocy for f per(omimceuf
a > the work rue which this permit is Wad(Sun.3097,Civ.C.)
Wim'Q Lenders Name
a z, Lmde sAddw
V 1 cenlfy that 1 have read this application and sum Nat the above information is
IT,F correct.I agree m comply with all city and county ordinances and aunt laws relating so
O V building construction,and hereby authorize repmsema0wsorthis city to enter upon ft
[gl shove-memi.ned property for inspection pure SH.
(We)agree to save,indemnify and keep harmless the City of CLPmtinm xgaist
n„y liabllides.judgments,cora and exporters which may In my way satin against said City
in C.3 APPLI'ICCANT UNDEumm,or Me RSTANDS Aof dINPe ILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCEREGULA ONS. er
Re-roofs
Signatu Appliam/Contrucmram
HAZARDOUS MA AIS DISCLOSURE Type of Roof
Will Ile applicant or forum building occupant cam orlundle hecamoas material
u donned by Ne Cupertino Municipal Cods.Chapter 9.13.and the Health and Safety
Cade.Section 25532x)? All roofs shall be inspected prior to any roofing material being installed.
Q Yes
WIII the applicant or future building occupant use equipment m devices which If a roof is installed without firs[obtaining an inspection,I agree to remove
emit haxardns air comma mu u do d by Ne Bay Am.Air Quality Management all new materials for inspection.
District?
❑Ycl u
I have read the hoanlos materials requirements under Chapter 6.95 ort the Califor.
.is Health gr SafctyCM.,3eetimts 25505.25533 and 25531.1 underamnd mu if Ne building
docs on,currently hew a tenant,th t' my respsnowitby,m easily de occupant of the
mquimmcnuwheh mart be met Wumm or a crnirecam01.7.1—
of a Signature of Applicant Date
S Ly 6S All roof coverings to be Class"B"or better
Owner VauthoArml agent DOW
v