05030275 CITY OF CUPERTINO
PERMIT NTRACT6
BUILDING DIVISION
BUILDING ADDRESS: W E O'NEIL CONSTRUCTION PER.M7"005 03 02 75
_Z0500 TOWN CENTER LN ft 195
R'S NAME: PERMIT ISSUE DATE
SILVERSTONE DEVELOPMENT 5245 PACIFIC r0NrQUR!JE, DRIVE 08/29/2005
PHONE: SANITARY NO. CONTROL NO.
(510) 385-0121
ARCHITECrIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
.0 0 LICENSED CONTRACTORS DECLARATION lob Description
w J I hereby Option Oat I am licensed under previsions or Chapter 9(commencing
with&.He.101111)of DIA&I..3.f pro Business and profersdurest Code,and my]am=Is
filf d IT NEW CONDOMINIUM
Glx c ce, A TqI9 I
ell Date 9 Continuator Lve QrFJL- 1116 SQ. FT. LIVING AREA
3 ARCHITECTS DECLARATION
I Moderated my plimsidisdi hic used as;public necords
u. Licensed Professional
'0 OWNER BUILDER DECLARATION
i�x I hereby art..that I A.commit form Me Capacities License L.w for the
COO following Manor.(section 7031.5.Business FOW Prefoudoes C. My City OF County
which equities.Permit an consider.iflun.improve.deprolish.M repair any murpeourn
Prior in its isappence.also requires,Me applicaurp,for such popprit Or fil,.d,rcol slaterne.1
that he is licensed!pudempt In pro provisions offtCM=WrS�Fpm Law(ChAPICF9 Sq.Ft. Floor Area Val$109 18 8
(commencing with Section 7190)of Division 3 of the Busuncessand
that he I,exempt therohmen and the ledusis for the alleged exemption.Any violadom of
Section 7031.5 by any applicant for a perind,subjects;the applicant in a civil penalty of APN Number Occupancy Type
not in=than Ever hundred d.flards,(SSW). 36940002 . 00
w.gu u Nab reps
will do theivok,and OF concepsom hemirmanded croffored forsuak(Sm.7044,Rosevear
and Prfessions Code:The Commandoes Liverese Law do
an,apply W an onverear of Required Inspections
property who Wilds or Improves;thernmen,andt who does;sub work hirmelf or through his
mon comployces.providect dust such Improvemema surce not intended or offersed for sake.If.
however.did building or Improvement is sold whion..year Of courridiftho,ft pwmM-
builder wild have Me When of proving But Ito did ran Wild or Improve for purpose of
.I..)
❑1.as Owner of use property am exclusively commending with licensed coaddederna in
renames Fix project(Sec.7044.Bumpada;and Professions Code:)TU Comnector's U.
cove Law door not apply an an owner of property who Wilds or Improves Onamon,and,
who contracts,for such projects with.contrancou(s)licensed porsount in the conmioes
Lk..Law.
moomp,proder Sec. B&P C for this rtuon
Date-
WORKERI COMPENSATION DECLARATION
I hereby afflan under penalty of perjury on of the following declarations:
0 1 hew and will noximairaCtenisomenfConsperstonself-ileum forrWorlece.Compere
cation,as provided for by Section 3700 of up,Labor Cook,for the porformamed of the
work for which this permit is Wood.
E]I have and will mainum Worker's Comptereummin Insurance.re,required by Section
3700 of Oct Labor Code,for the performance of the wade for which this portable thesuccL
My Workmes Compensation Insurance carrier and Policy number an:
Card.:dult-wilt evO 14W Policy NO.:11 0r.01a.3-a-f
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(lil,rectice need not the,oreplord If the Permit Is forope hundred dollen(SIM)
or less.)
I CCFdfY Oat in Oc performance,of Me work for which this permit is issued.I shill not
employ any person In any nomenerse,des to become subject to the Workers Compensation
Laws of California,Date
Applicant
NOTICE TO APPLICANT.If,after making this Certificate of Exemption,you should
Income subject th the Worker's Compensation provisions of On Labor Coall you mum
z forthwith comply with such provision or this pardii shall be doomed mocked.
z 0
CONSTRUCTION LENDING AGENCY
lZI I hereby&from that them I.a compositor lending alOrM,for Oc performance or
> Me work for which this Permit Is issued(Sm.3097,Civ.C.)
LcnbF`3 Name
CS, Lenders Addmars
I ocnify that I have mad this application and sum,that ulic above Information It
IS. coma I Spec to comply with all city and county Onfinamel and sow law,MIAWAS In
0 C.7 building construction,and hereby mulborrind representatives of this city in enter urmor the
.1mvI-apeopficorml proptnty,for inalecdon purPML
(We)agree to gave,indemnify and keep laamless the City of Cupertino afteraL a17
,A Ifirbillmop Judgments, Oita and esp..s which may in any way accruc.,Iindl aid City
U Z in consequenct,or the greptinz of th, It
ons
"Of 4AWILL COMPLY WITH ALL NON-POINT
APPLICANT UNDERSTANDS Issued by: Date
S
SOURCE REGULX1 LONS.
4ft� 4 Z 912 Xo(al- Re-roofs
SgCl/
grearcer0l'ApplicapI/Conametor .0" DAM
HAZARDOUS NITTERIALS DISCLOSURE Type of Roof
Will the tpplicare,w form Wilding occupant nom or handle hapospelous material
an
apti, y Cupardno Municipal Code.Chapter 9.12.moi the Health and Safety
Fe,=11 n do,25532(.)7 All roofs shall be inspected prior to any roofing material being installed.
cy. 911W
Will the applicant or future building=opsnt use equipment or dcvi=which If a roof is installed without first obtaining an inspection,I agree to remove
eirph hvzdw airpaudin defiled by the Bay Area Air Daily M&FAMprent all new materials for inspection.
Disuict?
0 ye, 7m`-
I have Mad the IWXdM MMHAIS TnUmnotput under Charity 6.95 Of the Cidifff-
pis Health&SaletyCode,Sccum 25505,25533 and 75534.1 undcricand ship ifft building
does not currently haw a sompro.LW us my responsibility in nodry did occupant of the
momimorwrius which must be FML"to happeocc of a Opuricsic Of Occupancy. Signature of Applicant Date
Imo,
r, 912-f 95— All roof coverings to be Class"B"or better
Copper"thorind agent "Or I