05030276 CITY OF CUPERTINO
BUILDING DIVISION PERMIT PCUNTRACTQR INNFFUI2MATIq.N ffi'.
BUILDING ADDRESS: W E O'NEIL CONSTRUCTION PERMIT NO.05030276
9.prnn TQWN (-ENTER LN it 1751,
R'S NAME: PERMIT ISSUE DATE
SILVERSTONE DEVELOPMENT 5245 PAC F 5
PHONE: SANITARY NO. CONTROL NO.
(510) 385-0121
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
3 6 LICENSED CONTRAMR'S DECLARATION lob Description
I hereby afnrm them 1 mm hummed motor provisions of Chapter 9(mmmeucing P
e wh Section 7").f Division 3 of the Bud.and Profesalnns Code.and my Ecenm is
!Z
is
+< 10 hit
631
NEW CONDOMINIUM
Z Licenan CI Con
Data ern sear �. ONEyL 1116 SQ. FT. LIVING AREA
5e ARCHTTECTSDECLARATION
C Iundcntandmyplansmailheusedapublicrecords BMR UNIT/ NO CONSTRUCTION TAX
9p� Licensed Pro(cestnnaI
OWNER-BUILDER DECLARATION
I hereby nrnrm Not 1 am exempt from tho Crntramr'a Licence Law for the
Coe) following mann.(Sectiun 7(D 1.5,Business and Professions Code:Any city or county
5$ which acquires a Permit to mammCn elan improve,demolish.or repair any swcrom
_zY poor to its issuance,also requires the applicant for uch permit M file a signed statement
f€`o that M b rm
licensed puant m tie ns provisioof the Conuectorl Liana law(chapter 9 Sq.Ft.Floor Area Valuation
$ (commencing with Swam 700t1)ofDivision 3ofme,Business and Proresion,Coast)or $129188
—
that he is exempt Nemfmm and to basis fns the alleged exemption.My viotation of
Smdm 7031.5 by any applicant for a permit subjects the applicant W a civil penalty of APN Number Occupancy Type
not mom than Ove hundred doltan(M).
I,arwnerof Nn Paperty,ormyemployceswhhwagassthebmlecampenadon.
wuldo the work,md Nemuctum is nmminded or ofrerad forub(Sm.701,Business 36948- 22
Required Inspections
and Profealons Cade:The Canuacums Liatua Law does roet apply to an owner of q P
property who build,or improves thereon,end who does arch work himsul(ar thmugh his
awn employees,provided that such Improvements art not Intended oroRemd forum.if.
however,the building or Improvement is mid within ow year of compledon,Ne Owner.
Wilder will have the burden of proving that M did not build or imports for purpose of
sale.).
❑1.as Owner of the Protons,an emlusively contracting with licensed contractors to
constmet On,project(sec.7a .Business and PrOca ons Code:)The Cont actor's U-
cena law dace.,apply to an owner of pmpm y who builea m improves thereon.and,
whoc omma fnssuch projects wide secontrrtm(a)licensed ponswnt to the Conamalms
License law.
Q 1 am exempt under Sec. .B d P C for this won
Data
WORKERS COMPENSATION DECLARATION
I bemby affirm under malty of perjury one Of the following decimations:
❑Them and will maintain aCemfiam of Consenttoself-InaumforWorker'sCrmpen-
ution,aprovided Tor by Section 37110 Of the labor Code,for We Performance of the
wart for which this permit is massed
❑1 have and will maintain Warkarl Compensation Wmrana.as acquired by Section
37W dee Labor bor Code.for de performance of the work far which this permit Is issued,
MY,
afte,Compensation hum u a carrier Band Policy number am:
Gone..YUlfIGy-A,,aK'A"Polr�yNo.: L S J -O
CERTIFICATE OF EXEMPnON FROM WORKERS'
COMPENSATION INSURANCE
(Tib section and notbecmnpleted lithe permit is froom hundred dollars(SIM)
or las)
I anify that In the performance of the work for which this permit is Ware,I Mall not
employ any person in my mmmran U m become subject to dee Workers'Comp oOmOO
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If.aRe,making tab Cenina¢of Exemption.you should
become subject to the Worker's Compensation provisions of the labor Codu,you meet
Oforthwith comply with such provisions or this permit shall be dared revoked.
ZCONSTRUCTION LENDING AGENCY
[.`
.r I hereby affirm Wt Nem is•consumdon tending agency for the perfanmance of
ai 7 ted work for which this permit is Wood(Sue.3097,Civ.C.)
QLenders Name
z Lenders Address
Add
U Q 1 anify that 1 have mad this application and state that the Oban information b
IL contact.l agree to comply with all city and county ordinances and stag laws relating to
p building construction,and hereby authorize representatives of this city to enter upon the
W shove-mentioned property for inspection proposes
(We)agree to um.indemnify ad trap harmlw the City o(Cuperdno against
v) thallities,judgments,cams and espeues which may In my my accrue against said City
U Z In consequence of the granting of this permit.
.. APPLICANT UNDERSTANDS AND ILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCEREGULATI� Ns.
�-n ,� Re-roofs
Signature ppliesn✓CrnuaSnr Dam
HAZARDOUS MAfERIALS DISCLOSURE Type of Roof
WIII the applicant or future building occupant nom or handle harerdous material
,flood by the Caperton Municipal Code.Chapter 9.13,and the HcaIN ad Safety
,section 25532(al? �Na All roofs shall be inspected prior to any roofing material being installed.
❑Ya
Will the applicant or future building cecupont use equipment or devices which If a roof is installed without firs[obtaining an inspection,I agree to remove
untie hotudnus oto contaminants a dcnwd by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yea t4<�
I have mW the harardeus materials requirements under Chapter 6.95 of the Califor.
nb Health R SafctyCodc.Suctions 25505.25533 arvd 25534.1 moderated Net if the building
does not currently have a tenm6 Ne t' my responsibility m notify the comment of deo
requirements with mussbemetp' iawwcofa CeNOcmeci Occupancy. Signature of Applicant Date
Owner mtnariyedagen, ' All roof coverings to be Class"B"or better