05030278 CITY OF CUPEPERMIT �CO,N'TRA� ANFORMATION4
BUILDING DIVISIONSION s TORS
F_%BUILDING ADDRESS: W E O'NEIL CONSTRUCTION rmmirNO.O503O278
0500 TOWN CENTER LN 4 179
•Its NAME: PERMIT ISSUE DATE
SILVERSTONE DEVELOPMENT 5245 PACIFIC C 005
PHONE: SANITARY N0, CONTROL NO.
(510) 385-0121
ARCHITELl7ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
t� I�
3Op LICENSED CONTRACTORS DECLARATION Job Description
1 hereby affirm WI 1 m licensed under provisions of Chapter 9(an mane ng
with Section 70111)of Division 3 ofdm Business and Profoatmu Code,and my Iicenseb
t I fmceandeifet. f NEW CONDOMINIUM
o fq 69
CMM c ganmr L 1116 SQ. FT. LIVING AREA
' ARCHITECTS DECthiA ION
Q I male mad my plana NW he used As public accords,
,tt; Licensed Professional
OWNER-BUILDER DECLARATION
1 Maclay affirm that 1 am exempt from IM COPIOmo(a License Law for the
p o following roues.(Section 713 1.5,Business and Professions Cade:Any city or county
CaO
� which requires a permit In construct.alcor.harrow,demolbh,or repair any muetum
-zi prim At its issuance,also tequirta the applicant for such Permit to rile a signed summem
£ that be is licensed pursuant to the provisions of the ContacuKIIJccnse Law(Chapter 9 Sq.Ft.Floor Area Val$&10618 8
y+ (commencing with Section 70D0)of Division 3 of the Business and Profession.Code)or
$ that he is exempt therefrom and the bub for the alleged compiler.Any violadon of
Section 7031.5 by any applicant for a permit subjects the applicant to A civll Penalty of APN Number Occupancy Type
sat mom rim m hundred dollan(SSW), 36940002 . 00
0 1,u owner of IM property,or my employees with wages As Heir sole compensation,
will do the work,and the structure lenot lmenddara@rod foraale(Sec.7014,Business Required Inspections
and Profeuiana Coda:no Conuacmfa License Law does,not apply m An Owner of q P
Property who builds or improves thereon,a nd who dao ouch work himself or through his
awn employees,provided thauuch impromments m noUntended aroRered far=is.If,
however.the building or Improwment ie sold within ane you atcomple0on.the owner-
builder will hem the burden of proving than he did not build o Improw for partners of
ala.).
❑1,as owner of dm property,am exclusively contracting with licensed contemn to
construct the project(Sec.7014.Business and Professions Code)The Contractors LI-
cense law doea not Apply In an owanr of property who build,or improvm thereon,and
who contracts for such projects with a conuacter(A)licensed pursuant In the Conuamota
License Law.
❑1 am exempt under Sec. .B Al P C for Nb reason
Data
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury am of the following decimations:
1hamendwillmainWna Ce riamof ConsentmulFinsumfm Warl esCompcn-
saron,as provided for by Section 3700 of the labor Code,fm the part....of are
wait for which this permit is issued.
O 1 law and will maintain Wallace,Compensation msuance,as no shed by Section
3700 of the labOcCode.far the performance of the work forwhich this permit is issued.
My Wallace,Co npeaution Insurance carrier and Policy number m:
Canicr.'�U�/(iN'it^dKl«"' PoIIry No.:C✓G JT�JlO3-al
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need on,hecampkmd if Ila permit Is far onchundred de0ars($10(1)
or leu)
I MrOfY that in the performance of the work for which this Permit is issued,)shall net
employ any person In any mater m u In become subject to the Worker'Compensation
Laws of California,Dam
Applicant
NOTICE TO APPLICANT:If.afar making this Cemacam of Exception,you should
become subject to the Warker's Compensation Proinions of the labor Cade,you const
.,O foMwith comply with such prevision or Nis permit Mll be deemed ranked.
r ti CONSTRUCTION LENDING AGENCY
[-r I hereby Africa that dart is a contraction lenciing Agency for the performance of
6i 7 the work for which can.Permit Is issued(Sm.3097,Civ,C.)
G Q Lender'sNme
.7 z Lenders Address
U C 1 certify that I new read this application and sum that the,bow Infomadun Is
tf.;-+ camacL 1 agree to comply with all city and county aNinMLVS and sum laws relating m
0 U" building convection,and hereby sutharim representatives of this city In enter upon the
Ik] above-mentioned Properly for Inspection purposes,
G (W:)ages to um,indemnify and keep hamdeu the City of Cupertino against
r'n Iiabilidebjudgmenu,coo and expenses which may In any way seem agtlnsuaid City
V 7 In eonaegwenec of the gaming of this permit _
F7 APPLICANT UNDERSTANPS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIO
�i., A z�'�ef Re-roofs
Sign sof Appli=VCon Am
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will th:applicant or future building occupant atom or Media A.Malms material
faW by the Cupertino Municipal Code.Chapter 9.13,and see Health and Safety
40,Section 35532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes EllDla
Will the applicant or future building Occupant use equipment o devices which If a roof is installed without first obtaining an inspection,I agree to remove
..It he,anuus air coaWninants As defined by the BAY Asa All Quality Management all new materials for inspection.
Dwict7
O Yes pRu
I ha a read the huaNwsmmriab mquimmems underCMpserii.95 aria:Califon
nit HealthkSafctyCode,&Lli=35505,25533and2553/.lun@auMthatifdc Wilding
dao Imt cunemly haw a mat.th h b my ouponsibilky m notify the Occupant of do
requirements ormiv=anaeafaceaifcamdrQ /us Signature of Applicant Date
Own.. uthorisdapcm 1S+ " Date All roof coverings to be Class��8��or better
G