05030280 CITY OF CUPERTINO ' "
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION•
_,' �'la R,'; .ION.;
BUILDING ADDRESS: W E O'NEIL CONSTRUCTION PERMITNO.05030280
2050
R'S NAME: PERMIT ISSUE DATE
SILVERSTONE DEVELOPMENT 5245 PACIFIC CON OTILE, DRIVE QA/29/20115
PHONE: SANITARY NO. CONTROL NO.
(510) 385-0121
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
l� C=
10 Z, LICENSED CONTRACTOR'S DECLARATION Job 4 1 hereby affirm that I am oe
licensed under provisions of Chapter 9(commencing p
with Section 7000)of Division 3 of the Business and Profoulom Code,and my license is
In fullferocandoffut. �qC� 03 NEW CONDOMINIUM
�? License Clµr Lm.4
Date canlran�'o i�f L 1116 SQ. FT. LIVING AREA
ARCHITECTS DECLARATION
1 understand my plans shall he used as Public records
a W Licensed Pmfessimal
50 OWNER-BUILDER DECLARATION
I I hereby affirm that I am exempt from nim Contractor's License Law(ser the
O O following mason.(SecGun 7031.5,Business and Profusions Code:My city Or county
$ which requires a pmmll an camtmc4 after,improve.demnlW,or¢pair My structure
prior to its issuance,abs to tat.the applicanl lersuch permit to file a atgred statement
Nal M is licensed pursuant to the provisions of Ne Conu mss License Law(Chmner 9 Sq.Ft. Floor Area VaI4109188
y S (commencing with Section 70W)of Division 3 of the Business and Profesdam Code)of
— that k in exempt therefrom and the bub for the alleged eamp0on.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not mato than 0w hundted dollars($500k 36940002 . 00
D I.as owner of the pmpmy,or my emplaycea wish wages as their sole emnpeandon,
will do the work,and use anumum 1,.1 uteuted Or offered far nil(Sec.70/4,Business Required Inspections
and Pmfesslons Cade:The Comment's Lt.=Law does not apply m an owner of q P
propeny who bui Ids ser improves theroon,and who dms euah work himulf or through his
awn employees,provided that such impmwments are nal Intended oraffered formic.IL
hoose.,Lha buildingor hopmwmentbsold within ane year ofwmpledon,haowocr
builder will ham the bumdu of proving the M did not build ser Impmw for purpose of
ale.).
D 1,as owner of the property,me exclusively consuming with licensed mntnnan m
construct the project(Sec.7044,Business and Professions Cade:)The Canutcmr's Lt.
came Taw does not apply man owner of propeny who builds or impmves themon.and
who convects for auch projects with a conhxmor(s)licensed pursuant m the Contnmm S
License Law.
D 1 stn exempt undar See. .B k P C fm Nis reason
Date
WORKER'S COMPENSATION DECLARATION
I hereby alRmt under penally of pe0ury aro of the following decbntiom:
D 1 have and will maintain•Certificate of Common reset(-Insure for Wmkera Compen-
satian,as pmvidcd fm by Section 37W of the labor Code.far the performance of One
work fm which this permit is ismed
D I have and will maintain Workers Compemadon Insurance,As required by Section
37W of the Labor Code,fns the pe fmmance of the work for which this permit is Wood.
My Worker's Compensation Insurance cannot and Policy number use:
Carne,TV�,+,x N-t&APolicy No.:1.,16 5127
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
('rites section reed norhecompleted Ifthe permit Is(mane hundred dollars(SIM)
or lest)
I certify that in the perfo,maoce of the work for which this permit is issued,I shall am
employ any person in any manner an as as become subject In the WorkerCompensation
Laws of Callionam.Dam
Applicant
NOTICE TO APPLICANT:If.aper making this CeniOam of Exemption,you should
become subject to the Waders Compensation provisions of the Labor Code,you mus
z forthwith comply with Meh Provisions or this pmnit shall he deemed revoked.
z O CONSTRUCTION LENDING AGENCY
Esu Ihereby alfimt that dwrc is a comuunian lendingagency for the performance of
C >
the ,it for which this Permit b issued(Sex.3097,Civ.C.)
QLanders Name0.z Lenders Address
V Q 1 coolly that I have mud this application and mm that the show Information is
W !-�
comm.I agree to comply with all city and county ordinances and sum laws relating to
UC building construction,and hereby amhatlm mossex utiws of this city to color upon tie
D7 shave-mentionedproperty fan Inspection experms which eL
may
a
gL (We)agree m sew.indemnify and keep Iwmlras the City of CYPenirro against
.costs and
VI liabilincomusquedgmenueramsofthis whichmryln any wYacmw against said City
z income Acnes of the hat of this look.
V�-•n APPLICANT UNDERSTANDS Alp WILL COMPLY WITH ALL NON-POINT Issued by: Dale
SOURCEREGULA IONS.
S12-9'10-f-
Z9' OS Re-roofs
wSiIssues of Applica VConsacmr 1117 NO
HAZARDOUS M IALSDISCLOSURE Type of Roof
Will the applicant car future Wilding occupant pore or handle haamdous material
fined by the Cupertino Municipal Cade.Chapter 9.I2,and the Health and Safety
,sccum 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes T u
Will the applicant or(mums building occupant use equipment or device which If a roof is installed without first obtaining an inspection,I agree to remove
..It hunOmas air mmueninanu as de0rcd by tie Bay Arta Air Quality Management all new materials for inspection.
Diarim 7 , /
Dyes B59u
I have mW the becandousnommiabrequitemenu under Chapter 6.95of the Califon
nes Health d:SarmyCodc.Sections ri505.35533 and 25534.1 understand thulflhe Wilding
does not cumcnnly haw a mnMt,dun it u ralistsmadbilily an many the occupant of tie
require cnuwhmhmuahemetpdor anceafaCcrdOum f cupany. Signature of Applicant Date
M
Z`� °S^ All roof coverings to be Class"B"or better
0vmmcB1Thmixml,js,nt Date
G
CITY OF CUPERTINO ' "
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION•
_,' �'la R,'; .ION.;
BUILDING ADDRESS: W E O'NEIL CONSTRUCTION PERMITNO.05030280
2050
R'S NAME: PERMIT ISSUE DATE
SILVERSTONE DEVELOPMENT 5245 PACIFIC CON OTILE, DRIVE QA/29/20115
PHONE: SANITARY NO. CONTROL NO.
(510) 385-0121
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
l� C=
10 Z, LICENSED CONTRACTOR'S DECLARATION Job 4 1 hereby affirm that I am oe
licensed under provisions of Chapter 9(commencing p
with Section 7000)of Division 3 of the Business and Profoulom Code,and my license is
In fullferocandoffut. �qC� 03 NEW CONDOMINIUM
�? License Clµr Lm.4
Date canlran�'o i�f L 1116 SQ. FT. LIVING AREA
ARCHITECTS DECLARATION
1 understand my plans shall he used as Public records
a W Licensed Pmfessimal
50 OWNER-BUILDER DECLARATION
I I hereby affirm that I am exempt from nim Contractor's License Law(ser the
O O following mason.(SecGun 7031.5,Business and Profusions Code:My city Or county
$ which requires a pmmll an camtmc4 after,improve.demnlW,or¢pair My structure
prior to its issuance,abs to tat.the applicanl lersuch permit to file a atgred statement
Nal M is licensed pursuant to the provisions of Ne Conu mss License Law(Chmner 9 Sq.Ft. Floor Area VaI4109188
y S (commencing with Section 70W)of Division 3 of the Business and Profesdam Code)of
— that k in exempt therefrom and the bub for the alleged eamp0on.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not mato than 0w hundted dollars($500k 36940002 . 00
D I.as owner of the pmpmy,or my emplaycea wish wages as their sole emnpeandon,
will do the work,and use anumum 1,.1 uteuted Or offered far nil(Sec.70/4,Business Required Inspections
and Pmfesslons Cade:The Comment's Lt.=Law does not apply m an owner of q P
propeny who bui Ids ser improves theroon,and who dms euah work himulf or through his
awn employees,provided that such impmwments are nal Intended oraffered formic.IL
hoose.,Lha buildingor hopmwmentbsold within ane year ofwmpledon,haowocr
builder will ham the bumdu of proving the M did not build ser Impmw for purpose of
ale.).
D 1,as owner of the property,me exclusively consuming with licensed mntnnan m
construct the project(Sec.7044,Business and Professions Cade:)The Canutcmr's Lt.
came Taw does not apply man owner of propeny who builds or impmves themon.and
who convects for auch projects with a conhxmor(s)licensed pursuant m the Contnmm S
License Law.
D 1 stn exempt undar See. .B k P C fm Nis reason
Date
WORKER'S COMPENSATION DECLARATION
I hereby alRmt under penally of pe0ury aro of the following decbntiom:
D 1 have and will maintain•Certificate of Common reset(-Insure for Wmkera Compen-
satian,as pmvidcd fm by Section 37W of the labor Code.far the performance of One
work fm which this permit is ismed
D I have and will maintain Workers Compemadon Insurance,As required by Section
37W of the Labor Code,fns the pe fmmance of the work for which this permit is Wood.
My Worker's Compensation Insurance cannot and Policy number use:
Carne,TV�,+,x N-t&APolicy No.:1.,16 5127
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
('rites section reed norhecompleted Ifthe permit Is(mane hundred dollars(SIM)
or lest)
I certify that in the perfo,maoce of the work for which this permit is issued,I shall am
employ any person in any manner an as as become subject In the WorkerCompensation
Laws of Callionam.Dam
Applicant
NOTICE TO APPLICANT:If.aper making this CeniOam of Exemption,you should
become subject to the Waders Compensation provisions of the Labor Code,you mus
z forthwith comply with Meh Provisions or this pmnit shall he deemed revoked.
z O CONSTRUCTION LENDING AGENCY
Esu Ihereby alfimt that dwrc is a comuunian lendingagency for the performance of
C >
the ,it for which this Permit b issued(Sex.3097,Civ.C.)
QLanders Name0.z Lenders Address
V Q 1 coolly that I have mud this application and mm that the show Information is
W !-�
comm.I agree to comply with all city and county ordinances and sum laws relating to
UC building construction,and hereby amhatlm mossex utiws of this city to color upon tie
D7 shave-mentionedproperty fan Inspection experms which eL
may
a
gL (We)agree m sew.indemnify and keep Iwmlras the City of CYPenirro against
.costs and
VI liabilincomusquedgmenueramsofthis whichmryln any wYacmw against said City
z income Acnes of the hat of this look.
V�-•n APPLICANT UNDERSTANDS Alp WILL COMPLY WITH ALL NON-POINT Issued by: Dale
SOURCEREGULA IONS.
S12-9'10-f-
Z9' OS Re-roofs
wSiIssues of Applica VConsacmr 1117 NO
HAZARDOUS M IALSDISCLOSURE Type of Roof
Will the applicant car future Wilding occupant pore or handle haamdous material
fined by the Cupertino Municipal Cade.Chapter 9.I2,and the Health and Safety
,sccum 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes T u
Will the applicant or(mums building occupant use equipment or device which If a roof is installed without first obtaining an inspection,I agree to remove
..It hunOmas air mmueninanu as de0rcd by tie Bay Arta Air Quality Management all new materials for inspection.
Diarim 7 , /
Dyes B59u
I have mW the becandousnommiabrequitemenu under Chapter 6.95of the Califon
nes Health d:SarmyCodc.Sections ri505.35533 and 25534.1 understand thulflhe Wilding
does not cumcnnly haw a mnMt,dun it u ralistsmadbilily an many the occupant of tie
require cnuwhmhmuahemetpdor anceafaCcrdOum f cupany. Signature of Applicant Date
M
Z`� °S^ All roof coverings to be Class"B"or better
0vmmcB1Thmixml,js,nt Date
G