05030286 CITY OF CUPERTINO r=� wfw r `" x L •�:;: +�. °
BUILDING DIVISION PERMIT e,0* eTORANFORRMATIOM,
BUILDING ADDRESS: W E O'NEIL CONSTRUCTION PERMIT NO.05030286
20500 TOWN CENTER LN 4 272
IFITS NAME: PERMIT ISSUE DATE
SILVERSTONE DEVELOPMENT 5245 PACIFIC 2005
PHONE: SANITARY NO. CONTROL NO.
(510) 385-0121
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
p t— 0 t�
LICENSED CONTRACTOR'S DECLARATION Job Description
�i 1 hemby afnrm that I am licensed under provisions of Chapter 9(commencing
with Sudan 7M))of Division 3 of the Business and Professions Code,and my license I.
in fail force mdeaxt. NEW CONDOMINIUM
License 1 s Lic.R
Dam Contractor Ls, - ONETL— 1116 SQ. FT. LIVING AREA
" ARCHITECTS DECLARATION
1 undcratand my ph.atoll be used as public records
a c Licensed NuMat...I
A'0 OWNER-BUILDER DECLARATION
N N I hereby affirm that 1 am exempt Tram the Contractanl License Law for the
o C following mason.(Section 7101.5,Business and Professions Code:My city at county
$ which mquimt a permit to construct,alcor.improv,demolish,nr rePat,any maxwo,
prior m its Women,also requims the applicant farsuch permit m rile a signed stattmem
< that ha is licensed pursuant m the provisions of the Conummr's License,Law(Chapter 9 Sq.Ft.Floor Area Val atlZi9 188
8 (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
.. that Its h exempt therefrom and the bash for the alleged exemption.My violation of
Section 7031.5 by any applicant far•permit subjects the applicant in a civil penalty of APN Number Occupancy Type
ml marc than five hundred dollar.(s5W). 36940002 . 00
❑Luownuuftlie property,mmyemploycu with ngexudMir mkcampensstian,
Mil do the work and thesoucmm bmummnded oorfemdfor ale(Sec.70N.Business Required Inspections
And Profusions Cade:The Contncmes Lt.=Law does nut apply at an owner of q P
property who bui Ida car improv a thereon,end who dms each work himself car though his
Own employees,provided thauuch improvements art not Intended chartered fns We.If,
however,the building or improwment Is mid within ane year of mmpledon.the owner-
bollder will haw the burden of proving that he did not build or improve for purpose of
uM.i.
❑1,u swan or the property.am excluaiwly convening with licensed conn eemn m
conswn the project(See.70".Business and Professions Code:)The Communes Li-
cense Lew does not apply m an owner of property who builds or improves drtrem.and.
who contracts for such projects with a contractor(i)licensed Formation to the Conuanoea
Lkense Law.
❑1 me exempt antler Sec. .B&P C for this mason
r Data
WORKERS COMPENSATION DECLARATION
' I hereby ellimm abler peulry of perjury oro or the hollowing dalantiorts
=have and will main by Section
of Consent r Conn.furemor Wokeeace of the
utim, r provided rte mi Stttiun 3700 or the lsbor Cade.for the performance of the
work for which this permit Is issued. ,
❑1 haw and will maintain Warker's Compensation Ittsuranw,As required by Section
37M of the Labor Code,for the petfannutce or the work for which this permit is Issued.
My Wankel's Campensafl a Insurance carrier and Policy number am:
Canter t/L/L/1-/'f/sr L aEeyNa.:we3S3310?-0
C RTIRCATE OFEXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
rlhbseetion need nor beconpieud time permit b fm one hundred debars(5100)
or Mas.)
I century the,in the performance of the work for which this permit Is Issued,I"I not
employ any person in any manner m as m become subject 0 the Woken'CompeasNon
Laws of Califomta.Data
Applicant
NOTICE TO APPLICANT:If.after making thin CcmOcate of Exemption.you should
become subject m the Womr's Compensation provisions of the Labor Code,you must
.,Q forthwith comply wish such provisions o this Permit shall be cleared aroma.
Z^ CONSTRUCTION LENDING AGENCY
I hereby affirm Nat mem is amnstruction kndingaprary for tho performance of
fL w�i
U.work for which this permit Is issued(Sec.3097.Civ,C.)
W Undoes Name
72 tenders Addmu
O Q 1 aniry that 1 haw read this application and rota that the above information b
n.!' cornet I agree an comply with all city arta county ordinances end mute laws misting to
O buildingconstruction,and hereby awharim repremnmiwa of this city to enter area use
W .hove-mentioned property for inspection purposes.
LL (We,)agree to saw.indemnify and keep harmlw the City of Cupertino against
(A liabilities,judgments,cots and expenses which may in my way seems Unnst said Cily
()7 in conrequence of the grmting of thin ix
F7 APPLICANT UNDERSTAND$$$$$$//�� WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCEREGUL ONS
2 Re-roofs
Sign afApplicanuConuecmm Dem a of Roof
HAZARDOV MATERIALS DISCLOSURE TYp
Will due applicant or future building occupant atom or handle huudou material
Med by the Cupertino Municipal Code.Chapter 9.13.and the Health and Safety
Sestion 355320)7 All roofs shall be inspected prior to any roofing material being installed.
❑Ys
Will Ne,applicant or future building occupant use Nuipmant or divim which If a roof is installed without first obtaining an inspection,I agree to remove
ems,haurdnu.ircmurdramsasdefm dbythoBayArtaAirQWdltyManagement all new materials for inspection.
District?
Yu
1 have mad the heaardrm s materials requ immense under Chapter 6.95 or the Cali for.
nla Hcaldm&Safety Code,Sections 25505.25533 and 35534.1 understand that ifthe building
does not currently haw.Meant,that It' my mspormlhility he notify the occupant of the
mulmmenu which mu be metp' seance of a Ceniricamof " Signature of Applicant Date
9 - �' Y�es All roof coverings to be Class"B"or better
Owner aN h filed agent am
e