05030288 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CON'Cl2AGQRNFt?xLMt1,' 101 . �
BUILDING ADDRESS: W E O'NEIL CONSTRUCTION ""'No.05030288
20500 TOWN CENTER LN if 279
OWNER'S NAME: PERMIT ISSUE DAZE
WNSILVERSTONE DEVELOPMENT 5245
E: SANITARY NO. CONTROL NO.
(510) 385-0121
ARCHITECTIENGINEER: - BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
300 LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby affirm Nal I am licensed under provisions of Chapter 9(commencing
With Section 70111)of Division Sof Ne Business and Professions Code,and my license Is
imm11fameandcffecl. NEW CONDOMINIUM
Pyrt-? Da�nse Ian �wL O
CommwrONF f f_ 1116 SQ. FT. LIVING AREA
3Q ARCHITECTS DECLARATION
ryJ I underamnd my plans shall he used as public records
G Licensed Pmfcssionel
g
OWNER-BUILDER DECLARATION
9 M f 1 hereby muso a(Srm that 11. exempt from the Contractors License Law for the
my
p o following muton.permit
i )(131.0.Business and Improve.
de ou Cam:Any city or county
$ which requires s permit re cnuwc4 elms improve,demolish.m repair any swduru '8
tprior uthm hoitsiensedprsua requires;lbe applicant fordo,Such CMPormitao file Lt.. Law(cd Bammcnl l$&09188
gg C that(commencing
withSesuammtkpmvislomoftimConuanessAncenseLaw(Chapmr9 Sq.Ft.Floor Area Va
Y� 'at he is
exempt
therefron om
and M basis
r the
the BusinessAnd
Proon.M vi Cnde)of
$ Net k u eumpt them(mm and Um buss(er the alleged exemption.My violation of
Section 7031.5 by ally applicant for a permit subjects the applicant to a curl penalty of APN Number Occupancy Type
Am mere Nan 0m hundred dollen(ML 36940002 . 00
I,u ownu of the pmpony,army employcu with wagee m Meir mle cempenudon,
will dothework,ands:The CumsemenLt.= ottcrd.not apply owner
Required Inspections
And property
ou Code:The Conummrs Licence oessucci not apply lf an ower is q P
pme eny who builds or improves thereon,and who ares ouch work himselfor through his
own m u,the Wiping or iMalsuch Improvements Ian m year
of c m pored for owner.
however,the building or improvement is mid within one Wild
of completion.theowner.
of
builder will have Ne burden of proving Wt he did not build m improve for purpose a(
ulcJ.
❑1.as owner of the propony,am exclusively contracting with licensed co bscun In
construct Ne project(Sec.70".Business and Prafeuiam Code:)The,Cenrrmmr.Li.
cense Law doer net apply m an owner of Froparty who builds or impmw desmon,and
who contracts for such projects with a conu uor(s)licensed pursuant In no centncters
License Law.
ri 1 am exempt underSec. .B&P C for Nis mason
caner Dam
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following decWatiom:
❑I km and will maintain a Certificate of Consent b selfAmsure for Worker.Camper-
ration,an provided for by Section 3700 of the labor Code,for Ne performance of ale
work for which this permit is issued.
❑1 have and will maintain Worker.Compensation Insurance.as mquimd by section
3700 of dm Labor Code,for the performance of the work for which Iia permit is imued.
My Workers Compensation Insurance mmerand eliry number am:
Carrier.7i/f A"°E7�-� aliry No.:�✓L?S�?�d?-�
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thissectlon need not W completed If lk permit Isforoac hundmddollan(SI00)
or leas.)
1 certify that in the performance of the work for which this permit Is Issued.I shall not
employ any Perron in any manrer an ass M Wcomesubject to the Workms'CompeuaMm
Law.of Cnlifmnin.Dam
Applicant
NOTICE TO APPLICANT.If.aMr making this CorOEeete of Exemption,you should
become subject In the Workers Compensation provisions of the Labor Code,you most
.J Q forthwith comply with such provisions or Ise Permit shall be deemed revoked.
zCONSTRUCTION LENDING AGENCY
HN" 1hereby air,.Wt More is a construction lending agency for the performance of
ai the work for which this permit Is issued(Sec.3097,Civ.C.)
W�Q lander'&Name
z Landers Address
U 0 1 certify that I ham reed this application and sum that the strum information is
U.F correct.1 agree to comply with all city and county ordinances and sum laws relating In
DU building construction,and hereby aulhodm representatives of this city to enter upon the
W above-mentioned property for inspecdcn purposes.
(We)agree he sem,indemnify and keep harmless Ik City of Cupertino against
„y fai0 liabilities,judgments.cuts and expenses which may in my my monk against said City
U 7 in consequence of le granting of this mit.
tom- APPLICANT UNDERSTANDS A ILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCEREGULA ONS.
/� oXin_ i B Q S- Re-roofs
Signalum I HAZARDOUS ATERIALS DISCLOSURE IDM Type of Roof
Will the applicant orfumm building occupmt Imre or handle hamolous mated&[
An domed by Me Cupertino Municipal Code.Chapter 9.13.and the Health and Safety
Code,Section 25532M)? All roofs shall be inspected prior to any roofing material being installed.
01 Yet f$Au
Will the applicant or future Wilding occupant me cy9lpment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hammed.air contaminants As defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes u
1 have mad Ieh.rdummamdalsmquimmenu under Chapmr6.95 ofdm Califor-
niaHui"SafetyCoM,Secoom1550.255 Sand 23334.1 understand MagiMc Wilding
does not currently have a mnana Mat it is $Pensihilhy m notify the occupant of Me
mqulmm�u which matt ren pdo mm �a¢
ofaccr;Beam efoc Signature of Applicant Date
er un
8/ /4� All roof coverings to be Class"B"or better
gem