05030289 CITY OF CUPERTINO x :1477=77,—,4
BUILDING DIVISION PERMIT CONTRACTORANFOI MATIO.N
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BUILDING ADDRESS: W E O'NEIL CONSTRUCTION vmmirND.05030289
20500 TOWN CENTER IN
OWNER'S NAME: PERMIT ISSUE DATE
10 SILVERSTONE DEVELOPMENT 5245 PACIFIC CONCOURSE DRI E 08/29/2005
RMNE: SANITARY NO. CONTROL NO.
(510) 385-0121
ARCHITECT)ENGINEER: BUILDING PERMIT INFO
BLDGO ELECT O PLUMB MECH
O �
3pZp LICENSED CONTRACTOR'S DECLARATION JobDescrition
4 I hereby affirm that I am licensed under provisions of Chapter 9(commencing p
with section 7O)O)of Di,W m 3 of the Business and Professions Code,and my license is
In fon lamcmdenect. NEW CONDOMINIUM
n�2 Llcenu 1
LIC. N9Y 0�
?�' Dam Contractor w 1116 SQ. FT. LIVING AREA
e; ARCHITECTS DECLARATION
t I unchanged my plana Nail w used an public records;
y C Licensed Professional
m Oat I am exempt
fro DECLARATION
a S I Wroby.(Sero that 11. exempt from the Connectors Licence Law for de
5 pO which ngmason. (anion ]oslas,Bminr. and Preare,de aro Cade:AnYCity tarcucunty
$Or which rtqui issuance.a•permit M tiastrthe alcor,hnpmsu demolish,or mpair ed statement
zy pdamslsedpursuamquime theapplicantfor wchpumitm Nose Law catemat Val atl�
gg
that
ommencce WithSeoant7010)ofDivisions n oftheSthe uanessAn ProessonsCoder9 Sq.Ft. Floor Area
E€$ (commencing pt doer fromon 700 0)the basis forn 3 of the eg Business pt on.Any
violA de)of
that W is exempt thora(rom and the bub for the alleged Gumption.Any violation of
Section 7031.5 by any appl7am for a permit objects the applicant 7o a civil penalty of N 7�Umber Occupancy Type
not mart Nen five hundred dollars(SSW). 3��4 V(]02 . 00
❑Lu awnerof chap somactamy 1intendes with wmadW ste'v sole e0mpeusades,
will ds Prtieoak.andft c:The umbrwesilced oro@rWfor sale(Sec.7014,Budass
aid Profwious code:The CanvanoM1 Lice7sm taw chase not apply b u awncr of Required Inspections
property who Wilds or imposes thaenn,and who does such work himselfa through his
Om employees.Provided that such Improvements sat not intended aoRened forsala.If.
howev.the building a Improvement Is mid within arc year of eempletion.the owner-
builder will hive the burden of proving that W did not build or Improve for purpose,of
tele.).
❑1.as Owner of de prepeny,em exclusively contracting with licensed contractors to
eomuuet the projes(Sec.7044,Business and Professions Code)The Contactors U.
cense Law doe not apply man awns of proper who Wilds or improv thereon.rod,
who contracts for such projects witha contra ner(s)licensed pursuant to de Contractors
License Law.
❑I Am exempt under Sec. .B A P C for this reason 1
Owner Data
WORKERS COMPENSATION DECLARATION
I hereby Affirm under penalty of perjury,nee of the following delaatioa:
❑1 have and will maintain aCenlOate of Coaseneto self-lusum for Workcra Compen.
nation,an provided for by Section 3700 of the labor Code,fa the performance of the
work for which this permit is issued.
❑1 have and will maintain Worker,Compensation Imunnce,as required by Section
3700 of the labor Code,for the performance of the work for which this permit is Issued.
My Wor�ke's,.FfClo�mpensWlos
mance lonnce cares and Policy number am:
C,MIer,WcH-A—eYLl f rh1 Policy N..:6&_2 S77 JA 2—b
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(this section recd not W completed Iliac permit isforonch utdred dollars(SI W)
ai toss.)
I cenify that in the Performance of the work for which this permit Is Issued,I shell not
employ any person in any manner an as to beamesubjauo the Workers'CompemNon
Law,or California Date
Applicant
NOTICE TO APPLICANT.If,after making this Certificate of Exemption,you should
IeeOme MOW M the WOrkcra Compee,tion Provision of the IaM Code,you nuc
0z forthvdth amply with such provisions or this Permit Nail W dcem)d murlmd.
z^ CONSTRUCTION LENDING AGENCY
F+ IWmby a I..that deo h a construction lending agency for the Performance or
lY� the work for which thin permit Is issued(Sec.3097,CO,.C.)
GQ Iandcrs Name
a z Larder's Address
C.)Q 1 certify that 1 have mad this ppikation and sum that the Above Information is
Cama 1 Agro)M comply with all city and county ordinances and rote laws mlatint in
O building convection,end hereby authanu repvenativ of this city m enter upon the
Lal aWw•mentioned popery for inspection Purposes
6. (W))agree in carve,indemnify and keep humlas the City of Cupertino agaius7
ra TA liabilities.judgments,eau and expenses which may In any my acme agalatt said City
V 7 In consequence of the gran off of this p tIL
71— APPLICANT UNDERSTANDS Af ILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
gat App
HAZARDOUS
O oto
DOUS M upa DISCLOSURE Type of Roof
WIII the Applicant forum buildingOccupant state tar handle hazardous material
As darted IW daed by Cupertino MunicipalCode.Chapter 9.11,roHe
ti the Health and safety
Code.Sectian15531(a)1 All roofs shall be inspected prior to any roofing material being installed.
CI Yes
Will the applicant a rutum building occepont use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit husolous alt contaminants As dcRncd by tha Bay Am,Air Quality Management all new materials for inspection.
Dlnrim7 / /
[IYes Q4�
1 have mad the hanrdaa materials m4ulroments under Chapter 6.95 of the Celifor.
nla Health@ Safmy Codc,Scedous LSNj5.2S53 and 25534.1 und)rswM that If tite Wilding
does not currently haw a enm4 Nat It h mspomihit to acuity the occupant of the
mqulmmems which mug be met pn 7 aance of,Cenirleate or Occupancy. Signature of Applicant Date
�!A"-" � __� �>/� 'e'r- All roof coverings to be Class"B"or better
Owner adzed agent Dom¢