05030290 CITY OF CUPERTINO
BUILDING DIVISION PERMIT WONTRA ITQR INFORMATION
BUILDING ADDRESS: W E O'NEIL CONSTRUCTION PERMITNo.05030290
20SOO TOWN CENTER LN ft 292
OWNER'S NAME: PERMIT ISSUE DATE
SILVERSTONE DEVELOPMENT 5245 PACIFIC CONCOURSE 08/29/2005
E; SANITARY NO. CONTROL NO.
(510) 385-0121
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
O O O
fop LICENSED CONTRACTOR'S DECLARATION Job Description
1 bmeby afRon that 1 am licensed under provisions of Chapter 9(Commencing
ilh Sued.7000)of DlWion 3 of tho Buaar os and Prrfecsiou Cock,and my Iicerue is
n'1 i�mllforceandenea (/ NEW CONDOMINIUM
2l3 LIConmC Lima Lt f (,. 0 3 /
Date contractor tiea.� 1116 SQ. FT. LIVING AREA
5 o used as
BMR UNIT/ NO CONSTRUCTION TAX
1 undesund my plansdWIn
cHr E used u publicION
5 u
ggt7 Licensed Professional
OWN al.BUILDER DECLARATION
4 a i I hereby.(Sero Net 11. exempt from the Crntns Co e:Any C Law for the
p o which
mama.permit
u 7113 L5,Business and Professions Code:Any City or County
lure
$ which to r issuance.
ss a a e.al re cnrswn.alter.Impmvu,h Permit
i ri masts any armmum
SC
prior at tlicen ancaatu requires the applicant tforhe such Permit m filca Uw statement
-�<
mast he tslicensed pussuanlmNe provision of the Contractor's LIceue law Chapter Sq.F[. Floor Area Valuation
C (carrmenrinj with Section 7000)of Divsion3of the Businwand Promsslou CoLe)m .$129188
$
that he".exempt therefrom and the basin for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a Permit nbjecu me applicant m a Civil Penalty of APN Number Occupancy Type
not mom than five hundred dollars(5500).
❑I.u owner of the Property,as my employees with wages as their auto compensation,
will do the work,and the structure is not Intended or offered for sale(Sec.7044,Business Required Inspections
and Professions Code:The Ca osences Litters Law don not apply m e ns an owner of q p
property,who builds orireprom 0wrmn,and whodo asuchworkhimself orthrough his
awn employee,provided last such improvements are act inended moRered torula If,
however,the building or improvement is mid within ane year of Completion,the owner
builder MB have the burden of proving that he did not Mid or Improve far purpose of
ale,).
❑1,as owner of One property,am exclusively contracting with licensed Contractors to
ernWct the project(Sec.701x,Baines and Professions Code:)The Contractors U.
cause law does not apply in an owner of property who boi1N or impruvea theman,and,
who Contracts for such projects with a conuscmr(s)licensed pauwrn m the Commons
License law.
❑1 am exempt antler Sec. .B&P C fm this mason
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury on of the following declarations:
I have and will min W
aa a Cetificam Cocoanut m elM1huure for Workers Camper-
utian,as provided fm by Secdoa 37M of the Lathan Code.for de parfon.of the
work for which this permit is issued.
71 1 have and will maintain Waist's Compensation Insurance,u required by Section
3700 of the labor Code,for the performance of de work for which this Permit is bound.
My Worker's Compensation Insurance curter and Policy number am:
carrmr:FyAxA-Af7Q fLA—Fuficy Na.:h•t-3533/O ro
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thtsectirn need not W campicted if tie Immit is form hundmddoRan($100)
or len.)
I cenify that In the performance of the work for which this permit Is issued,I shall not
employ any person In any mannerm as in become subject to the Workere Compensation
Laws of Califomla.Das
Applicant
NOTICE TO APPLICANT,IS afacr making this OnIMMIC of Emmpian,you should
become subject b tie Warkcr's Compersatlon provision of the Land Cade.you most
0 0 u(oMwith comply with such ProvisirW this Permit shall be domed revoked.
r 14CONSTRUCTION LENDING AGENCY
(ti l hereby slams dial ahem is a Construction lending agency lot Ne performance of
ai > the work for which this Permit b issued(Sec.3M.Civ.C.)
a.
Ls Name
Z)Z lander.Address
U Q I cenify that I have red this application and sum that the above information is
ly correct I agree to comply with all city and county oo ince and sum lawn relating m
C SV^ building construction,and hereby authndm mpmmnutivss Of this city to enter upon the
W move-mentioned property for Impaction purposes
LL (We)agree in uve,Indemnify and keep harmless tie City of Cupertino against
y IimIH6esjudgmenu,cosu and expe"•-•which may in anyway accrue agalnstsam City
t„)7 In consequence of dm{ranting of this Tomtit
Fi APPLICANT UNDERSTAND ND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
saroadil.of ApplicanVConsey' a9le
HAZARDS MATERIALS DISCLOSURE Type of Roof
Will the applicant or forum building uccupantsmro or handle hamar s material
as defined by tiro Cupertino Mun'cipal .Chapter 9.12.and the Health and Safety
Code,Section 255324>7 All roofs shall be inspected prior to any roofing material being installed.
❑Yen o
Will the applicant or future building Occupant use equipment m devices which If a roof is installed without first obtaining an inspection,I agree to remove
II Imewdous air crnuminanu u dcflmd by the Bay Area Air Quality Management all new materials for inspection.
Dlatria7 /
❑Yes
I have mid the haramrusmateriaisrequirements under Cha uer6.95 of the Califm.
na Hold)&SalmyCade.SeNrn 25505,25533 rx125531.i undcsamW laatifthe building
don owl currently have a tenant dual ipil my reaprmibility in ratify the occupant of the
requirements whichm the met d n issuance ofa Cadficamor "I' ey. Signature of Applicant Date
owner marisedspr, p�r All roof coverings to be Class"B" or better