05030291 CITY OF CUPERTINO '�%'=' e°<s* as�.s °•`�'` " " +
BUILDING DIVISION PERMIT ';',CONTRACTORINFQRMA'Y'IION
BUILDING ADDRESS: W E O'NEIL CONSTRUCTION PERMIT NO.05030291
OWNER'S NAME: F@2MIT ISSUE OATS
SILVERSTONE DEVELOPMENT 5245 PACIF 05
E; SANITARY NO. CONTROL NO.
(510) 385-0121
ARCHITECTrENGINEEK: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH O
30o
LICENSED CONTRACTORS DECLARATION Job Description
bt 1 hewby affirm got,I Am licensed under provisions of Chapter 9(commencing, P
with Section HAD)of Division Sof the Busineuand Profession,Cade,and my Iiceve is
lfunfnrcaand effceL �9 A?f NEW CONDOMINIUM
V12 Lkenm Cl s
Dam Oa.wr L> Asef L 1116 SQ. FT. LIVING AREA
ARCHITECTS DECLARATION
I undcnund my plans shall he used an public records
5 U
yQ Licensed Panfesslonal
OWNER-BUILDER DECLARATION
F 1 hereby affirm that 1 am exempt from the Conuemor's License Law for the
OE fallowing,mason.(Section 7031.5,Business and Professions Coda:Any city or County
3$ which mquies A permit m cnnstrucl.Altar,improve,demolish,or repair any snermt
-iy prior m itsissuance,also equina Ne applicant for such permilin,rite asigned statement
£g < that Wislicensed pursuant mtheprovisions ofThe CanuArtorsLiecnseLaw(Chapter 9 Sq.Ft. Floor Area Valtt1i818188
y+�D (commencing with Section 7000)of Division 3 of Me Business and Profeasiona Cobalt,
$ that he b crzmpl therefrom and Ula bub for the alleged exemption.My violation of
Section
e tome Nm ossa a yaRaidmw(ism, it subjects me applicant m a civil penalty of APN Number Occupancy Type
36940002 . 00
❑l,asawnoraf Nepmpmy.mmyemploycowit mMuftirwle=pcmUon,
willdo the work and the swcium is Ml intended Oscillated forssk(Sec.7014,Butircas Required Inspections
and Pmrevlons Cade:The Canuacmra License Law dues and apply m e
wnq an Owner of P
property who builds or i ignows Merton.and who doessuch work himself or Ihroujh his
own employees,provided that such improvements are natimeared oro0esed portal.if.
however.Ne building or improvement it said within arc year of compkeion,Ne many.
builder Mn leve the burden of proving Mut he did Out build or imponw far purpose of
ole.,.
❑L as owner of the property,am excluively conuacting with licensed contractus m
construct the project(Sec.7044,Business and prufrasions Cade:)The Conuacmh Li.
«nse Law dean not apply m an owner of property who Wilds as improv Monaco.and,
who comsat,for such projects with a conttacror(s)licensed pursnant m de ConuArmrt
License Law.
❑1 am esempl under Sec. .B St P C for this mason
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby eRLm under penalty of perjury ane of the following,decludions: '
I haw and will maintain a CmlOceteof Covent a self-insum forWorlares Compen.
ution,as Provided for by Section 3700 of Me labor Code,fm the Performance of the
wade for which this permit is isund.
❑1 have and will maintain Workers Compensation lnaunnec,a acquired by Section
37W of me LaingCode.for the performance of the work for which this permit is Tuned.
My Workers CompewMon Insunnce carrier and Polity ndmbmue:
Carticr�U/JGN CA^tO say Nf` -O
CERTIFICATE OF 70NFROM WORKERS'
COMPENSATION
INSURANCE
(This secdon need wine completed If Me permit is(moat handed danars(SIM)
or leu)
I unify the,in the performance of the work for which this Permit is issued.I shall net
employ any person In any manner an An At become subject in Me Warless'Compenanan
Laws of Ceiifomla.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
became subject in the Worker's Compensation provisions of the labor Code,you muss
0z
forthwith comply with Such Provisions or this permit shaled e
l W deemvoked.
„zs y CONSTRUCTION LENDING AGENCY
[-i I hereby alTrm that More is a construction lending agency for Ne performance of
Ix 7 Ne work for which this permit b Issued(Sac.3091,Civ.C.)
W0. Q reader'.Name
2 Larder's Address
V Q I certify that 1 have mad this application and sum that Me above information la
U.F cmtecL I alpra in Comply with all city and county ordinances and mute lawn relating m
C U building construction.and hereby Addiction represenutiv of this city In enter upon Me
sal ahom-mentioned Property for inspection purposes
(We)agree to saw:,,ndcmnify and keep harmless the City of Cupertino MIAMI
y liabilities,judgmenu,cote and expenses which may in my way Arcane against said City
(„)Z in consequence of the granting of this permit
APPLICANT UNDERSfANpppyyy��� D WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGU A710N /2 S
SI{neaof AppllanUContrctor / DDDate Re-roofs
HA RDOUS MATERIALS DISCLOSURE Type of Roof
Will IM applicant or rut.building occupul Roe orhandle hazardous material
as defined by the Cupertino Municipal Cors.Chapter 9.12,and the Health and Safely
Cade,Section 25532(a)7 0 / All roofs shall be inspected prior to any roofing material being installed.
❑
Will the Applicant or forum Wilding,Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it havardnuA air conuminenu de0nc by the Bay Area Air Quality Management all new materials for inspection.
DlstricR
❑Yon Nu
I have tend die hassol ms materialswquiements under Chapter6.95ofthe Califor.
nb Health A,Safety Cors,Secoms 25505.35533 wa1 34.I understand MatiflW Wilding
docs mol cumord,havea ansa that 1,is y IMHLY m Wry the Occupant of die
requirements which run Wand prior u ofa Ccnifcateof Occuency. I Signature of Applicant Date
ownmar arIZr Agan) DAM All roof coverings to be Class"B"or better