05030301 CITY OF CUPERTINO " -• � N4. F+s
BUILDING DIVISION PERMITCONTRACT,ORINQRMATIOI�i •:.
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BUILDING ADDRESS: W E O'NEIL CONSTRUCTION 'EBMITND'05030301
_ZD500 TOWN CENTER LN 4 162 —
'RE NAME: PERMIT ISSUE DATE
SILVERSTONE DEVELOPMENT 5245 PACIFIC CON OURbE DRIVE 08/29/2005
PHONE: SANITARY NO. CONTROL NO.
(510) 385-0121
ARCHITECTFNGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMBMECH
0 0 0
3o'z LICENSED CONTRACTOR'S DECLARATION Job Description
0 1 hereby affirm Nat I Am licensed under Provisions of Cluptar 9(Commencing
a; with Section 7000)of Division 3 ofto Busircu W Plefessiam Code.and my license is
immllforce.nderfeet NEW CONDOMINIUM
Z Ucense Cl Lk.g L/44 o 3
Dam Caouaemr 1, E 0 ✓FN 1230 SQ. FT. LIVING SPACE
ARCHITECTS DECLARATION
1 to dcram Sal my place"I W used AS public onards
s C� Licensed Pmfcuional
h OWNER-BUILDER DECLARATION
WI hereby affirm that 1 am exempt from ft Contractors License Law for the
0 o following mosan.(Section 7131.5,Busiaets and F r(euimu Cam:My city err counry
S29 which momma A permit An construct.altar.Improve,demuluh,or repair any swerun
_3y priorm its iuu"Co,also requires the applicant for such permit to file a signed sutamem Vali i0@384
G Nmoielican¢dpurmanlmthe provisions uftheCommon's License Law(ChaNcr9 Sq.Ft.Floor Area
zC� (commencing with Section 7000)0(Division3 of Nc Buhussamd Pormtions Code)or
$ thm bec'.exempt decafrom and the basis for de alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the spplicem to a civil penalty of APN Number Occupancy Type
nut more Nan flue hundred dollen($500). 36940002 . 00
❑I,ummoftliepmpeny,ormyemploymwlNwaguumelrwlecompemdon,
will do Newark,and thesuucmre ts notinmtded aranered for We(Sec.7044,Budpem Required Inspections
And Professiam Code:Tom n
Conors Licemdao mat Law damal apply to anw
owner or - q P
property who builds or i mprov Ihemeen.a nd who does such work himself or through his
own employees,provided thauuch Improvements see not inmoed oroffmad for Sale.If,
Inmenr,the building or improvement is told within one year of completion.the owner.
builder will hors Ne buNat of proving dut ire did not Wim or improve for purpose of
Sale.).
❑I,as owner of Ne property,am exclusively contracting with licensed comnemrt m
construct the pmject(Sec.7014.Business and Prafessiam Cade:)The Conuacmrs Li.
cern Law does not apply to an owner of property who Wilds or Improv Neeson,and
who comment for such projects with A eontractons)licensed potatoes IS doConuAcrora
L.iceve Law.
IAmexemptunder See. ,B&PCfor Nismuon
i Dam
WORKERS COMPENSATION DECLARATION
1 hereby mMm under penally of perjury ane of the following declmdons:
❑I have and will maintain a Certificate mf Convent to self-insure for Worker's Compen.
talion,AS provided for by Section 3700 of tim Labor Code,far tits performance of the
wort for which this permit is imund.
❑1 have and will maintain Workers Comperwuon Imorsnce,AS required by Section
37M of the labor Cade,for tita performance of She work for which this permit is issued.
My Workers Compensation]=ran=carrier and Polity number am:
Carrier:ZU/✓LN- A^tt,�tt LA�`Falicy Na:-L.AC 3533)o 3-OS
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be complcmd if tie permit isforama hundred dollen(1100)
or im.)
I ecor)v that in the performance of Ore work for which this permit is issued.l"I Sea
employ any person In any manner an As to become subject to the Workers'Compemndom
Laws of California.Dam
Applicant
NOTICE TO APPLICANT.If,aper making this Cetufteata of Exemption,you Should
become Subject to the Workers Compensation provisiom of to Isar Code,you most
O 2 fuMwith comply with such prevision or Nis Permit hall be dcemcd revoked.
z OCA CONSTRUCTION LENDING AGENCY
l.r 4 Ihemby alfnmost Nen its consuatinn lending agency for the Performance of
p$> the work for which this permit Is issued(Ser.3097,Civ.C.)
L[7 Q Lenders Name
z Lenders Address
U O I certify,Nat I have Send Wer applicW on and sum our the move urnommtiun H
E correct I Agree to comply with alp city And county oNinances and sou laws Santung to
O Wilding construction,and hereby auhorim mpresentauv of Nit city to enter upon the
[i7 cove-mentioned property for Impectian Pugmses
gy (We)agree to Save,indemnify and keep harmless She City of Cupertino agaimt
y liabilities,judgments.cats and expenses which may In any Wayacere,against Said City
U 7 in consequence of the Owting of this Permit.
G APPLICANT UNDERSTANDS AVG WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
8Z4f Re-roofs
signature dfApplicaMCanuacmr
HAZARDOUSMA RIALSDISCLOSURE Type of Roof
Will the applicant or future building Occupant score or handle hamNous material
entad by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
Section 15532(07 All roofs shall be inspected prior to any roofing material being installed.
Will LW applicant or futon Molding occupant use equipment or devices wM1IcM1 If a roof is installed without first obtaining an inspection,I agree to remove
emit hanrdou air conuminanu u dcOned by the Bay Area Air Quality Management all new materials for inspection.
District?
C]yes t$Ko
1 have read the hmelom materials requirements under Chapter 6.95 of the CAlifor.
ma Health&Safety Cade,Secdom 25505,25533 and 25534,I undeuund that if the Wilding
does ant curtentiy bac A mman4 that It is my responsibility to maofy the occupant of the
requlrcorenu which atm he ¢warree of a Ccni6cale of
Occupurey. Signature of Applicant Date
- agent a m r All roof coverings to be Class°Ban Or better
Ownerthori