05030303 CITY OF CUPERTINO mss . -,e„✓ �' """ �'' ' '"
BUILDING DIVISION PERMIT CUNTRAC QRINFU'RM�.TION'°F
BUILDING ADDRESS: W E O'NEIL CONSTRUCTION PERAvITNo'05030303
W:R's NAME: PERMIT ISSUE DATE
SILVERSTONE
PHONE: SANITARY NO. CONTROL NO.
(510) 385-0121
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0
3oi
LICENSED CONTRACTORS DECLARATION Job Description
1 Manby affirm that I am licensed under previsions of Chamr 9(Commencing
.IMc.lhm 7fXf.f Division 3 of on Business and Profmians Co o,m i my license is
infull fame and efr« N Oil NEW CONDOMINIUM
2�? Leans Cl Lde.R
3 Dae con� r✓ Or€lg 1230 SQ. FT. LIVING SPACE
Q
ARCHITECTS used
DECLARATION Iundcrsund my plans shall
W her Cdu public rtcnrda
] 0
b LLp
Licensed Pndestionsl ER
OWNER-EUILDER DECLARATION
i 1 herehy.(Tire that 11. exempt from de Contractors o License Law for the
O O following recon.(Section RD LS,Business and Ro(essluns Code:Any city or County
5$to which requires•permit re Construct do tllee Improve,h e n h u or repair and aloomm
_I'i an
Hearted purmmatin os do of far suchpermttefile aaLaw(clesmem
O (comme11ttvcdpumantbNeprevivision3dam ofoBusiness
umessandemisorCluptn9 Sq.Ft.Floor Area Vat$Bttb2384
(eat he is empt therefromon
and
CI Division 3 the
al eged evand proon.Any v teflonConle)or
Nat he is eumpt IMrtfrom and de basic for the alleged exemption.Any voted on of
Section 7031.5 by any applicant far a permit subjects the applicant e a civil Family of APN Number Occupancy Type
ret mom man Ove hundred dollars($50)). 36940002 . 00
0 I.uowneroft property,WmyMPlaymwirewgesu Meirsoleemnpemdon,
will do the mak.and thastracture ism,intadcd or offered orwe(Sm.7044,Business - Required Inspections
and Professors Code:The Comment's License Law does not apply m an owner of q P
property,who builds or i mpromes thereon.a nd who doeasuch work himself or through his
own employees,provided thatsah improvements Are not InendrA oro@red for sale.If.
however,me building or improvement is mid widen one year of Completion.the owner.
Wilder will ltaw dee burden of proving that ho did nm build a improve for purpose of
Asia.).
❑1,an owner of the property,am eacluaively convecting with licensed Contracmn to
comma rhe project(Sec.7044.Business and Profession Cade:)The Conuuwr's Ll-
comm
Lcomm Law doer not appy An m owner of property who builds or Impmw ft..red,
who Contemn;for such pmjeeu with a contractor(s)licensed parecant an the Gnuacroes
License Law.
1 ore=xempt under Sm. .B&P C far this won
Dae
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declanaons:
❑I ham and will maintain a Certificate of Consent o selGlmum foe Worker's Compen.
Came.As provided(a by Section 37M of the Iaba Code.foe the performance of the
work for which this permit is issued.
1 have and will maintain Worker's Compensation Imrance.As mgaired by Schon
3700 of the Labor Code.for the performance of the work for which this permit is Issued.
My Worker's Cc mpeallon Insureme Cartier end Policy number am:
Grtier.e'4sltfG(I�Av'a t7(fC A'r Policy Na.:42.3f�J/v4'O S'
CERTIFICATE OF EXFMPrION FROM WORKERS'
COMPENSATION INSURANCE
(rots section need eat bccompleed If the permit is fmonehundred dollen(5100
or less.)
I certify that in tine performauee of 0th work for which mix permit ts issued.I shall nm
employ any person In my mwnerm As to become subject to the Workers'COMNnaaaon
Laws of Celifomic Date
Applicant
NOTICE TO APPUCANT,IL after making this Certificate of Exemption,you should
become subject at the Worker's Compensation provisions of the IANC Cade you muss
0z forthwith comply with such previsions or this Permit hall be domed revoked.
OCONSTRUCTION LENDING AGENCY
C~ I hereby aRim than liters,is a cmulratom lending agency ler the perfummce of
a> the wank for which this permit is issued(Sec.3097,Civ,C.)
Qlender's Namc
iit z lender's Address
J O 1 certify that I haw rad this application And see the the.have Information is
^'. Cozen.I agree to comply wide all city and county ordinances and sure laws relating In
Q rV' Wilding construction,and hereby authorize reprrsenutiwa of this city an cmer upon the
{37 show mentroned Property fa i.P.W..purpms
(We)agree to saw,indemnify and kap hamlet the City of Cupertino against
rr liabilities.Judgments,cats and expenses which may in any way acme against Cid City
U 7 in mganmlL
mee of the granting of this pe
r7 APPLICANT UNDERSTANDSAAD WILL COMPLY WITH ALL NOWPOINT Issued by: Date
SOURCE REGUL TIONS. �r
h .y- Z cJ�"1ef Re-roofs
Slgnat of AppRcut/Cmunmr
cff One
HAZARDOUSTAATERIALSDISCLOSURE Type of Roof
WIIINeeCupertn Telma Wildingoaepant poemmand b Health amaedsi
41FMed by me Cupertino Municipal Code,Chapter 9.@.mtl are Health and Safety
,Section 25533(07 All roofs shall be inspected prior to any roofing material being installed.
❑Yea 9140,
Will she applicant at fuure building occupant can equipment at devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hanrdnm air eau nlmml�u dcRad by dee Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes u
I have reel thehavardousmaedalsrequiremems underCMpiard.95 ofthe Califon
.is Hab"SafGyCode,Sections 25505,15533and 35334.1 understand met iftle building
does FAX currently haw a Ienml mu is my responsibility in notify dee occupant of the
requirtments which must M met ' w iuuaacofa CeNlICAM upmcy Signature of Applicant Date
owners Ina(v=aa ret 0 r All roof coverings to be Class"B"or better
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