05030307 CITY OF CUPERTINO P •':� "'sz «= �<'w '""' 'r'"�-�'^°'' 1
BUILDING DIVISION PERMIT ACU�RACTOR4NFORMATION -,
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BUILDINGADDRESS: W E O'NEIL CONSTRUCTION 1ERMIT"°'05030307
OWNER'S NAME: PERMIT ISSUE DATE
SILVERSTONE DEVELOPMENT 5245 PACIFIC 08/29/2005
E: SANITARY NO. CONTROL NO.
510) 385-0121
ARCHITECDENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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LICENSED CONTRACfOWSDECLARATION JbDescription
I hereby affirm Nat 1 un licem ed under provisions of Chapter 9(commencing o
with Sc loan)IXiaf D"" n3ofthe Butinessead Fmfe0nu Code,and my licensees
Infullfortemdenect. 1J ,1( NEW CONDOMINIUM
j Z License s Lk.M �� /
Z Dora Cumrmmr t✓ ' nT wPT— 1230 SQ. FT. LIVING SPACE
3
ARCHRheuse DECLARATION BMR UNIT/ NO CONSTRUCTION TAX
�i i understand my ptsm atilt be used u public mcarN
3 c 9 Licensed Pso(essional
OWNER-BUILDER DECLARATION'
<S 1 Masa affirm(Section n 1 am caempt Item Ne fission ors Any cense ty o far ane
p O whfollich requires a(Somcansm Business and improve,
de au h,or Code:Any city or county
$fVi which requires a permit re emnawcc nuc Improve,demolish,erre a sig any structure
pdormiu lensed tau the the povi.1 applicantforsuch Permit to Dense Law
statemem
<
the,he is licensed PurmantmlW pavislons of Nc Conuatorl License lsw(Chapres9 Sq.FI.Floor Area Valuation
$ (commencing with Section 7000)of Division 3 of the Business and Professions Cade)or $142384
— that he m easome thetefrom and the buss for the alleged exemption.Any violation of
Section 7031.E by any applicant for a permit,ubjecu the applicant on a civil penalty of APN Number Occupancy Type
trot more than five hundred dollen($500).
I]I,As owner of the property,ar my amploycu with wages As Near sale compensation,
will do the.,it.and On.baeWte1,mot intended oruffmad Real.(Sm.7044.Business Required Inspections
and Pmfessiuns Cade:The Omu Ames License Law don trot apply In in owner of q P
property who build,or Improve Neeson,and who does sucb work hiauelf or through his
own employers,provided Nat such improvements tie nen intended m offered for Asia.If.
however.the building or improvement is mid within am year of completion,the Owner.
Wilder will Tuve the burden of proving that he did trot Wild or improve for purpose of
ala.).
❑1,As owner of the property,am exclusively contracting with licensed con=10n on
construct Ne project(Sec.7044,Business and Professions Cade:)The Contractor's Li.
ccue Law does not apply In an owner of property who Wilda or improve thereon.and
who contracts fu such projects with a canuactor(s)licensed pursant in the Contractors
License Law.
❑lam exempt under See .B&PC for this reason
Owner Data
WORKER'S COMPENSATION DECLARATION
40 I Wmby dflon under penslty of perjury oro of IW following declarations:
ci 1nawandwillmsinuinacennf mof Consentmcalf-imumforwaftesCompen-
u0an,a pmvided for by Section 3700 of the Labor Code,for Ne Performance of the
work for which this permit is issued.
❑I ban and will msinuin Worker's Compensation Insurance,As required by Section
3700 of Ne Laear Cade,for Ne performance of Ne work for which this permit is Issued. r
My Warkera Compensation instance caoicr and Policy number Am:
came_vkIt:N—A—LkJ 6,1+✓Pollcy No.:1seC 7P.73/6 O
CERTIFICATE OF EXEMPn0N FROM WORKERS•
COMPENSATION INSURANCE
(Thu section need not be completed If the permit is Intone hundred dollars($100)
or less.)
1 certify that In the perfotmmce of the work for which Nin Permit a issued.I shall not
employ any pecan in any manarm As At become mbjecua the WorkerCompenss0om
Laws of California.Oats
Applicant
NOTICE TO APPLICANT:If.afar making this CeniRatc of Esemption.you should
become subject m the Worker,Compensation provision of the Labor Code,you most
.,O TOMwiN comply with such provisions or Nu permit shall W dcemed ranked.
CONSTRUCTION LENDING AGENCY ..
E+ I hereby affirm that inert is a convection lending agency for to Performance of
a 7 Ne work for which No permit is issued(Sec.7097,Civ.C.)
W ELenders Num
M.z lander.Address
IJ C 1 anify that I Mw read this application and.um that the Awn information is
W;'! mmone.l agree in comply with all city and county ordinances and smut Iowa reading in
building construction,and hereby emhonm mpremnutive of this city to enter open the
W ahone mentioned properly for impecdon purposes.
(We)agree to caw.indemnify and kap amolms;On City of Cupertino against
w+y Ilabili0a.judgments.cow cad expenses which may in any way am=against said City
().Z. in
fUNDEof the RSTANDf tht D WILL COMPLY WITH ALL NON.POINT Issued by: Date
SOU E REGUL TIONS.
e Re-roofs
SignatutilliTApplicantlConuactor gor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Oc applicant or future Wilding ocapanamre orhandle huasdous materia
as defined by the Cupenina Municipal Code.ChsPIM 9.12, d Out Health and Safety
Cade,Section 25532(.)1 ���• anAll roofs shall be inspected prior to any roofing material being installed.
❑yca
Will the Applicant or future building Occupant use equipment or devices which If a toot IS installed without first obtaining an inspection,I agree to remove
mit haurdnus air contaminants ss do ctl ray Ne Bey Area Air Quality Mdndgemenl all new materials for inspection.
Disoict1
❑Yesov
I have real On husrdmu materials requitemenu irdarChapter 6.95 of the Califon
.I.HoSIO&SalcryCOde Sectiau 25505.25573 25534.1 undcnuM NuifNe Wilding
does not currently baro a unanc Nat it u m nslbiliiy on notify tie oceupant of On
requirements which mu met plat ' ce of a Certi0cate of 0cap ay Signature of Applicant Dale
B all' All roof coverings to be Class "B"or better
LOwncrefRauffiarlyed agent Dau