05030308 CITY OF CUPERTINO "
BUILDING DIVISION PERMIT s'C TRACTQ 'RNF�ORMATIa!
n
BUILDING ADDRESS: W E O'NEIL CONSTRUCTION PEIIMir NG.05030308
20500 TOWN CENTER LN ft 282
OWNER'S NAME: PERMIT ISSUE DATE
SILVE 'STONE DEVELOPMENT 5245 PACIFIC CONCOURSE DR VE 08/29/2005
E: SANITARY NO. CONTROL NO.
(510) 385-0121
ARCHiTECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
30o LICENSEDCONIRACIDR'SDECLARATION Job Description
t 1 Imreby affirm that I Am liceved under pmvivana of Clupmr 9(commencing
IN Smdon 7010)of DiAai..3 of the Businra�and Prof.W nv Code,eM my license is
infull(am And art LNEW CONDOMINIUM
jgppp� DUNEW
c�vxmryw / 6-31F,_
3 �� 1230 SQ. FT. LIVING SPACE
` � ARCHITECTS DECLARATION
G 1 understand my plans"I W used as public necords
y C t7, Licensed PmfcWonal
5 OWNER-BUILDER DFCURA71ON
<i 1 hereby Aline Ilial 1 am exempt from the Communoes License Law for IM
p o following mason.(Section No 1.7,Business;end Perfessium Cade:Any city ar enemy
3$ which requires A Permit to consonant.alter,imprave,demolish,or repair any aumcum
iy priar m its iauanec.alio requires the Applicant forsuch permit m file a signed contractor
< der be is licensed Personal.to be provision or ft comettor-s uccrace Law(Chapter 9 Sq.Ft. Floor Area - Valfjati®18384
(commanNng with Seniors 7000)a(Divisione B
Jnf thusinnaend Profesaiav Code)or
hat be is buis for the
olallon of
_ Section 7031.3 by any applicant fur.A Permit au kcu Ne appled icant to My
civilipenalty of
.o ream thea nn hundred dollars,(M). 9 4 Number Occupancy Type
366 940002 . 00
❑Luown"k,the Property.mmyemployee wedwages r Heir sale 7W.Bcompounder,
amass
And
doumwmk.Cock heCuneanounlendedm offoreAwdes an[ask
1D N,owner of Required Inspections
Nd Pro&Wore Coda:The was them",Liame law don mI apply lf,t owner is q P
own emy wyebuildsm ed thatauthereon,andwho Amnetih work Mnwelredformic lila
ownemployaa,pingor lhnevemimprovements Am net ou of completion,
fm owner.
bull,"however.the building titer o Impronmenl is hold within rt war of mpro a for the ossa of
buildu will law the Wrdm of proving that he did nnI belle or Improv for purpose or
ale.).
❑1,As Owner of the property Am exclusively connecting with licensed eamoscmrs to
mvtrucl the Fmjea(Sec.7014.Business Sed Professions Cade:)The Contractor's Li.
came Law does not Apply m an owner of property who Wild,or improve thereon,and
who contracts for such projects with a eonuecmr(s)licensed pureuml in the Canuscrors
Lice.law.
O 1 am exempt under Sec. .B&P C fo this moon
Owner Data
WORKERS COMPENSATION DECLARATION
10 1 hereby al int under penalty of perjury aro of the following declarations
❑I haw and will maintain a Carol of Consent to self-insum for Wmkcr'a Compcn.
seuan,As provided for by Section 3700 of the Leber Code.for the performance of the
work for which this permit is iamd.
❑I ben and will maintain Workers Compensation Insurance,u required by Section
3700 of the Labor Code,for the performance of the work for which this permit is lasmd.
My Worker,Compensation Nuance gamin and Policy number sec:
camiar:7,61/6N ✓ Policy No:6titC 3133/g�—a
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Illi...need mol beeamplemd Iftbe permit IA fmombundred dollen(SIM)
or Icss.)
I'ar ify that intim perfmmaet of the work for which this permit is issued.I atoll net
employ any person in my mamerall a in become abject to TIM Warkeri L'ampcnWdOn
Lava of California.Data
Applicant
NOTICE TO APPLICANT.If.After making this Cenifiom of Exemption,you should
become subject an the Workers Compensation provisions of the labra Code,you meso
O O forthwith comply with each provisions or this permit Nall W deemed remakes. '
Z^ CONSTRUCTION LENDING AGENCY
(.r Ihereby aMmn that then is sconswction Lending agency for the performance of
G' the work for which his permit is Wood(Ss,.3091,Civ.C.)
4 Q Lenders Name
z Lenders Address
U O I certify that I haw mad This Application And num that an Anon information Is
us comecL 1 AS=he comply with all city and county ordinAoes and nese lava reining to
O building conemction.and hereby aubmiv rePmsenwiwa of this city to encu upon the
[i7 ,bon-mentioned Property for inspection purposes
(We)agree m ave,indemnify and keep harmless tine City of Cupertino Against
y liabilitia,judgmenu.emu andexpense,which may in anyway acme Against mid City
U 7 In consegmnce of the ISIf ar this rail.
r7 APPLICANT UNDERSTANDS A WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUEREOUL ONS.
8 2q c5 Re-roofs
SignetuslApplianUComnotoraxe
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building oaupaawro or handle haaEout manorial
As dented by the Cumnim Municipal ado.Chapter 9.11,and the Health and Safety
Code,Section 17731(.)7 All roofs shall be inspected prior to any roofing material being installed.
C Vas
Will the Applicant or future building occupant tax equipment Or devices which If a roof is installed without first obtaining an inspection,I agree to remove
call hAamkxU3 air comemivnts u do d by the Bey Arca Ab Ouelity Management all new materials for inspection.
District?
yes
I have mad thehaardous materials requirements underChapmrn.95 of dm Csliror.
niellcalth&Safety Codc,Sections 27517,75733 and 13534.1 understand tnetifthe Wilding
does not currently haw a tenant Nat It is apmlbility m ratify the meupol lir the
require cnuwhichmast be MCI prior anecofaccnincamofOcc acy I Signature of Applicant Date
OwnerwnarizedAppn, 2D aS' All roof coverings to be Class"B"or better
c