05030309 CITY OFCUPERTINOn.�,i
BUILDING DIVISION PERMIT CONTRACTOR TNF'ORIVIATION b
BUILDING ADDRESS: W E O'NEIL CONSTRUCTION PERMITNo.05030309
2 500 TOWN CENTER LN 11 288
OWNER'S NAME: PERMIT ISSUE DATE
SILVERSTONE DEVELOPMENT 5245 PACIFIC CQN(COURRE DR VP 08/29/200S
NE: SANITARY NO. CONTROL NO.
(510) 385-0121
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDO ELECT 0 0 PIS 0
jOp
LICENSED CONTRACTORS DECLARATION JobDescri [ion
riF i touchy salon that l am licensed under provision of Chapter 9(commencing P
]�`uf with section TOM)ef Division 3ofthe Business and Pmfaadan Code.atW my license is
n� in full force andeffcca yyy O �� NEW CONDOMINIUM
Z
Ll
can= I Lk.g
?�ttt-•• Dam Contractor IN oNEIL— 1230 SQ. FT. LIVING SPACE
n ARCHrreCr9 DECLARATION
I understand my plans shall he used u public mends
C
5 �a Licensed Pmfcuionel
g 3 Oat lam exILDERempt
DECLARATION
A O E 1 mosso affect Nm I em exempt from the Con..Co License Law far my
p o following moon. erten t 7(131.4 B.&list and Prorated..Cade:Any city or county
$ which am issuance.
ss a a permit ac cores ik elmG impmw,deurmit t lire a airsig ed ewment
-i y maAM
pram m its i licensed
pursuant
in the tbuvistapplicant the
pc tor'm file a signed(hwmcnl
that he is llecnmJ puruantwthe provislOn of th¢Contncwr's License❑w(Chepter9 Sq.F[. Floor Area Val¢ai®@384
RI (commencing with Section 7")of Division 3 of the Business and Profession,Code)or
that he 4 esempl therefrom and the buts for the alleged cwnption.My violation of
Section 7031.5 by any appliunt fears permit subjects the applicant he•civil potalty of APN Number Occupancy Type
not mem than live hundred dollars(M). 36940002 . 00 -
1,as owner of Ne property.or my employees with wages at their sole eampenution,
will do the work and thmaMon.k oat Intended or offered far on ask(Sec.
w lec.7014.Business Re aired Inspections
and Prolmo Cade:The Canuamarn apply a License LAW deOut ay an Owner of P
property who Wilda orimproves thereon,and who dousnhwork himsrdforthreugh his
awn employees,provided that such Improvement are not insisted oraRered(orale.IL
however,the Wilding or improvement is mid within one year of umpledm,the owner-
Wilder will have the When of proving Nat he did not Wild or improve fn purpose of
sale.).
❑1.as miner of the property am imitatively connecting with licensed unnacwra In
construct the pmjeo(Sec.7014,Businesa and Prafusdan Cade:)M Cantruaort U.
cone law does not apply in an owner of property who Wilds or impmw thereon.and
who contracts for such projects with•canmcto*)Ihuman d pwusm Or the Canuactars
License Law,
lamnsairtmetr See. ,BkPCf.ammuccon.
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 hereby of irm under penally of perjury aro of the follmving declaration:
❑I haw and will maintain sCenlOcamof Covent m self-insure far WorlacesCompen-
sation,u provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit Is Issued.
711 have and will maintain Workers Compensation insurance,u required by Section
3700 of the labor Code,(a,the pariormance of dm work fm which this permit is Issued.
My Worker's Compensation Insurance limier 5d Po ry number am:
Carrier. g/.L/GH ef-C / Her No.:&-a-3S
ERTIFICATE OF EXEMP170N MOM WORKERS'
COMPENSATION INSURANCE
(TM.mcdm need not W cnmpleed If tie Fermin is forme hundrtAdollar(SHO)
or less.)
1 comfy that In the perfem mic of to work for which this Permit is Wood.I shall not
employ any person In my mamcran u w become subject in the Worker'Compensation
lawsCeliforntia.Dam
Applicant
NOTICE TO APPLICANT:IL atom making n p CeAfiute of LdWr Exemption.you ushould
most
become tcomp y the WorkeY Coon or this erevl0ms of the IaWr Code.you most
�O forthwitheomply with such pmvWon or Nu Permit shall Wdomed revoked.
y rN~.. CONSTRUCTION LENDING AGENCY
[ti I hereby affirm Net Bert is a construction lending agency for die perfmrmance of
(Y the work for which this permit is Leaned(see 3197,Civ.C.)
QLanders Name
:1z Lenders Address
U Q 1 century the 1 have mad this application and state that de above information Is
Ir correct I agree in comply with all city and county ordinances and,tam Isola relating to
D U building consuuctimn,and hereby autharne mpretenmives of this eeymenmr upon tM
[i7 above-mentioned pmperly for inspection purposes.
(We)agree to save,indemnify and keep hamtlw the City of Cupertino against
rrA liabilities.Judgments,emu Intl expenses which may in any toy neem against cold City
C) in APPLICANToof the UNDERSTANDS AOrlinND�I L COMPLY WITH ALL NON-POINT Issued by: Date
SOUR REGULATI S.
te Re-roofs
sl{nuurt PPIIc HAZA DOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant Of future Wilding occupml rtom or handle hssmadou material
u deMcd by lie Cupertino Municipal Code.Chapter 9.13,and the Health and Safely
Code.Secti..z5532(a)7 ,vfJ/ All roofs shall be inspected prior to any roofing material being installed.
0
❑Yea `u
Will the applicant or future Wilding Occupant um cqulpment Or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit haurdeu aircmuMnenu u dcOnpd by the Bay Ame Air Quality Management all new materials for inspection.
❑Yu
Item mW thehu"N mamdalsrcquimmemsmderCMper6.95oftheCalifu-
nu Hnith&Safely Cade,Sttbon 25505.255330x125534,1 understand thuifthc building
dean Out conenly haw a Itamt.thO It is my 'bility W ratify dm ttcupant of the
requimmcnu which mustmepli fa Canircam of Oc cy. Signature of Applicant Date
2- All roof coverings to be Class"B"or better
Ownerorimd fjeral Do
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