05030311 CITY OF CUPERTINO +�f e •� "'"` ` •`'``
BUILDING DIVISION PERMIT `CONTRACTOR INF�RMATION�`°,
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BUILDING ADDRESS: W EhO'NEIL CONSTRUCTION PERMIT NO.05030311
R'S NAME: PERMPC ISSUB DATE
SILVERSTONE DEVELOPMENT 5245 PACTFT17 CONCOTIRSE DP F1/29/2005
PHONE: SANITARY No CONTROL NO.
510) 385-0121
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
300 LICENSED CONTRACTOR'S DECLARATION JobDescri tion
I hereby affirm that 1 am licensed under previsions of Chapter 9(commencing P
with Section 7010)of Division 3 of the Businees and Professions Code,and my licesm is
n'1 inmBfurteandeffa NEW CONDOMINIUM
AIR L camel ConnLic. or t I )?/ 1124 SQ. FT. LIVING AREA
5 Dau Connector ON t ONL's 1.
ARCHITECTS DECLARATION
Ij I underuand my plats shall be used As public rtcnrds
y
a 0 y� LMCNCd PNfC1LOMI
3 OWNER-BUILDER DECLARATION
I hereby o(fmm o that I em exempt from No CO.trmtCo License taw for the
yo o following a permit
t ]f131A,Business and flafeWuM Cade:Any city at county
3$(L whichitsissuance.
requires•permit re construct.alar,Improve,demolish,orerepairA lit any atexacre
_Z< prier m its i ensed p also requires thevisions o for each Caner Permit Ale a si Ave(Cha meal
p OthelhcincingwdpurwnntuNeprevivisMofofMeBuacuhnimnreiaw(Chapur9 Sq.Ft.Floor Area Val�Iialp114
y $ (commas exempt
Section 7010)and theof basis
far of tbe cipul ess and PmfcnioMCodo)or
Nat he V exempt therefrom and the bu4 foe to alleged exemptm.Any violation Of
Section 7031.5 by any applicant for a permit subjects Ne applicant to a civil penalty of APN Number Occupancy Type
oat.than Eve hundred do0va($500), 36940002 . 00 -
❑1,u own.of Ilm property,or my employee,with ergoat As their sole eampewtlon,
will do the wart,and theawcme,is not intended or offered for sale(Sm.7044,But=$ Required Inspections
and ProfcssuM Code:The Conummes License Law does not apply m m e owner of q P
property he builds orimprowathereon.and whodoessuchwork1t mselfwthrough his
mocmploym,provided Nat each Imprew sets atonal Intended or offered for ule.If,
however,the building or Improvement is sold within ons you o(compledon.Ne Owner.
builder will haw Ne burden of proving Nat he did rot Wild or improv foe purpose of
❑1,as Owner of the property,are exclusively contracting with licensed commacun to
...=I the project(Sea 7003,Business and Prolesshms Code:)The Commeme-U-
cense law does not pply m an owner of property who builds or Improve thereon,and
who contracts far such projects with a cunumeter(s)Ito rated pursuant to the Conuactoes
Licce.Law.
❑1 am exempt under Sec. ,B k P C for this rearm
r Dau
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury am of Ne following declantlonr:
(haw aha will mtlnuinaCnstfieuea/Conserv mall-IMurefwWaher'sCampen-
workfor which this
hY Sinton 3]00 OI the labor Cade.foe tin perlonnuce of Ne
permit is iuoed. ,
❑1 have and will maintain Workers Compensation Inaunna,As required by Section
37000f the tabor Code,far the part....of the work foe which N6 permit is issued.
My Wartime.Compensation to m car,rier/and Policy number are:
Carrier:-afl4l4* A. &Alt L It,No.:L✓C75-331Or"
r
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This seetm nod ret be area pleml if the permit is foe one hundred doBan(S 100)
or l.A.)
1 Wnify Not in the performance of the work for which this permit Is issued.I shall not
employ any ra non In any manneru As to become subject o Ne Worker'Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,afar making this CenMcate of Exemption,you should
become$Object m Ne Worker's COMmosaton provisions of the tabor Code,you must
•J O forthwith comply with such provisions or Nu permit Nre
all be decreed revalued.
z(ACONSTRUCTION LENDING AGENCY
[�w I hereby ARrm that them iso consuwton lending agency for Ne performance of
a 7 the work for which Nu permit is issued(Sec.309'1,Civ.C.)
GQ Iandcr9 Name
O z Leheels Address
U O I cemfy Nat I have read this application aha sum that the Abu"information is
corms 1 Agree m comply with all city and county ordinances and rete law relating m
O building construction,and hereby atehorim mpresemadws of this city in Now upon Ne
W ahave-Modoned property fm inspection purposes.
C (We)agree to saw.Indemnify And keep harmless the City of Cupertino against
yy y liabllite,judgmc.ts.euts and expeue which may in Anyway acerin aglinsl raid City
U 4 in con¢gmnce of the grant.{of this rmlt.
APPLICANT UNDERSTANDS WILL COMPLY WITH ALL NON-POINT Issued by: Date
9
SOURCE REGULATIONS.
61Z9oS— Re-roofs
SigNam ApplicaMContrutm Dau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant sone orhandle hammom material
coned by the CupeNm Municipal Code.Chapter 9.13.and Ne Health and Safety
,Seaton 35533(x)7 All roofs shall be inspected prior to any roofing material being installed.
❑Y. W40
WIII the applicant or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hoanNno Bir comamloanu As defined by tin Bay Area Air Quality Management all new materials for inspection.
DiwiC0
❑Yes b1a-
1 haw mad Ne harardaus materlaismquiremcnts under ChapaN6.95 of the Celifor-
M.H.0"SafmyCoda,Sodium 21505.35533 and 35534,I undcmmnd Natiflhe building
does not curenty haw a unane Nat It is y emponslhility m mdfy Nc occupant of Ne
requirements which mu be at prior uane,of a Ccmfcam of Occupancy. Signature of Applicant Date
8 05— All roof coverings to be Class"B"or better
Owner u wi.edagent oar
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