05030314 CITY OF CUPERTINO
BUILDING DIVISIONPERMIT C C NTRACTOR INFO MATIU
BUILDING ADDRESS: W E O'NEIL CONSTRUCTION PERMR NO05030314
OWNER'S NAME: PERMIT ISSUE DATE
2005
NE: SANITARY NO. CONTROL NO.
(510) 385-0121
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDGO O PLUMB
MECH�
300 LICENSED CONTRACTOR'S DECLARATION r� lob Description I Iertby affirm Wt 1 am Ikensed under provisions of Chapter 9(Commencing
with Section 7000)of Division 3 of Ne Business and Professions Code,aha my liccmc u
j'i L fulif rmandeRec` Lk.• y SIN Q? / NEW CONDOMINIUM
cense
zR' one a Conmadm L.e r L 1124 SQ. FT. LIVING AREA
0 ARCHITECTS DECLARATION
y I understand my plans shall Im wed as public record
SCC
iLicenced Professional
OWNER-BUILDER DECLARATION
G 0 I hereby affirm dun 11. exempt from U r Gasses Cc License Lew for the
D O following euon.(Section]0313.ct.Ow.s and Improve.
deaudi h.a,Any city or coumy
$m which requires•issuance.admin cores ft alter,Improve,demnlWs or mpalr any ttmctam
porn m its ensedpalw requires the inions m far such permit mice s,Land statement -
aofthe Sq.Ft. Floor Area Va .T1tI�p114
rc�s that he s ing exempt
Section7000)and du Division n l alone alleged
W Preforaon.My sh Code)or
.-
that M ts eumpt Uertfrom and Ne hula far the Jlcged ewnpUOn.My Holad'an of
Section 7031.7 by any applicant for a permit subjects de applicant to a civil penalty of APN Number Occupancy Type
.at mart than Rve hundred dollen(5500). 36940002 . 00
D I,u owner ofthe property,or my employees with wages as their ok compensation,
will do Uro work,and thesoucmm is motimanded oraffered forsale(Sec.70d,Business
and Professions Code:The Comanclors Licence Law data not apply in an owner of Required Inspections
property who butIdscrimproves theme,endwho doessuchwork himselfor umugh his
own employees,provided that such Improvements arc not intended osoResed forsak.IL
however,the building or improvement is said within we year of completion,the owner.
builder will ban the burden of proving dust he did oat build or improve for purpose of
sakJ.
0 1,u awmr of tie property,am exclusively convening with licensed wnuanora in
construct the project(Sec.7044,Business sed Professions Cad:)The Conuxm'a U.
ceman,law dow not apply In an owner of property.who build or improves demount.aha,
who contracts for such projects with a contactor(s)licensed pursuant a Uro Contractors
License Law.
0 l am exempt under Sm. .B k P C for this maven
Owner Dam
WORKERS COMPENSATION DECLARATION
I hereby maims under penalty of perjury oro of the following declantions:
sa 1 neve aid ids maintain•Certifies,of Concert r Came,
for WoraeM1 ce of the
utter, r which
this
fur mi Section 3700 Of de Leiser Code.for the performeme of the
work for which Nis permit is issued.
❑1 have and will maintain Workers Compensation Insurance.as required by Season
3700 of the Labor Code,far the performance of the wank for which this permit is issued.
My Workers Compensation Incannce Cartier and Policy number ace:
certier. 2�i VIC lGt1 A.a'ICYI-1� o icy No.:G.iL 36�?I D —D
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thiseec0an need not Mcompleted if the permit is tureen hundred dollars(SIM)
Or kis.)
I certify that in the performance of the work for which this Permit is issued.l shall and
employ any person in my mamersa u u WComa cabinet In tie Worker'Compeuasan
Laws of Califomis Das
Applicant
NOTICE TO APPLICANT:IC after making this Cemnese of Emmption,you should
become subject w the Workers Compensation provision of the Labor Code,you mum
.J O forthwith comply with such provisions or this permit shall be deemed revoked.
Z 0 . CONSTRUCTION LENDING AGENCY
E4 EI hereby million that them is a construction lending agency for Ne performance of
> the werk for which this permit is issued(Sm.3097,Civ.C.)
Q lenders Name ,
z Lenders Adduces
V Q 1 certify that 1 have read Nis applicmion and sue that Use above information Is
w corec6 I agree to comply with JI city and county ordinariness and sum laws relatiag to
building construction,and hereby authada representatives of this city as enter upon the
W shove-mentiorcd property for Impaction purposes.
(we)agree in save,indemnify and keep hmmleas use,City of Cupertino against
i,.h liabilidan,judgments.costs and expensan which may in my way accuse ajimma aid City
V In consequence of the graining of Nit Mit.
APPLICANT UNDERSTAND D WILL COMPLY WITH ALL NON-POINT Issued by:9 Date
SOURCE REOULA NS.
0 Re-roofs
Signa of ApplicanUCanueclor y °ice Of Roof
HAZARDOUS MATERIALS DISCLOSURE Type
Will de applicant or future building occupant mom or handle hvudous material
u de0ned by the Cupertino Municipal Cod,Chapter 9.13.and the Health and Safety
Code.Samoa 25532(.)7All roofs shall be inspected prior to any roofing material being installed.
Dy.
Will me applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit haurdou air Crawardways dacilSial by the Bay Area Air Quality Management all new materials for inspection.
Dlshi.0
0 Yes u
1 have mW me huudnummcri.ls requirements under Chapter6.95 of the Califon
.is Health&Santycode,Sremms 25505,M533 and 25534.Imulam ul that ifthe building
dean not curoody ham a tanant,that] my responsibility in notify Ne occupant of Ne
mquiromens which mum Im met issuance of a CcralicannoroeFumacy. Signature of Applicant Date
Owner union ed agent „p All roof coverings to be Class„B„Or better