05030315 CITY OF CUPERTINO
Cvs T0WW.0RMATI0Nv�i
BUILDING DIVISION PERMIT 7
BUILDING ADDRESS: W E O'NEIL CONSTRUCTION P"b"05030315
20500 TOWN CENTER LN 4 269
OWNER'S NAME: PERMIT ISSUE DATE
SILVERSTONE DEVELOPMENT 5245 PACIFIC QQNCQURaZ_Da1VE 08/29/2005
E: SANITARY NO. CONTROL NO.
(510) 385-0121
ARCHITECTrENGINISER: BUILDING PERMIT INFO
BLDG ELECT PLUMS MECH
Sop LICENSED CONTRACTOR'S DECLARATION
IfiI Inuchy,air,.that I am licensed under provisions or Charier 9(concrionacmir Job Description
with Section 70(X))ofolvislon 3 of the Business and Professions Code,and my license Is
In fuillormanclCUM. 12 NEW CONDOMINIUM
;H Li man Cl. uc.0
'c
contractor L�e 1124 SQ. FT. LIVING AREA
Date ARCHITECTS DECLARATION
Jy I unionized my plans"I W used m public icarcholi
Licensed Professional OWNER-BUILDER DECLARATION
I hereby from that I am exempt from ft Cormiclon'S License Law for the
O following memo.(Secton 7031.5,Business and Professions Cc
My city or county
which requires a pcoult to conestroul.alter,improve,demolish,or repair my as
prior to its issuance.alm requires dre applicant for such permit to rile a signed statement
hermed purismal Sq.Ft.Floor Area Val$alafi)114
is 8 chat he is I I in the provisions;of ft Contractors Lec=Low(Charter 9
(commencing with Section TODD)of Division 3 of the Burd.ted Professional Cade)or
bor I I.saempl proofrom and ite basis fix ibe alleged exemption.Any violation of
Section 7031.5 by&M applicant(.a permit subjects the applicants to a civil penalty of APN Number Occupancy Type
not more than live hundred dollars($500). 36940002 . 00
El 1,ast owner of the preptemy,u,my employees with wages m their=to counriceizzlim,
will do the surok.and the truclume Is not Intended or offered for aske(See 7044,Business
and Profession;Code:The Commences License Law does an[apply us an owner of Required Inspections
property who buiIds orimprove thumen,end who does such work himself or through his
chan employces,Provided that such Improvements as not Intended Whitened foulard.11.
however.the building or improveroment I.sold within one year irfoonpletion,Ne onwor.
Witcher will haw the burden of proving that he did not build in terminate for purpose or
sain.)
0 1.0 owrer of the Property,son exclusively contracting with reached commumbot In
construct done pmjm(Soc.71144.Business am recreations,Cade:)The Contruchmer's Li-
come Law does not apply M an owner of propeny who Wilds or improv unions.and,
who contracts for inch famijecut with a contramor(s)licensed pursuant in the Commuctor4
Lima.Law.
[j lannexempt under Bee. .B&PCfor this mason
ter
Date
e
WORKER'S COMPENSATION DECLARATION
I hereby affirm under readily of perjury am of ft following duclaradorm
❑1 ban and will maintain a Centricate cfConxcm in self-finsime for Wormes Camper.
I
saflon,u provided for by Section 37M of the Labor Code.for me performance of the
work for which this permit is Issued.
1 have and will maintain Worker's Compensation Insurance,as required by Section
311 of ft Lsbxa Code,to,ft porrmsmance,of ft work for which this permit is Issued.
Myl
My Warmes Compensation Insurance units and Policy number ince:
Cam __LVA44�
Carrier—,'
CERTIFICATE OF EXEM PITON FROM WORKERS
COMPENSATION INSURANCE
(rols section noul nottecompleted Ifflue permit Is for one hundred dollars($1110)
or leu.)
I ourfif,that I.the performance of the work for which this permit lut issued,I shall am
employ any person in any manner an as in become subject in the Worked Compensation
Laws of California.Date
Applicator
NOTICE TO APPLICANT:If.after making this Ocafficate of Exemption.you should
humme subject w the Worscr`B Comperoutdon provitionn;of that Litior Code,you much
Z fenumvidb comply with such provisions or this Permit mail the decomed revelood.
z CONSTRUCTION LENDING AGENCY
I bunchy afflorn that then Is a consintiction lending&:cwy for the performance of
IYm> but work to,which this permit is issued(See.30n,Ci,.C.)
Lenders Name
0. Lenders Add.
J I minify dust I haw read this applladon and state that the show hilourcultion I-
V. correct.I ations,in comply with A]city and county ordinsecri and sum lam Willing W
C) Wilding construction.and hereby scuthorins representatives of this City Us CAW upon be
0one-mentionned property for inspection puniones.
gL (We)agree u,saw,indemnify and trop harmless the City Of Cupertino Agairent
rA liabilities.Judgments,eau and expenses which may in any way see=ligbuLlindChy
in conwqwncc of the gaming of this permit. N-POINT by: Date
APPLICANT UNDERSTANDS AVIPILL COMPLY WITH ALL N Issued
SOURCE REGULAT. 7--110-�Re-roofs
Re-ro
Signature arAlicasuC.numccor 411 DamType of Roof
HAZARDOUS MA AIS DISCLOSURE
Will We appricam or in=Wilding occupant am or handle hasandeass mrsourfial
ss;defined by the Columba,Municipal Coin.Chariot 9.12,and the Health,and Safety
Cade,Section 111121,)? All roofs shall be inspected prior to any roofing material being installed.
ny. a Will 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
..It h..rd..a air matterol...M hat dc0n by me Bay Area Air Quality Management all new materials for inspection.
District?
[3 ye,
I new mad the haturindons materials requirements under Chapter 6.95 of time Cables.
nialked"SafictyCode.Sections 25505.25533 arxi I undmouldrul dead if Wilding
does,notmeremly he..uniant.uses Il repombiltly 0 malry pan occproot of the
sciiiiinumenditwh.hm tatmallarioror.c.mrkxuc �ZSignature ofApplicant Date
Owner drihorl agent xj
a All roof coverings to be Class"B"or better
[ upFor ob