05030316 CITY OF CUPERTINO tiKst .*mac,
BUILDING DIVISION PERMIT CONTR aTor"INFORMATION BUILDING ADDRESS: W E O'NEIL CONSTRUCTION PERMITH0.05030316
20500 TOWN CENTER LN if 981
O NER'S NAME: PERMIT ISSUE DATE
SILVERSTONE DEVELOPMENT 5245 PACIFIC
Et SANITARY NO. CONTROL NO.
(510) 385-0121
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
1 o p LICENSED CONTRACTOR'S DECLARATION Job Description
I hereby arm drat 1 We licensed under provisions of Chapter 9(commencing P
inIN Section 70(10)of Divitlo ]attic Butlnawi and Profruiou Coda,end mylicense ii
fuilforee anis If L NEW CONDOMINIUM
Licmso c.• Li -1 q d7 /
?�p' Date C. tenor er !r. 1124 SQ. FT. LIVING AREA
0 W ARCHr1ECrS DECLARATION
!] I understand my plans shell be used as public moods
y u
g G Licensed Poorest mnal
agy OWNER-BUILDER DECLARATION
2 S I hereby entrm that 11. exempt from tiro Cssions Co License Law for the ,
5 O o fallowing rens& panto r 7(171.0. t Maas and Professions Code:Any oily or county
$(tin which requires a permit ne ennera4 altar,impmw,demolish,or e a sig ed torment
_t�, pnord its issuance,pursuant
requires Hisapplicanto for mchpemitmiense Law(Cha statement IdtB10114
<
(that he commencing
licensed Purnant melte provisions of the Conuinessend Prarlaw(Chapter9 Sq.Ft. Floor Area Val Y.u'
3 tham a is exe pt tSection refrom and
the
Division r of tbe alleged
Business and Profeta violas k)or
Net be V exempt therefrom sod trt hula fa the atic{ed camps..Any vloladan of
Section 707 LS by any applicant for a permit subjects the Applicant m a civil Penalty of APN Number Occupancy Type
not mom thm rive hundred dollen(SSW). 36940002 . 00
0 I,u owner of Ilia pmpmy,w my mplayees withwages u deb mle compeuadon,
willdothework.mdlheumaumbnotintendedoro@mdforsak(Sec.7W.BLWmus Required Inspections
and Profeuieu Cade:The CommitteeLiave Law does not apply u m owner of q P
Property who builds or i mpromea thereon.and who doea much weak himself or through his
awn employees,provided thatsoch improvements me not Intended oroRered foraale.If,
however,Ne building or improvement is sold within aro you disinflation.the owner.
builder will have is bard.of proving Wt be did not Wild or Improve for purpose of
talc.).
0 1.as owner of the property,m exclusively consuming with licensed conuacmrs to
comauct the project(Sec.7014.Business and Profusions Code:)The Conuacteta Li.
cause law dose not apply in an owner of property who Wild.or Improves demon.and
who contracts for such projects with a eonuacuu(s)licensed pursuant m the Commete's
License Law.
C I on exempt under Sec. ,B R P C for this reason
net Data
WORKER'S COMPENSATION DECLARATION
I hereby aBbm under peeslsy of perjury one of Js fallowing declarations:
01 ha.emol will msinWna Cenifi u ofConanttomlf-iuumfmWorkeesCmpen-
sa ion,u provided for by Section 7700 of the Labs Cade,for the Performance of the
work for which this permit is issued.
0 I haw:and will maintain Worker's Compensation Insurmce.as required by Section
3700 of the labor Cade,for IN pRormance of the work forwhich this permit is issued.
My Worker's Computation munnee caffiSr WiIj Policy number are:
Carrier:?I/yt(G� "t04 Policy No:s" L-73� ^d
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(nusrstion used set be completed HIle pnnft Is formic hundreddoBars($1013)
or Ices.)
1 ceoily that In the performance of the work for which this Permit u load.I shall net
employ any person In my W meran as us become subject to IN Worked Compensation
Laws of California Date
Applfcanl
NOTICE M APPLICANT.IL after making this CcniRcate of Exemption.you Would
become subject to the Worker's Compensation provisions of the labor Code,you most
OZ
forthwith comply with each provisions ar this permit shall be deemed revised.
z v0 CONSTRUCTION LENDING AGENCY
[.r Ibereby ofirm bel dere is a comnvctinn lending agenry for the prfurmence of
a> de work for which this remit is issued(Sea 3097,Civ.C.)
a Q
Lenders me
7 Z landee'aAdd=
U Q I testify that 1 have rod this application and ante the the shave infomation is
is. cot 1 agree to comply with all city and county ordinance,and este laws relating m
O Wilding construction,and hereby authorim mpresenmiws of this city in reser upon the
IS7 above-mentioned property for inspection purposes
gL (We)agree in taw:,indemnify and keep homilies the City of Cupertino against
y liabilities,judgments,toss and expenses which may in my ray mttue aWnsl wind City
in eanxqucti a of the graft of this p L
APPLICANT UNDERSTANDS AN ILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULA77�NS.
✓">>/L5 ��2 9�// Re-roofs
7 gnats pphcmUCanindor fes^
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or fusion,Wilding occupant stare or handle huudou matetltl
as deflnW by IN Cupertino Municipal Cpde.Chapter 9.13,and de Health and Safety
Code,Section 11532(a)7 All roofs shall be inspected prior to any roofing material being installed.
0 Yes (�i /
Will the applicant or future building atopen(use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
..It haurdiou ai,commul nu delta the Bay Arne Air Quality Management all new materials for inspection.
District
0 Yes u
I hew mad the bacardas materials requirements order Chapter 6.95 of the Cal ifm-
naHcxI"SJGyCodc,a2Wilding
Wdoes not currently have a pbNty
m notify IN moupsm of the
requirements whichmica ametpno a or.Certificate of Ocmpany Signature of Applicant Date
q a All roof coverings to be Class "B"or better
Owner orApIlorindtagent Da
C