05030317 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CQNTRALGT0RIN 'UXtMA'Y'Y(;)
BUILDING ADDRESS: W E O'NEIL CONSTRUCTION PERMIT No.05030317
OWNER'S NAME: PERMIT ISSUE DATE
SILVE ,STONE DEVELOPMENT 4
'MONE: SANITARY NO. CONTROL NO.
510) 385-0121
ARCHIIEC(/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
app
LICENSED CONTRACTOR'S DECLARATION Job Description
r(�yFp 1 hereby AM.But 1 me licensed under provisions of Chapter 9(mmmcncin{
a X16 with Sec t(on70111Ba(Divialon ofthc Business And Profcnlnm costs,and myliccescla
SSS infulIfares and affect. NEW CONDOMINIUM
N Z Licemc 1 Lie.g 1
TF• Dao canuaemr 1124 SQ. FT. LIVING AREA
ARCHITECTS DECLARATION
I understand my plea shall he used As public records
)yU
M Licensed Professional
OWNER-BUILDER DECLARATION
Ro Z 1 hereby.(firm than 1 1. .exempt from die Conlon,Co Ucaze 4w for the
Coo fallowing meson.permit
a 7031.5.Business and pr Pnorve.demolish,
Code:My city Or county
5$ which its iirus a permit re sures the alter,improve,demolish,car mash any atramum
-Zi
prior uiuissued perm requires the applicant for amhpctor's Bernsle a Law
(Chtemem
ppx< Nu pmvistom of 9 Sq. Ft. Floor Area Val$ ® 114
YFth (comets exe pttSection and 000)
thasax n3 ofdleeged Business My viCode)of
� that he ts exempt therUrom and the Ensu for the alleged exemption.My violation a(
Sectors
e mme031.5bbyh any
tfdollars(sero) Bsubjects"eapplicant m'civil Penalty of APN Number Occupancy Type
36940002 . 00
❑L u owner of lane popemy,m my a intended
wgu ss deh ani. 044.Box.
will dotheaors,n'and the swnore rmeme nukes,,Law ffered
an,ApSec.IO N. atter of Required Inspections
and zany who
W Cade:The fonuxmrt.Liwho law such
Ilan apply df an owner cep q P
Own employe Wilde idmpowademon,•edwho doeaouc tended roffe m"rr ughals his
Own employees.Provided!IMtpchimpmsemenutee not earofdmaffered f Owner.
however.the Wilding aurimprovementisantwithinoroyear of completion.ft ase of
builder w01 have de OuNa of proving But he tlitl ml build m Improv for purpose of
sale.).
❑1.As Owner of lh pmpms un exclusively contracting with lianred coam=to
comuuct the project(Sec.IWC,Business and ProfessiOM Code:)The CONAM tes U-
come law data not apply to in owner of properly who builds,or improve therein.and,
who contracts for such pmjcm with a cuntracann(q liaised pursuant to the CoWanoes
Liceve Law.
❑lamexemplunder Sec .e&PCforthiamssan
Dau
WORKERS COMPENSATION DECLARATION
I bemby air=ander penalty of perjury ane o(the following daluatutu:
❑Ihaveantl will malnuin aCenifiatea(Caruwmtelf-ImumfmWarkeraCompen-
sation,As provided for by Sudan 3700 of du Labor Code.fm One performmm of the
wick for which this permit is issued.
0 1 haw Ona will maintain Workers Compensation Incomes,AS rayuirod by Section
3700 of the Labor Code,for du Performance of the arms formich this pmmit is Issued.
My Worker.Compensation luursnce carriier�aM�Policy number tet:
Carrier.�Ll/JLh "I'wisrA/T-,RBfiry No.: ie_Dr 36
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
Cnabaection need not Munificent if Oe permit is fm ane hundred mHm($IW)
or leu)
I certify that in the performance of the work for which this permit is issued.I shall not
employ anyperson in my manner an As to bccumesubject to the Worlous'Compensation
Laws Of California.Dau
Applicant
NOTICE TO APPLICANT.IL spur mking this Certificate of Exemption,you should
become subject to the Worlms Compensation provisions of the Lahar Code,you mast
,Jz forthwith comply with such Provinces or this permit hall Ie darned rooked.
zO CONSTRUCTION LENDING AGENCY
[r I hereby affirm Out there is a consumdon lending agency forth,performance of
ai> the work for which Nu permit u Issued(Sm.3091,Cie C.)
W Q Lenders Name
]z Lenders Address
UR 1 certify that I haw read this application and suss That the above Infmmmion is
D.U COML 1.gra to comply with JI city and county undimmed,and suss law relating u
C) building construction,and hereby authorize representatives of this city to enter upon the
W shove-mentioned property for inspection purpesea
(We)agme to save,indemnify and keep harmiw the City of Cupertino against
Lyti liabilities,judgments,casts and expands which may In my my ammo against laid City
V in APPLICANTaUNDEof the RSTANDS AIN�rm ILL COMPLY WITH ALL NON-POINT Issued by:9 Date
SOU EREGULA NS.
2' a Re-roofs
Signa fAppficmuCanuactar ' Data e Of Roof
HAZARDOUS MATERIALS DISCLOSURE Type
Will Lha applicant m future building Occupant Ram or handle handous material
as derined by the Cupertino Municipal Code.Chapter 9.13,and the Health and Safety
Cade,Section 25533(a)? All roofs shall be inspected prior to any roofing material being installed.
QYe
Will the 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 Weardnta air conuminm ss de0nc y the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes
I have mad the huandasmateriaismqubements underChapter6.95 of the Califor-
meHalth,9 Sarety Code.Sections35505,35533 an6255X 1 ondertund thuif 0u Milding
does not currently hams,tenant dol my reaponslhillly m notify ft occupant of the
myulrcmenu which sun Ec met issuance of a card maw of Occu ry. Signature of Applicant Date
0 2- All roof coverings to be Class"B"or better
Owner or Kthorized agmi D
L