05030318 CITY OF CUPERTINO
BUILDING DIVISION PERMIT .CONTRACTpRANFORM, ON
BUILDING ADDRESS: W E O'NEIL CONSTRUCTION PFRM11NO.05030318
WS NAME: PERMIT ISSUE DATE
TOWN CENTER ASSOCIATES 5245 2ACjZjQ_Z=C)lJR6E, DRIVE OR/29/2005
PHONE: SANITARY NO. CONTROL NO.
(510) 385-0121
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
jOp
LICENSED CONTRACTOR'S DECLARATION Job Description
1 hcroby affirm Net 1 am lived under provisions of Chapter 9(commencing
f�
wide Sued.7000)of Division 3 ofthe Bwinev and Prof/es/sions Condo.and my license is
in mu fame ane erfea g,y 7� �e NEW CONDOMINIUM
N Z Lmeve
J Dam Conlncmr -T.ic O✓tom 1349 SQ. FT. LIVING
�
ARW used
se DECLARATION� IuMcm
rnd my plans",IWI Musedu public record, BMR UNIT/ NO CONSTRUCTION TAX
LC Licensed Professional
OWNER-BUILDER DECLARATION
Si I hereby Affirm Net 1 em exempt from Ne Cantractofs License Law for the
y a poi following mason.(Scetiun 7031.5,Business and Pmfendom;Code:Any city or county
!$LL which requires a penult to construct,alter,Improve,demolish,or repair my muctum
_ZSa prior In its issuance,aim requires the applicant for well permit to rile a signed statement
ppm< thathelsllmnscdpuuumalotheprovision ofMeConvector's License Law(Chapur9 Sq.Ft.Floor Area Valuation
RI (commencing with Section 7000)."(commencing Division 3 of the Bu,inraeend Professions Code)or $156160
�.. Nat he A exempt therefrom and the basis for thd alleged exemption.Any violation of
Section 7031.5 by Any applicant for a permit subjects Ne applicant to a Civil penalty of APN Number Occupancy Type
Am mart Nan five hundred dollars($500).
0 1,W owner of dee property.mmy empl Y=whit rotes a Neu cele compewdon.
rum Profession.,
work.Code:IV numunors License
AW dos got A(See.As An angor
and property
r ywho v Code:The Csmeresm.Cleave Law ds cot apply lf rt auger of Required Inspections
man enywhobuildsorimprovechimpr andwho ds,mhwork himself ultluaugh his
ownemploys,provided than suchimpsovementaarene year fcoraRamd Me Sala If.
builder,Ne building m improvement is cold within one year of completion,Ne owe
builder will have tuNe burdan of proving Nat k did Cat Wild or Improve for puryoof
o!
old.).
0 I,As owner of Ne property,am exclusively contracting with lla®ed contractors to
construct the pmjea(Sec.7040 Business and Profudov Code:)The Canvactor's Li.
ave Law ds not apply to an owner of property who halide or Improves themon.and
who contracts for such projects with a contrmtorm)licensed Immune,An the Comouror's
License Lew.
❑1 Am exempt under Sec. ,B&P C for this moan
er Dale
WORKERS COMPENSATION DECLARATION
I hereby Ailing under pmW ty of perjury one of Ne following deelentions:
0 I baa and will maintain a CeniOou of Covent m self-Inure fm WorteY,Compns-
sation,as provided fm by Session 3700 of de Labor Cods,for dee Performance of the
work for which Nis permit is issued.
0 I ham and will maintain Worker's Compensation Insunna,an required by Section
3700 of the Labor Cons.for the performance orbs,wort forwbich this permit is issued.
My Worker',Compensation Insurance eerier and Policy number am:
Cartier.?-rndyL/,E gr.At'Yt-(L ayNa.:lA✓63T?313
CERTIFlCAM OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
frills suction need Out hecompleted time Permit is for one hundred Minot(5100)
Ica.)
1 ce dfy Na,in the performance of the work for which Nis permit is Issued,l still na
employ any person in my Customer an An w become subject to the Worions Compcommon
Laws of California.Dau
Applicant
NOTICE TO APPLICANT:If.afar making this CeniRau of Exemption,you should
become subject in Ne Worters Compevavon provisions of the Labor Cade,you most
.J O forthwith comply with Inch provisions m this permit mail W deemed re elmd.
z CONSTRUCTION LENDING AGENCY
[•r I hereby kms Net More is a construction lending agency for dee performance of
a the work for which Nix permit is issued(See.3097,Civ.C.)
W�Q Under's Name
7 2 Ldnder'x Addmas
t)Q I certify that I have and this Application W,tau Nu the above information is
L4 F Comm l agree to comply with all city And county ordinances and mm law,relating to
OU building cansmction,and hereby Auhodve representatives of this city in tour upon Ne
W above-mentioned pmpeny for inspection purpmea
G (We)agree to van,indemnify and keep hArmless Ne City of Cupertino aPMM
tqy, Ilabilida,judgment.emu W
and expenses which may in my way Kenn age t said City
V G In comequance of the grm,in'of Nu permit.
APPLICANT UNDERSTANDS ANO I' COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS,
ell Re-roofs
Signature pplicm numtor Au
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will dee applicant or future Wilding occupant store or handle hva dons material
de0vd by Ne Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
A.Section 25532m)? All roofs shall be inspected prior to any roofing material being installed.
Yes tw
Will the applicant or future building ocoupam use equipment or devil which If a roof is installed without first obtaining an inspection,I agree to remove
emit hanrdnv air contsminmu an defined by the Bay Are Air Quality MAnagcment all new materials for inspection.
District?
0 Yes dM
1 bac mad deehvaNausmaterials requirements underCMpur6.95 ofdm Califor-
meHalth6 asfety Code,Seenov25505,25533 And 25334.1 uMemend dutifNe building
ds Out currently have a tenmL dear it u my Napejudailly to Canty the occupant of the
requirements which mug be met p. to fa CcniMam of Oce Signature of Applicant Date
Z
caner ar. .Ada ant air All roof coverings to be Class"B"or better