05030319 CITY OF CUPERTINO =r +•-4'= «_64, , 'T+ "s a
BUILDING DIVISION PERMITCONTRA.0-'TOR INFORMATION:
BUILDING ADDRESS: W E O'NEIL CONSTRUCTION PERMIT NOO 5030319
20500 TOWN CENTER LN ft ign
OWNER'S NAME: PERMIT ISSUE DATE
TOWN CENTER ASSOCIATES 5245 PACIFIC 08/29/200S
Et SANITARY NO. CONTROL NO.
(510) 385-0121
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
joo LICENSED CONTRACTOR'SDECI.ARATION Job Description
1 Mmhy affirm Net I an licensed under previsions of Chapter 9(commencing
with section 7")of Division 3 of the Business and Professions Code,and my license is
+� in fun fn=andercxt. �9N 07 NEW CONDOMINIUM
2 i-2�, License 1 IJc.N
�
Date cantraur 6..0 •✓ 1349 SQ. FT. LIVING
Sp
ARCHITECTS DECLARATION
p6`lu I undrawn my plan shall W used n public rewrds
a Licenced Professional
5g OWNER-BUILDER DECLARATION
i 0I i hereby so affirm that 1 L Attempt from the eonoectore Licence Law for than
$O followingmason.(Schon 115 LI, t,elect. mp profession Code:My city arroomy
$ which require[a permit m comment,the Blur.improve.demolish,or reptir any structure
aSat
poor W is licensed
p ata mqulme lW applicant for such actor'm rile s,Law chanterstatement
2x< muWeNkcnadOunuanunmoprovisions oftfftBusiness
uactosandPreclaw(Chepter9 Sq.Ft. Floor Area Va altin616O
2 � theis
(commencing pt Section enfrom000 th basis n3of NCeged euand ProfMyvl Centel or
(133$ Olaf he b essmpt therefrem ad the breis for the Alleged eamption.MY vlobUn of
Section 7031.5 by any applicant for a permit subjects tho applicant in a civil porosity of APN Number Occupancy Type
not mare then Eve hundred dollar($500} 36940002 . 00
❑I,as owner of the property,or my employees with wages a their am compensation,
will do the work and meawmum b not inundcd orolfemd for We(Sec.7064.Business Required Inspections
Lad Pmfavion Cade:The Connn rean
nmt Licsome law dot apply ee owner of q P
property who builW m improves thereon,and whodwauchwrk himse3f ormmugh his
ow employees,provided thatach improvements rte al intended or offered for sale.U.
however,the building or improvement it sold within ane you of completion.The owner-
Wilder will have the burden of pmving that he did at Wild or improve for purpose of
sale.).
❑1,As owner of the property as exclusively cmonating wim thanked ce nnceers te
awnct the project(Sec.7044,Business and profession Cade:)M Contravenes LI-
cente law does not appy 0 an owner of property who Wilds or Improve Neaten.end
who contracts for such pmkM with a contractor(&)licensed pursuant be than Contractors
License Law.
O I.m eandin under Sec. B d P C for mla mason
sonar Dau
WORKERS COMPENSATION DECLARATION
I berebY afn=under faulty of perjury on of the following declsomon:
❑ehew.ndwillmainWnactia 3cae of thecaeto ous.for fmWoakehCampen-
satia,As rpre h this
for by Ss l an 3-/00 of the labor Code.for the performance of de
work for which Nis permit is laud ,
❑1 have and will maintain Worker's Compensation Insurance,u required by Section
3700 of the Labor Cade,for de performance of the weak for which this Park it issued
My Worker's Compensation inseemnc:ca i" d reynumber art:
Cmricr`'7AV( 1C& f�"'rG/y L" hry No.:tw-K. 7331/7 t7
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Tab ane tim reed not W completed If the permit It forone hundred dollars($100)
or local
I certify that in the perfarmance of the work for which this permit is issued.I shall am
employ any person in my matter as At become abject to the WorkersCampeneNon
L.of California.Dam
Applicant -
NOTICE TO APPLICANT:IL after making rob Cenifica t of amoupdon,you should
Iecome object m the Worker's Compensation provision of tie LAW Code.you most
3 0 faMwith comply with such such prnvuior this permit 0311
1 M domed montane.
y CONSTRUCTION LENDING AGENCY
[..t I hereby affum that tMrt is a construction lending agency for the performance of
C> the..,it fm which this Permit Is issued(Sec.3091.Civ.C.)
lit ca.Q Landers Name
}z Lenders Address
U Q I certify that 1 haw read this application and sou that the slow information is
W,','! correct,l gree on comply with all city and county ordinances and sum laws totaling in
065.'! Wilding construction,and hereby authorize reprm•nt fives of this city m enter upon the
tf7 aWw-men6aend property for impemion purposes
(We)agree to an,indemnify and keep hatmmn tie City of Cupertino against
y liabilities.Judgments,coats and eepemn which may in my way acme against aid City
() in APPLICANTcof theUNDERSTL'of Sthat r TILL COMPLY WITHAL NON-P INT Issued by: Date
SOURCE REGU ONS,
Re-roofs
Signature of ApplicenUConlrector am
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant seem m handle hvanams memo,[
s defined by me Cupertino Municipal Coda.Chapter 9.11.ad the Health and Safety
cede.Section 15533(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes a
WIII the Applicant or forum Wilding mcupam era equipment or device whichIf a roof is installed without first obtaining an inspection,I agree to remove
emll haardon air co munimnm As defined by dec Bay Area Air Quality Management all new materials for inspection.
District?
[I'ib. u
1 have mad the husedus materials requirements under Chapter 6.95 of the Califor-
niaHaIN&SafciyCo1c,Seen..35505,2553333534,1umlmmha the if me Wilding
dans amt currently have.tenant,Nat it is tponihillly m r mil'y me occupant of the
requirements which mus met prior aofacenilkalc of f�ccYNACY ZAC/e Signature of Applicant Date
owns'-- r ata( homed agent 87 � All roof coverings to be Class"B"or better