05030322 CITY OF CUPERTINO 7 "�
BUILDING DIVISION PERMIT ,(.`Oi`t'TRe .0 QYt Ib 2MATIONW. ss
BUILDING ADDRESS: W E O'NEIL CONSTRUCTION PERMITNO.05030322
0 NER'S NAME: PERMIT ISSUE DATE
TOWN CENTER ASSOCIATES 5245 PACIFIC CQNrQ1JR,�E DR VP OR/29/200S
1IMNE: SANITARY NO. CONTROL N0.
(510) 385-0121
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
tap LICENSED CONIRACTOWSDECLARATION JobDescrition
(Y I hereby affirm that I sununder licensed provisions of Chapter 9(commencing P
with Section 70(41)of Division 3 of Ne Business and Pmfusians Code.and my license is
m tafullfameaderfn 9 NEW CONDOMINIUM
z Lk1ena Lc.a N9'f o /
�— DamContractor w e.r ElL 1349 SQ. FT. LIVING
n p ARCHITECTS DECLARATION
I mrdcramnd my plana shall he bond at public recmda
J
s c�a Laenad Pmfcsuond
3 OWNER-GUILDER DECLARATION
ContrON
<$ 1 hereby affirm that 11. tamps from the Comamr's :License
yc Law for the
04 which following moon.(Suitt 7031.5,Business and veRWnns Code:Aubwa orcounty
5$� which myuiru a permit m casvoel,eltot Improve,demnlieh,ver repair any avecmm
_zY prior to its comance,also requires the applicant for such permit to file a signed smtemem
< On he is licensed pursuant to the provisions of the Comon's License Law(Chapter 9 Sq.Ft.Floor Area Val$�tt�s�160
B (commencing with Section 7000)of Division 3 of the Businusatl Promuions Code)or
.. Nat he is exempt timrefrom and the basis for the alleged assumption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
nal more than 0n hundred dollen($500). 36940002 . 00
❑I,as owner of the properly,or my employees with wages as their ale wmpeasellon,
will do the work.and the structure 1,.1 amended chartered far ask(Sec.7654,Business Required Inspections
and Professlom Code:The Contractor's Lho me Law does an,apply W an owner of q P
Cher ay who buildsterimprov,Woman,andwhe doessuch workmmself orthrough his
own employees,provided that such Improvements art not Intended oraRmed trestle.IL
however,the building or hnprovement is said within aro year of completion.the awner-
builder will ban the burden of proving that M did not build or Improve fm purpose of
ale.),
❑L as owner of Ne prepeny am exclainly contracting wit licensed conbsctom to
construct the project(Sec.7044,Business and Profeasiam Cade)The Consatos's Li- '
cense law does not apply to on mottoes of property who builds or impruws Nemon,and,
who contracts for such mojccu with aconuaar(t)licensed pursuant th the Contractors
License Law.
❑1 am esempt under Ste. .B k P C fm this roan
Date
WORKERS COMPENSATION DECLARATION
1 hereby M.under penalty of perjury oro of the foltowing declaratwns:
❑1 ban and will maintain a CW Mte of Consent to self-insu,fm Wo k e Compcn-
ation,as provided for by Section 3700 of the labor Code.for the performance of the
wants for which this permit is issued.
0 1 Nn sand will maintain Worker's Compensation Insurance.u required by Section
3700 of the Lather Code,for the performance of Won work forwhich this permit is iasoed.
My Worker's Compensation Insurance canter and Policy number stn:
rti
Caer.7y/1&/F If 'fC^f4141fPOIicy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMMSA71ON INSURANCE
(Thissec0nn need notbocompleted Irthe pmmh Is fmanc hundred dollars($1010
or len.)
1 cavity that In the pmfmmanee of the work for which this permll is Iasued.I shall not
employ any paean In any manner so as to become subject to the Waders'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this CCalfli of Exemption,you shauW
become subject to the Worker's Compensation provisions or Ne IaMr Cade,you must
.J O forthwith comply with such prevision or this pumi,shall M decreed anted.
'y r~N.. CONSTRUCTION LENDING AGENCY
[r I hereby trillion to.,then H a censuucdon timing agency for the perfurmuae of
0: the work(or which this pail 4 issued(Sec.3091,Cih,C.)
WQ Lanni Name
0.
0.2 Leaders Address
U Q 1 madly that I hart sad this application ad same that the abort information is
Uy F mnecL 1 agra to comply with all city and county andinuResand sum law relating to
Or, building construction.and hemby authorise representatives of this city W atm upon the
W ahon-mantimed property for impaction purposes
y (We)agree to un.im icmnify ad kap Iwmleas the City of Cupertino against
fq liabilitiu,judgments,cmustdexpwes which may in my coy smve alimmiaid City
V Z in consequence,of the granting of this permit.
APPLICANT UNDERSTANDS OD WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS,
S dr Re-roofs
SignsiffircorAftlicamuContatICLEN Done
HAZARDOUCMATERIALS DISCLOSURE Type of Roof
Will One,applicant or future building=upon,more orbandle haeamous material
as de0ned by the Cupemno Municipal Code.Chapter 9.12,and the Healer and Safety
otic,Section 25532(1)7 ��. All roofs shall be inspected prior to any roofing material being installed.
Ely..
Will the applicant or future building occupant on equipment of devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit harardoa air contaminants u dcOned by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yea a
I have mad the hasardous materials requirements under Chap ar6.95 of thc Califon
riaHealth k Safety Code,Seedans 25505,25533 aad 5534.Iundcrsund thuifthe building
does not cuvendy haw a moani.Net It is my worm t hility to notify Wte occupant of the
mgmamcnts which must W m rr to iaaance or a complete or Dc"
f 9/ pane. Signature of Applicant Date
2-`r� All roof coverings to be Class"B"or better
Owner authorimd agent Dia
r