05030324 CITY OFCUPERTINO r'^ -^
BUILDING DIVISION PERMIT 4CONTRACTOR INFORMATION a
BUILDING ADDRESS: W E O'NEIL CONSTRUCTION PEaMrr No.05030324
20500 TOWN CENTER LN fi 291 —
O NERS NAME: PERMIT ISSUE DATE
TOWN CENTER ASSOCIATES 5245 PACIFIC CQNCOUR62 DR VR 08/29/200S
11ME: SANITARY NO. CONTROL NO.
(510) 385-0121
ARCHITECTIENGINEER: _ BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
] O O O
Yp� LICENSED CONTRACTOR'S DECLARATION Job Description
1 heonby affirm Nal I am licensed under provision of Chapter 9(commencing
with Section? MH of Division 3 of Me Business snj Processions Code.and my license is
^'1 in fall fomeand eM.I. NEW CONDOMINIUM
pa,nse`I e C �9� OIL 1349 SQ. FT. LIVING
ARCH.,ECI SDECLARATION
I understand my plana Nail he used as public Ards
tea Licensed Profc clonal
OWNER-exempt fr DECLARATION
$ 1 hereby ra .('Rem on I sue sumps from the Canlrac Co Licence Lew for the
OO following.coon.permit
?113 car Business and PmfeWuns Code:Any city or county
$ which myuim•pmmil to racial.
, cher,improm,demolish,lir mash any ttrement
-iy poor Wits issuance.
ensedpalvo mantin rra theapplieanl far mehpaArnit ctar's Rm a,Lawned summem
■F � NatoisliConsedpumeantWtheprovialonsofNeContrmWriLicenselaw(Chapter 9 Sq.Ft.Floor Area Va1Q$86160
Y�$ (Commending with Scedon 70M)of Division 3 or the Busi••..and Professions Coe)ar
�.. slid he ts exctnpt therefrom and the basis fee the alleged exemption.Any violation of
Section 7031.5 by any Applicant fora pewit subjects the Applicant W a civil penalty of APN Number Occupancy Type
not mare than rem hundred da1Hn 35oo). . 36940002 . 00
❑1,ass owner of the property,or my employees wide wages u Neo We Compensation,
will do the work and domucture is at intended ar offered for W.(Sec.7044,Business Required Inspections
and Pmfessiam m
Code:The ConcW = W want Liam Law dnot Apply an r of q P
property who builds or i mprovu theraon,and who does such wart himself or through his
own employ=,provided that such improvements are notimended Or offered for We.it.
however,the Wilding ar,hnpmvemenl is said within one year Mcompletion,the ownu-
builder ,will hne Mu burden of proving Mut he 414 ml build ar Improve far Pulp.of
axle.).
❑1.o awner of the property,am exclusively contracting with licensed mm rum.to
construct Urt pmkct(Sec.7044.Business and Professions Code:)M Contractors Li-
cense law d=not apply W an owner of property who Wilda or Impmns Neman,and
who contracts for such projects with a contowwr(s)licensed pursuant W the Contranaes
License law.
❑I am exempt under See. B k P C for this reason
e Date
WORKERS COMPENSATION DECLARATION
I hereby affirm under penally of penury am of the following declvatiom:
❑I Mw and will maintain•Coni am of Cansent W self-in ium far WarkersCompen-
sation,as pmvidcd for by Sadon 3700 of the Labor Cade,for the performance of the
work for which this permit Is issued.
❑1 have and will maintain Worker's Compensuion Insurance,as required by Sccdon
3700 of the Labor Code,far the peefarmance of the work for which this permit is issued.
My Worker's Compensation beau came carrier and Policy number son:
CERTIFICATE OF 10N FROM WORKERS
COMPENSATIONINSURANCE
(Thu soden need rot uncompleted If the permit is foram hundeeddollan($1011)
or las.)
1 eenify Nat In the performance of the work for which this permit is issued.I shall not
employ any pmean in my manner a W became subject M the Worlass Compnnadon
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
became subject W the Workers Compensation provisions of Mee Iabar Code you mon
Oforthwith comply with such provisions or this perm,mall mall he deemed nnvlwd.
r CONSMUCIION LENDING AGENCY
F+ I hereby affirm Met there iso contraction lending agency for the perfmmmee of
C(i the wodt fur which this permit is issued(Sec.3097.Civ.C.)
QLenders Name
r7 z Lender's Address
V Q 1 cmtify that I have read this application and sum that Ne move information it
(~' canon.l agree to comply with all city and county ordinances and sum laws relating W
C V Wilding Construction,and hereby suhoriarepmsenlaimofthis City WCAW upon Me
above-mantioned property for inspection purposes.
g� (We)agree in save,indemnify and keep hamleas the City of Cupertino against
s,y I,) liabllltia,judgmesu nu.coand expenses which may in my way mc.m against said City
in V
APPLICANT eof the UNDERSTANDS Aia permit.
COMPLY WITH ALL NON-POINT Issued by: Date
SOURCEREGUL IONS.
? oS Re-roofs
Signa of AppianVContrmWr On
HAZARDOUS hCATERIALS DISCLOSURE Type of Roof
Will Me applicant or future Wilding mxupant am m haerdlc hvudeas maWrW
as defined by the CupmJno Municipai Code.Chapter 9.12,and the Health and Safety
ode,Smtian25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Ya
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 haaardnas Coir cantsminants de0ned by me Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes u
1 lam read the hmnl=maverialsmiuim umv,underoapW6.95 ofthe GIifor.
nia Health At SafetyCode,Swam 25505.25533 kAd 25534.1 undersmM thstirden building
data diol curtemly"agcm
thaty rapo.o nitY W mtifY Mte omupant of Mee
requirements whicance ora Certifwam afoc pancy. S ignature of Applicant Date
/ 19&r- All roof coverings to be Class"B"or better
Owners uthariza�