08060083 BUILDING DIVISION PERMITCAIVTRACT�R INORMATOrF
BUIL/31L1 ,OIIR TPERMIT NO.
A1OWN CENTER LN W E O'NEIL CONSTRUCTION 08060083
lR'S NAME: PERMIT EWE DATE
S�ILVERSTONE COMMUNITIES 909 N SEPULVEDA BLVD 06/20/2008
PHONE: SANITARY NO. CONTROL NO.
(310) 643-7900
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG EIECT PLUMB MECH
O O D O
X00 LICENSED CONfRACOR'S DECLARATION Job Description
inF I hereby"m Nn I am licensed under provisions of Chapter 9(mmmcnciny P
Ui`uf with Semon7")ofDiA.m.3ofdmBusinnvand Pmfctiomcode.and mylicense u REWORK 2HR CHASE WALL FOR KITCHEN EXHAUST-NW CRNR
=N in full fora and olives. 4814 o3!
,jjZ License Clan n i_� —Lk.M 1 r OF BLDG FROM 3RD FLR LINE TO ROOF LINE, NO RE-RF
Dam Contracts,Conr / = )tlee-
ARCHITECTS DECLARATION OR STRUCTRL
WI undersand my plans shall W used as public records
lu�L
g 0 Licensed Professional
OWNER-BUILDER DECLARATION
.i�z 1 hereby a?uro that 1 am ucmpt from the Contractors License Law for use
p O following mason.(Section 7rn 1.5,Business and Professions Code:Any city or county
m E which requires a permit on cmounm,alcor,improve,dm ullah.or repair any um Bare
=< prior to its issuance.also requires the applicant for such Permit to file a signed suement
that W is licensed pursuant to the provisions of the Conu.mu's Umorm Law(Chapter 9 Sq.Ft.Floor Area Valuation
2 (commencing with Section 7000)of Division 3 of We Business and Profession.Code)or $3000
Nat he Is ssempt dusefrm.and Nthe e basis for alleged assumption.My viWation of
Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty ofumber Occas ane Type
nutmore than Five hundred dollars(M). .36955999 .'�LVK P Y YP
[,no nuordepmperty,mmyemploycawitswagesudmirmlec.mpensadon,
will do tseworL and the suumure b notimm�d Fir oRemd forsale(Sec.7W.Busi,mcs
and Prodamns Cod,The Cl macer,,License Law does not apply to a maner of Required Inspections
property who build,mimprowa tsuan,andwhodoasuN work himself.,through his
own employees•provided that such improvements are notimumdcd oronered for We If.
however.the Wilding or improvement Y sold withinmm year of completion,the...
Wilder will have dm Wrdcn of proving that he did not build or improve for purpose of
sale.).
❑1.a owner of Out properly,am a elusively contracting with licensed contractors;to
construct the project(See.7W.Business and Professions Cale:)The Comu.emrs U. .
cense law dors Out apply was Owner.(property,who Wilds or improves Norton.and.
who contracts for such projects wits a consracsm(s)licensed puauant a the Conuactoh
License law.'
am ucmpt undo See ,B 6:P C for Nu reason
Dam
WORKER'S COMPENSATION DECLARATION
1 hereby arm under perWty of perjury mm of she fallowing declarations:
❑I beer and aNl malnWn a Certifi®mor Conacnt m self-insure forWaM1crseompen-
cellon,a pmvidcd for by Section 3700 of dm labor Code.for the performance of the
work for which this permit is banned.
❑1 have and will malmam Workers Compensation Incur .as required by Section
3700 of the tater Code,For the performance of Ne works for which this permit is issued.
My Wmiters Compensation I surarmde man�i��essrvvand Policy number art:
C.orm..ZULICA AthMOhliryN..: lonst;s03ag
CERTIFICATE OF HEMP ION FROM WORKERS
COMPENSATION INSURANCE
mus scetiw need Out W completed if 1W permit is foronc hundred dollars(5181)
or less.)
1 moi(v tsm in the performance Of the work for which this Permit is issued,I,hall not
employ any person in any mammrso as ut Wcomo subject to tWwmkm Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:IL after making this Ceniftcsm of Exemption,you should
become Subject mdse Workers Compensation pmvisioru of the labor Code,you most
.J O Forthwith with comply wird such provi4nm this permit 0.11 x decreed mvokcd.
z'r7 CONSTRUCTION LENDING AGENCY
r
(~ I hereby ch thi err dmm'ua ed(Sec.
lcmdimg agency For tsc performarae of
fY dm work for which this permit u issued(Sec.JOffI,Civ.C.)
� -
D 0 landerm
.Nae
z Lenders Adtlmss
U C) I mtify Nat I have read this application and sum that the,shove information is
V, ^F Comm I agree to comply with all city and county ordinumxs and sum laws relating to
0U Wilding construction,asW hereby atsorim rtprtxnutiws of Nis city to color upon use
F [Z7 move-mentioned Properly for inspection purposes.
4 (We)agree to aw,indemnify ad Veep harmless the City of Cupertino against
vn h liebilides.jWgmonu,cost.and expenses which may in any way accrue against and City
U 2 cPLICAN m of the granting of A t
permi
^v APPLICANT UNDERSTANDS AND WILL OMPIY WITH ALL NON-POINT Issued b 6
OUR EGU ONS.=yL_ f Y: Date �-
Signa of ApphanUC.nuacm, Dam Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will tsv applicat or future Wilding occupantsmm or handle huud0us material
40
0rmd by dm Cupertino Municipal Code.Chapter 9.13,and dm Heald,ad Safety
.semi.n 25532(a)7 Ely. 'ks.r+
All roofs shall be inspected prior to any roofing material being installed.
, .
Will the mPlicaut or future Wilding dominnt use equipment m devise which If a roof is installed without first obtaining an inspection,I agree to remove
end,leuvdna air camminants as defaced by use Bay Area Air Quality M...gcmcnl all new materials for inspection.
DuitrieC
❑Yca fir.
I have mad the srdoua mamrisls mwimments under Chapter 6.9sofNcCaefor-
meReal"safsty cork.Seedom 25505,25533 and 25536.1 undcnund that if the Wilding
doss not momently have a auras dual it i,my respontihility to noufy the uccupat of the
napor neswhichm/stWmetPop,mi.ma¢ f.ceNficamofCecupaq. Signature of Applicant Date
owns,0 am.ri rdagent D m All roof coverings to be Class'%¢"or better