05030282 (2) CITY OF CUPERTINO +v'1'k6.P� wa �»s✓x.ayGz xbe �i"'�"` .;r-:: -
BUILDING DIVISION PERMIT CONIR"1CTOR INF012MATIOIV '`
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BUILDING ADDRESS: W E O'NEIL CONSTRUCTION PERMIT NO.05030282
OWNER'S NAME: PERMIT ISSUE DATE
E; SANITARY NO. CONTROL NO.
(510) 38S-0121
ARCHITECfIENGINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
Q l�
�oo LICENSED CONTRACTOR'S DECLARATION Job Description
r� I barely affirm Nei l am licensed under provisions of Chapter 9(commencing p
wuh Seatiw700B.f DIA* 3 ofde Business an Protrusion,Codomat my licenses
in full forte anti
. Lic.B cli e3 f NEW CONDOMINIUM
1HE License ClanDab Contractor 1116 SQ. FT. LIVING AREA
ARCHITECTS DECLARATION
I unemmand my plans shed be used as public records
�a Licensed Professional
OWNER-BUILT ER DECLARATION
1 berehy M.that 1 am exempt from be Canueclofs License Law for Me
0 o following round.(Section 7071.5,Business and Pmfessium Cade:Any city or county
$ which requires a permit W construct,alter.improve,demalbh,ar repair any structure
HZ�n
prior it)its issuance.also require,the applicant for such permit to rile a signed sabment
< Nat he is licensed pursuant in Me pmvisiou of Ne Contractor's Liana law(chapter 9 Sq.Ft.Floor Area Valhifl18188
$ (commencing with Sasion7000)of Divisive3ofbe Bumnusand PronasionsCade)or
.. that he In esempt them(¢¢and Ne hub for Ne alleged examples,Any violation of
Section 701.5 by any applicant fm a permit aubjwd,the applicant W a civil penalty of APN Number Occupancy Type
net tome than 6w hundred dollars($500). 36940002 . 00
❑1.u wneraf the Pmpasy,m my wplayw wia wage u ihevsale wnpensWon,
will do Newark,and aesuuctme is notimendedoraRered fmule(Sm.7044.Business Required Inspections
and Proletarians Code:The Cont acWfs License Law does,tet apply W an Qatar of q p
property who builds or Improves careen,and who doeuuch work himself err through his
own employssm,provided cut such Improvements art not Intended maRaed forsake.IL
however,ere buildin6 or imPmvement is and within ane yea of comPleuon.the weer-
builder will have the burden of proving that he did rot bulb or Improve fm purpose of
sale.).
0 1,u owner of Ne properly,am exclusively concocting with]learned contractors W
construct the project(Sec,]044,Business and Profession Code:)The Comemor's Li.
cents law darn not apply b an owner of property who builds or improves aereon,mrd,
who contracts for such projects with ecanuacuu(s)licensed pursuant on ere Contractor's
License Lew.
0 l am exempt under See .B B P C far do$mason
Owner Date
WORKERS COMPENSATION DECLARATION
10 1 Mmby&M m under penalty of perjuryone of Ne following declamlou:
0 I haw aW will mdnWn a Cersifnwm ofCoueni b wlf.iuum for Warkces Compen-
u0on,as prwlded for by section 7700 of ere labor Cade.for Ne performance of Me
waft for which this Permit Is Issued.
0 1 have and will maintain Wmkefs Compensi luuran¢,a myumal by Swum
7700 of be labor Cade,fa ere perfarmanceof ae wort(or which Mia permit b iswed.
My Workers Compensation Totems carrier add Policy number M:
Carder. / Na.:4/e 3s331e —� fKMio0NcFROM o
WORKERS'
COMPENSATION INSURANCE
Ihb section need an,ed completed if tie permit Ice faruee hundred dollar(5100)
or leas.
I unify Nat in the perf"Ance of tine work fm which this permit is issued.l shall not
employ anypereon in any manner an as m become subject to Ne Workers'CompensWon
Law,of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making Nis Certificate of Exemption,you should
become subject W the Worker's Compbaadon provision,of the lab¢Code,you must
.,7 0 ford th comply with such provide.or Nb da permit Nall be reed rewkad.
.7 CONSTRUCTION LENDING AGENCY
Thereby af0rm bat Nem is a Comanoction lending agency fur Ne perfurmance of
l� 0e work for which Nb permit Is issued(Sec.7(197,Co.C.)
W Lendce3 Name
D Z Lender.Address
U Q 1 coolly that I have mud this application and sate Nat the above Information is
IL,F contact I agree In comply with all city and County ordinances and sate law,matin{in
OI, building CansWcdon.and hereby Wdlari2 RpmaeamlMa of Nb City b enter Olson de
I✓a ah w-nnnfioned pmpeny fm WIXOM Purposes
(We)agree W saw,Indemnify and keep harmless the City of Cupcnim against
fad liabilitlu.judgments,coca and expenses which may in any way accom against said City
V in APPLICANT UNDEience,of Me RSTANDS Aof nND wk
nt.
L COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
8 2 Re-roofs
Siewurt pylic anuocturDito
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will um applicant m future building oaupantaom m haedk haradam matelot
as dented by be CupeNno Municipal Code,Chapter 9.12.and the Health and Salary
Code,Section 25532001 / All roofs shall be inspected prior to any roofing material being installed.
❑Yu
WIII be applicator luso¢building Occupant true If a roof is installed without first obtaining an inspection,I agree to remove
{ p equipment or dcvitta which
It
homewards air cmlamimme u def d by the Bay Area Air Quality Management all new materials for inspection.
District?
Yes
I have mW the ha xamlousmateoaia requirements under Chapter 6.95 of the Califon
Iia Han!"Safaty Code,Sachons 25505,25533 and 25534.1 understand tom if Me Imiiding
dean net currently haw a¢nem.tial it is My roulleembility W notify the occupant of Me
rcquimmcas which an met poor to ofa Certificate of y Signature of Applicant Date
Owner uthaor a On D tc
° All roof coverings to be Class "B"or better