05030283 (2) CITY OF CUPERTINO ' .^ €-� ,
BUILDING DIVISION PERMIT CONCRACTORrtINFORMATION i
BUILDING ADDRESS: W E O'NEIL CONSTRUCTION IERMRNO'05030283
OWNER'S NAME: PERMIT ISSUE DATE
ilkSILVERSTONE DEVELOPMENT 5245 PACIF r r()NrC)TJRqP =VF 08/29/2005
E: SANITARY NO. CONTROL NO.
(510) 385-0121
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
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+5+0� LICENSED CONTRACTOR'S DECLARATION Job Description
I hereby affirm that I am licensed under provisions of Chapter 9(commencing
',� who Section 7000)of Division 3 of the Business and Profcaiens Code.and my license is
nhd', ndeRan NEW CONDOMINIUM
Z L".oue Clan Lic.Is Lf 9 y Q?
F— Dam Contrxvar wC a.✓�/L 1116 SQ. FT. LIVING AREA
ARCHITECTS DECLARATION
I understand my plans dull he used u public records
U
5 tad� Licensed professional
y i OWNER.BUILDER DECLARATION
I I herchy affirm that I am exempt from the Commodes License Law for the
Ea O following reason.(Section 7031.5,Business and Profession Cade:Any city or county
$�a which requires a permit in eommea altar,improve,demolub,or mair any structure
y.ZE prior to its issuance.also requires the applicantorsuch Permit to rile a signed statement
Wt he is licensed pursuant to tiro provision of the Cootramla
r't License Law 9 Sq. Ft. Floor Area Val$W6188
as mcnern ndnj with Section]0007 of pivNonlof the Businca and Profwalou Code)or
3— and he is eumpt dteufrom and the Wit for the alleged exemption.My violation of
Section 7011.5 by arty applicant for a permit subjects the applicant u a civil Penalty of APN Number Occupancy Type
not mare than five hundred dolhn(55006 36940002 . 00
❑1.as owner of the property,a my employees with wages as Ibeiranla compensation,
will do the work,and thestructme laser intended arofferW for We(Sec.7046,Buainms Required Inspections
and Professions Cade:The Coomcmrs License Law does not apply m e an owner of q P
property who builds or improves thenom and who doessuch work himself or though his
own employees,provided thatsuch Improvements arc not Intended woffered forsde.If.
however.the building or improvement is old within an year of Completion.the owner.
Wilde,will have the burden of proving WI he did n s build or improve fm purpose of
ark.)•
❑1,as owner of rho propeny,am uclW vely contracting with licensed centrecars to
construct not project(Sec.70U,Business and Profesdam Code:)The Convectors Lt.
came Law does not apply to an owner of property who Wilds or improves desmon.and
who contracts for such pmjecM with a conhamor(s)licensed pursuant m the ConvactorS
License law.
❑1 am exempt under Sec. .B @ P C for this recon
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 hereby anion under pmulty of perjury man offt following declaration:
Thaw and will malnuln•CeNOeateofConsentmal6WumfnsW�rkersCampcn-
satlon,u provided for by Section 7700 of Ne Inter Cade,for the perfe mrance of the
work for which this permit is Issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
17W of the Labor Code,for the performance of to work for which this permit is laved.
My Workers Compensation Insurance Cartier and Policy number art:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(ibis section need tut W completed if the permit is Were humped dollan(S10()
or lass)
1 ceNfy that in the performance of the work for which this permit is issued,I shall not
employ any person in any mannerso as in becomesubjecl to the Workcn Compensadon
Laws of California.Dam
Applicun
NOTICE TO APPLICANT.If,after making this CeniOnte of Eumption.you should
become subject in the Workers Compensation provisions of the labor Code,you muss
.,0 forthwith Comply with such Provisions or Nis permil shalm
l be deemed reroked.
'�.r .~�.
CONSTRUCTION LENDING AGENCY
(•+ I hereby Mm that there is a construction lending agency for the Performance of
p;> the work fur which this permit Is issued(See.3097,Civ.C.)
aQ Landers Name
D
zLanders Address
U0 I certify that 1 rove read this application and tote that the show information 4
0.E coma I epee in empty with all city and county ordinances and rote laws r alng m '
C Wilding Contruction.and hereby authorise octmemtNves of this city to enter upon the
f17 shove-mcndawd pnPeny for InSICCoOn Purpama
(We)agree to save.Indemnify and keep harmless;the City of Cupertino agdml
v„r cn liabilities,judgments,costs and expenses which may in any way accrue against said City
In U
APPLICANTUNof me granting of DERSTANDSANTAILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULA NS,
�� Re-roofs
�naum ppheanvconvamor Of Roof
HAZARDOUS M IAIS DISCLOSURE ype
Will IW LRdiant m future Wilding occupantaom or handle hanaNaw material
as dcMed by the Cupertino Municipal aOe.Chapter 9.12,and the Health and Safety
Code,Section 05532(a)7 All roofs shall be inspected•prior to any roofing material being installed.
❑Yea 40
Will the applicant or future Wilding Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit haameus air contaminants as do mcd by the Bey Area Air Quality Management all new materials for inspection.
District?
❑Yus u
I have mW the haardws muse als requirements under Chmcar6.95 of the Caller.
nla HWthBsaretycolle.Savoru75505.13533 314.iuedemudthuifthe Wilding
dew not currently have a tenane Nn it' y ihilhy to notify the occupant of the
mremcnts which mu vent pear eaquifseerfirte.tear Oce cy. Signature of Applicant Date
ownse .athorixed.ant pa All roof coverings to be Class"B"or better