05030310 (2) CITY OF CUPERTINO �xtw�a ` "-`
BUILDING DIVISION PERMIT a CON CRAJGTUIi�INik�O.Iti'IATION `,
BUILDING ADDRESS: W E O'NEIL CONSTRUCTION PP'tMr"ND'05030310
-10500 TOWN CENTER LN ft 191
R'S NAME: PERMIT ISSUE DATE
SILVERSTONE DEVELOPMENT 5245 . PACIFIC CON r)Ug,�p nR7yE 08/29/200s
PHONE: SANITARY NO. CONTROL NO.
(510) 385-0121
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
'j op LICENSED CONTRACTOR'S DECLARATION Job Description
I1 hereby affinn that I an Become under provision+of Chapter 9(commencing P
a� Section 7000)of Division 3 of do Business and Profession Code,and my license ie
imm�foraandefre NEW CONDOMINIUM
�� License CI Uk., NT 3 /
- Dek C, Contractor L. 0. vll 1124 SQ. FT. LIVING AREA
0 ARCHr7ECrS DECLARATION
I understand my plans shall M used As public mcnrde
u
Licensed Professional
OWNER-BUILDER DECLARATION
1 At.Srm that 1 1. exempt from the Contractors License Law for the
3o o which re mama.(Section co mu5. t.Business and Pron.de sem Code:My city or county
$ which requires ere.Permit lsorecont;thea@cimprove,deermitt fire a sig anyawment
thatW1u iumnM,almnqulms ponymossof for memmon'tofileu Law(ned auomcnt
G thathemci...sad pursuant ngwithSection7 )ofDiviommNtheBut mr'AndPreclaw(Cod�r9 Sq.Ft. Floor Area Val$$i�m114
$ do,he I. otmp, mmfed.And thDmah,fron 3 o(IMBueiwsmton.Mvi Cmk)oe
dot M is ewnpl thert(rom and the Mets for the alleged assumption.My violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more than five hundred dollars($500). 36940002 . 00
❑I.uawxroftliepmpmy,armyemployeeswithwgantl irmlee mpeoudon,
will do the work and the strumme is not intended reoffered fmak(Sm.7044,Busirru Required Inspections
And Pmfesmom Cade:The Contractor,Lfame law does rot appy to an owner of q P
property who builds orimp uvea themon,and whodoessuch wmkhimtelf.or through his
own employees,provided Net such improvements see not Intended moRemd forsadc if,
hawveA Ne building or Improvement is sold within can you of completion,the owner.
builder will haw the tames of proving that he did n n build Or improve for purpose of
sok.).
❑I,as Owner of the Property,am exclusively contracting with licensed cenwerors to
construct the project(Sec.7044.Business and Professions Cede:)The Contractors L(.
cause Law does not apply to an owner Of property who Wilds or improves thereon,and,
who contracts for such projects with a con onear(s)licensed pursuant to the Contractors
License law.
1 em exempt under Sec. .B&P C for this mason
at Dam
WORKER'S COMPENSATION DECLARATION
1 hertby aRrm under penalty of perjury ane of use following doclarthimV
sat1ham pro for
Section
37M of Cori um Cods,
WObeh Compere
workf r provided far by Section 3700 of the Labor Code,(m the peefasmance of the
work for which this permit is luoad. ,
❑1 ban,and wilf maintain Workers Compensation huurance,.required by Section
3700 of the labor Cade,for tie performanee of the work farwhich this Permit is issmd.
My Workers Compensation Immoom carrier and Policy number am:
Cartier.-y14ce-ff A-eA1C14C"ft1liry No,: .7
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thkseerfon read not bucmnpkell Roe permit 4fmove hermaddellaes(Stop)
or less.)
1 certify that In the performance of the work for which this permit Is issued,I shall am
employ any person in my mummer an as to become subject to the Workers Comper satian
Laws of Calif(smis Data
Applicant
NOTICE TO APPLICANT:If.after making this Cenffecao of Exemption,you should
become subject to the Workers Compensation provisions of the labor Code,you most
0 ft forthwith comply with such provisions or this permshall be deemed mokcd.
rCONSTRUCTION LENDING AGENCY
[r4
4I hereby eirom that then is a conamctitm lending agency for the performance of
rL> the work for which Nis pemtit is issued(Sex.3097,Civ.C.)
W Q Lenders Namc
Z Lenders Add.,
U Q I cenffy that I haw feed this applkadoe and team that the above information is
LU!•�. moves.I agree m comply with all city and county ardinmms and sum law miming to
O building construction,and hereby sumorim representatives of this city to enter upon the
W above-nonlored property for inspection purposes
We)agree to raw,Indemnify and keep hseem.the City of Cupertino against
C4 liabilities,judgments,cmu and expenses which may in any my cane against said City
in eonxyurntt of the gestin[of this Pe I1.
F7 APPLICANT UNDERSTANDS N WILL COMPLY WITH ALL NON-MINT Issued by: Date
SOU CE REGULATIONS.At
,Z Re-roofs
Sionsm fAp a
ro✓Ctmamemr D
HAZARDOUSMOLIUALSDISCLOSURE Type of Roof
Will the applicant w forum building occupant am or Modic harndous maoriat
dented by the Cupenito Municipal Code,Chapter 9.11•and the Health and Safety
,Section 15532(e)7 All roofs shall be inspected prior to any roofing material being installed.
Yes
Will the applicant or fumm building ocrospam use equipmem m devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit horardnm air contaminants As de0ned by the Bay Arta Air Quality Management all new materials for inspection.
District?
❑Yee ti+�
I have mad the Im a ndous materials ecquimm mss wder Chapter 6.95 of the Califon
me Hot"SahotyCede,Sections 25505.15533 and 25534.1 tuammand that if the building
does not currently haw a octant,Nat It ts y responsibility to notify the occupant of the
mquimmmas which must be met pd enter"of a Cemfmao of Occu aney. Signature of Applicant Date
"; s -, All roof coverings to be Class"B"or better
Come,owgillihonhad"gem Dom