05030313 (2) CITY OF CUPERTINO 77. c 1'
BUILDING DIVISION PERMIT *CONTRACTgRRINFgRMATION '
_Ra r.-. �n'. §
BUILDING ADDRESS: W E O'NEIL CONSTRUCTION PERMIT'00503 03 13
OWNER'S NAME: PERMIT ISSUE DATE
SILVERSTONE DEVELOPMENT 5245 PACIFI 08/29/2005
E: SANITARY NO. CONTROL NO.
(510) 385-0121
ABCHITECTMNGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
O p LICENSED CONTRACTOR'S DECLARATION
YI 1 hemby afOm that I are Imemd under provisions of Chapter 9(commencing Job Description
U with Section 7")of Division 3 of de Business sod Professions Code.and my license is
meoll force and effect. �/ I NEW CONDOMINIUM
Lkevo CI Lk.{
Comnetm67FnNC7F 1124 SQ. FT. LIVING AREA
�e ARCHITECT'SDECLARATION
y I understand my plans Mail be used u public records
3
`va Lk:evcd Professional
OWNER-BUILDER DECLARATION
1 hereby,(item mat 11. exempt from the Gonmmarl e:Any
4w for the
0 0 fallowing rtahan,Permit
i 7th 1.5,Business and .,churl li Code:Any airy m ome my
K$� which myulms•permit b ennsUud.alar,improve,demollah,or mpsir any urocwm
£=£�0prior a its issuance,also rtquiros the applicant for such permit to rite ulgned statement
Nat he is licensed pursuantin me provisions of the Contractors Liccne law(Chapter9 Sq.Ft. Floor Area Va altimp 114
C�$ (commencing with Section 7000)of Division 3 of the Btedrom rad Professions Cock)or
that he Is eu ni t therefrom and the basis for the alleged exemption.Any vlaladon of
Section 7031.5 by any applicant for a permit ubjects the applinnuo s clvll penally of APN Number Occupancy Type
not mom man Ove hundred dollen(5500). 36940002 . 00
❑I,ummrafinepmpwy.mmyempioymwimmguutheirmleeampenndon,
andProfessions,
rhecumunmeterldedoroa hofs Out apply 70M, wniror Required Inspections
and Pro.Ito w Cade:The Ces domaar. nd.l a law does IIRI apply to Maudlin,d owner is q P
properlywho it,provided
edInnthat sudemon,andwho aaasouebworkoaffedthrough bf
own employes•proVlori den such impmvemuta tee not year
of c m completion,
for We.lf.
bowdr the building ardeprovemetstmid withinoro year of mmpletian,the awned
builder will here Urc burden of proving that he did not bWild or Improve for purpose of
talc.),
❑1,u aw ar of Ile properly,son exclusively contracting wide licensed contncton to
construct the project(Sec.7014,Business and Pmfusio s Cade:)The Convectors U.
cave law docs not apply a an owner of propeny who builds or improm themem.and
who convects for such projects with a conuactorts)licerued pursuant in me Contractors
License taw.
❑I am exempt under Sec ,B&PC for this moon
FI
Data
WORKERS COMPENSATION DECLARATION
I hereby alflrm under Kindly of perjury one of the following dectatalions:
1 hs"and will maintain aCerofieate of Covent to half-insure for Workers Compcm
urian,u provided for by Section 3700 of me tabor Cade.fm the performance of the
work for which this permit is issued.
❑I have and will maintain Workers Compensation Irumuee.u mquired by Section
3700 often labor Cade.for de imformsree of the work forwhich this permit is issued.
My Worker,Campewtian Inhannce Mori.and Policy number are:
carner:'�iu/,4ff FlhCtll t.4✓Posey No.:w4=)-f 0
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need Out he completed time permit Is formic hundred dollars(5100)
or less)
I certify met In me ptolon uce of the work for which this permit Is imued.l shall not
employ any person In any monnerm as be become subject to the Workers'Compenullon
Laws of California.Dale
Applicant
NOTICE TO APPLICANT:IL after making this Cer iOute of Exemption,you mould
become subject in me Worke's Compensation provisions of the Labor Code,you most
Oforthwith Comply with such provisions or this permit shall W doomed rtvnked,
z ti CONSTRUCTION LENDING AGENCY
[.n 1hereby,Rum met More ies comruction lendingageney for the pefomerxe of
y' � me work mil is which this peissued(se.3097,Civ.C.)
Q Landers Name
=z Lenders Add.
f,6 T cenlfy that l have rad this application and sure that the above information Is
correct.I agree in comply with all city and county ordinances and sou law.relating to
0 building construction,and hereby authorise mpmunutim of this city a enter upon me
LkI above-mentioned property for inspection purposes
(We)agree in ave,indemnify and keep hamtless the City of Cupertino against
Laj liabilities,judgments.costa and expenses which may in any way accrue against said City
tJ'Z in consequence of the grating of oris permit.
t'+ APPLICANT UNDERSTANDS AN COMPLY WITH ALL NONP It Issued by: Date
SOURCE ECULATJOINS.
/.1 , e Re-roofs
Sigaatumaf IicanUConmctor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will tie applicant or fu en,building Occupant noteor handle hauNaus material
as derined by me Cupertino Municipal Cade,Chapter 9.11.and the Hulth and Safety
code,sedan ss53zfa>7 / All roofs shall be inspected prior to any roofing material being installed.
40 0Yu [�Ioo
can the appbeent or future wading Occupant me equipment m devices which If a roof IS Installed without first obtaining an inspection,I agree to remove
cmil haeummus air conamivm n defined by the Bey Area Air Duality Management all new materials for inspection.
DinriclT
❑Yca
I have mad the huardau materials requirements under Chapter 6.95 of the Cables.
iia Health H SafetyCede,Section 25505.25533 125534.l underse n thmlfthe lmidinit
rime no how,be ml.that it porn ccryunotify Icap&eCyf lo(the
royuim cntawhlchmutbcmelpno anccoftCcrtidnuof°�'upanry Signature of Applicant Date
/fir All roof coverings to be Class"B"or better
owner ulhoriud agent Dau