06120166 CITE' CIA:IJPERTINO
BUILDING DIVISION PERMIT �1 'R�CT�'!
PERMIT NO.
BUILDING ADDRESS:
PERMIT ISSUE DATE
OWNER'S NAME:
SILVERSTONE 5245 PACIFIC CONCOURSE 01/19/2007
ONE: >,0 T`r TU SANITARY NO. CONTROL NO.
(510) 3E5-0121
BUILDING PERMIT INFO
ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH
J0G LICENSED CONTRACTOR'S DECLARATION Job Description
t V P 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing
ez� with Section7000)ofDivision3oftheBusinessandProfessi�nsCode,andmylicenseis REVISICN• DUCT SHAFT FRAMING STRUCTURAL DETAIL
y in full force and effect. y�' (�0 3
Z License Cl Lie.g S PAC E
M Date / dam-Contractor W /�`�'
ARCHITECTS DECLARATION ORIGINF.L PERMIT: 05070074
a< 1 understand my plans shall be used as public records
�aU
tt.F Licensed Professional
a OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the
pO following reason.(Section 7031.5,Business and Professions Code:Any city or county
e which requires a permit to construct,alter,improve,demolish,or repair any structure
Z y prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation
a that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area $2000081
x[_ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
y that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 6 9 4 0 0 C 2 Number Occupancy Type
not more than five hundred dollars($500).
❑1,as owner of the property,or my employees with wages as their sole compensation,
will do the work and the structure is not intended oroffered for sale(Sec.7044,Business Required Inspections
and Professions Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.if,
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
V
wner of Ute property,am exclusively contracting with licensed contractors to
Ute project(Sec.7044,Business and Professions Code:)The Contractors Li-
cense Law does not apply town owner of property who builds or improves thereon,and
who contracts for such projects with a contractors)licensed pursuant to the Contractor's
License Law.
❑I am exempt under Sec. B&P C,for/this on
�� Owner Date /
WORK 'S COMPENS ION DECLARATION �/ 11
I hereby affirm under penalty of perjury one of the following declarations:
❑]have and will maintain a Certificate of Consent to self-insure for Worker's Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number are:
Cartier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or less.)
I certify that in the performance of the work for which this permit is issued,i shall not
employ any person in any manner so as to become subject to the Workcrs'Compensation
Laws of Califotia. arc
Applicant 7 U S A�N 5
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you mast
Z forthwith comply with such provisions or this permit shall be deemed revoked.
Q
Z"" CONSTRUCTION LENDING AGENCY
E~-t►�-� I hereby alum that there is a construction lending agency for the performance of
(xthe work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lender's Name
= z Lender's Address
U 1 certify that 1 have read this application and state that the above information is
u, `" correct.I agree to comply with all city and county ordinances and state laws relating to
0 U building construction,and hereby authorize representatives or this city to enter upon the
U above-mentioned property for inspection purposes.
CL (We)agree to save,indemnify and keep harmless the City of Cupertino against
„Ey liabilities,judgments,costs and expenses which may in any way accrue against said City /
U Z in consequence of the granting of this it. Date
APPLICANT UNDERSTANDS AN ILL COMPLY WITH ALL NON-POINT Issued by:
SOURCE REGULATION Q
Re-roof:
Signature pplicant/Contractor ate Type Of Roof
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? ,/ All roof.,;shall be inspected prior to any roofing material being installed.
❑Yes go
• If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as dcftned by the Bay Area Air Quality Management all new materials for inspection.
District? f/
❑Yes o
1 have mad the hazardous materials re uircmcnts under Chapter 6.95 of the Califor-
nia Health&Safety Cade,Sections 25505, 3 and 25534.1 understand that if the building
does not currently have a tenant,that it i responsibility to notify the occupant of the
req:: cnts which must be met prior
an
o(a Ctnlfic mroctopaney. Signature of Applicant Date
14 07 All roof coverings to be Class"B"or better
Owner or orircd agent Datc