07010100 777777777777777
CITY OF CUPERTINO
BUILDING DIVISION PERMITZMTION:
BUIL IN DRE PERMIT NO.
GJAVZA BLVD R2 W E O'NEIL CONSTRUCTION 07010100
OWNER'S NAME: PERMIT ISSUE DATE
SILVERSTONE 5245 PA-_IFIL CONCOURSE 02/07/2007
ONE: r1r)TN rU SANITARY NO. CONTROL NO.
(510) 385-0121
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
L (� 0
i O p LICENSED CONTRACTOR'S DECLARATION
U P 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description
.zEn withSection 7000)ofDivision3ofthe Businessand Professions Code,and mylicense is REVISION RETROFIT FOR A STAIR STRINGER AT STAIR
? a, in full force and effect.
h v�z Liknsw01ass Lic.! #2
y Date ARCHITECTS ConDE LARATION ORI G INA L PERMIT: 06110011
7 C< 1 understand my plans shall be used as public records
�yU
tL in Licensed Professional
yOWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from tine Contractor's License Law for the
C O following reason.(Section 7031.5,Business and Professions Code:Any city or county
<$ which requires a permit to construct,alter,improve,demolish,or repair any structure
Z} prior u)its issuance,also requires the applicant Cor such permit to file a signed statement
=C that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Valuation
r (commencing with Section 7000)of Division 3 of the Business and Professions Cade)or $3035479
L 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 Number Occupancy Type
not more than five hundred dollars(5500). 369400022 . W
❑I,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections
and Professions Code:The Contractor's License Law does not apply to an owner of q
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
sale.las owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li-
cense Law does not apply to an owner of property who builds or improves thereon,and
who contracts for such projects with ontractor(s)licensed pursuant to the Contractor's
License Law.
❑1 am exe pt under Sec. B&P C for this ffas
Owner Date
O KER'S COMPENgATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
❑I have and will maintain a Certificate of Conscnt 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.
❑I 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 ate:
Cartier: Polley 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.)
1 certify that in the performance of the work for which this permit is issued,1 shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of California.Date
Applicant
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 must
,J 0 forthwith comply with such provisions or this permit shall be deemed revoked.
z" CONSTRUCTION LENDING AGENCY
PV) I hereby affirm that there is a construction lending agency for the performance of
1Y4> the work for which this permit is issued(Sec.3097,Civ.C.)
0 Lender's Name
2 Lender's Address
V C) 1 certify that I have read this application and stale that the above information is
LL h r correct.I agree to comply with all city and county ordinances and stale laws relating to
Ubuilding construction,and hereby authorise representatives of this city to enter upon the
W above-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harm ess the City of Cupertino against
►F-t C/1 liabilities,judgments,costs and expenses which may. anyway accrue against said City
U,'z in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WIL MPLY WITH ALL NON-POINT Issued by: Date
SOUR EGULATfoNS.
G 7 Re-roofs
Signature of A canticontractor 10, D
HAZARDOUS MATERIALS DISCLOSURE Type of R sof
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Munici f Code.Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? All roofs::hall be inspected prior to any roofing material being installed.
C]Yes o
Will the applicant or future building occupant use equipment or devices which If a roof i:;installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants u ncd by the Bay Arca Air Quality Management all new m iterials for inspection.
District?
❑Yes u
1 have read the hazardous materials quircmens under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505 533 and 25534.1 understand that if the building
does not currently have a tenant,that i m responsibility to notify the occupant of the
requirements which m be met of a Ccnife of oc panty Signature 3f Applicant Date
2 d All roof coverings to be Class "B"or better
Owner or a6florized agent Date