05060211 CITY OF CUPERTINO +`p.*aae+*s$, n
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:T�::
`..%6.fWlP#. t}e 3�•^�".- G+,
BUILDING ADDRESS: W E O'NEIL CONSTRUCTION PER"HIN='05060211
10287 PARK ( RP.P.M I'M
OWNER'S NAME: PERMIT ISSUE DAM
SILVERSTONE DEVELOPMENT 5245 PACIFI 5
E: SANITARY NO. CONTROL NO.
(510) 385-0121
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG O PLUMB
MSCH
O
j86 LICENSED CONTRACTORS DECLARATION lob Description
4 I hereby affirm dust I am Ree sed under provisions of Chapter 9(commencing
with Sccuon 7M)of Division 3 ofthe Business and profeWons Code.and my litmus is
infullfomeandefrceL2 STORY TOWNHOME 1441 '
icense
g i LCl L'ie# Y qN o71
aDem *S DECLARATION 4i r d"NE/l
ARCHITEC7TS LAR ION
0
I undersand my plans shall be useJ Is,public records
C
Licensed Professional
OWNER-BUILDER DECLARATION
I hemby affirm that 1 1. exempt from the COnmam's License Law o for the
o O following mann,Permit
t 8131.5,Business and rte. a rmil Cole:My city or county
which requires+permit m cnnemcL alms imPmw,ticmnlUh,or repair any auucwm $166810
_Z'a Prim m its issuance,also rental.the applicant far such permit m file a signed Immanent
:4< that he is licensed Portugal to de provisions of to Camuactur's License Law(Chapter 9 Sq.Ft. Floor Area Valuation
YFct (commencing with Section 7M)of Division 3 of the Business and Profession Code)or
$ Nat he Is exempt therefrom and Ila buts for the alleged csempme,My violation of
Sec
tion
7them 1.Ow any applicant
pplica t f(SSWAnb subjects the applicant m civil civill penalty of r Occupancy Type
net
❑I,uowneroflife Vopwy,mmyemploycmwithw+guutheirtolecompr dan,
will do the woBC and destruction ts aatinanledaro@real forsale(Sec.7044.Bunneu Required Inspections
and Profmsions Code:The Contracmefa License law does not apply m an owner of q P
part whobuiIdaorimprove,Barran,andwhodoessuch woekle mselforthrough his
Own employes,providnd that such improvements use not Intended araReand for um.if.
however,the building or improvement is mid within one you of compledon.the owner'
builder will have the burden of proving that be did not build or Improve for purpose of
ale.).
0 1,as Owner of Use property.oro uclusimly contracting with Iiceuod contracma to
construct the pmjem(Sec.7014.Business and Professions Cade)The Conum m's Li.
a.Law does at apply no an owner of property who build,or Impmva thereon.rod,
who contracts for such projects with a carmactor(s)licensed pursuant m de Contractors
License law,
❑1 am mcmpi under Sec. .B h P C In,this recon
mer Due
WORKERS COMPENSATION DECLARATION
I hereby option under penally of perjury am of the following declarations
❑1 haw and will maintain sCertiftma of Consent to self•luum for Workers COmpen.
terms,as provided for by Section 3700 of the labor Code.fm On performance of me
work for which this permit is intend.
❑I have and will maintain Worker's Compensation Laurance,u required by Section
3700 o(de labor Code,foe the performance of the work foe which this permit i,issued,
My WorkeM1 Compensation su
ation Inrance crm
ier and Policy number :
cortico.7A41 z,9 -A..M1(-4"Policy No.: 4v C'35 33/0-0
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(71essection hand rot be camp lead if the permit Is fm one hundred dollar($100)
or mum)
1 certify that In the performance of me work for which this permit is issued.I shall am
employ any person in my manna.as to become subject to the Workers'Compensation
lawa of California.Dam
Applimm
NOTICE TO APPLICANT.If,after making this Cen lhuft of Exemption,you should
become subject M the Worker's Compensation provisions Of the labs Code,you must
.JO foMwith comply with such provisions or this permit shall bke deemed revoed.
tiIn CONSTRUCTION LENDING AGENCY
(–, I bunchy arthro mat Vert is a construction lending agency for On Performance of
C tW work fur which this permit 4 issued(Sec.3097.Civ.C.)
WM Le ekes Nuns
2 lander.Addross
fJ O 1 certify that 1 have read this application W mm that the,bow information b
conom l agree ro comply with all city and county ordin+haes and ma law,relNng m
Q building commission.and hereby authorise mpmxmatims of this city in enter upon me
[77 ¢hove-mentioned property far inspection purposes.
gyre
(We) to ave,indemnify and keep humku to City of Cupertino against
y IlabilitieLjudgmeds.Corn and expenses which may In my my ac cme against Wd City
V inconsuencoofOospe it.
APPLICANT UNDERSTANDS AIN WILL COMPLY WITH ALL NON-POINT Issued by:9 Date
SOURCE REGULATIONS
i X29. D ta Re-roofs
Bignat of Apptic+H +m
HAZARDOUS S MATERIALS DISCLOSURE Type of Roof
Will ieentser( uni Wading Occupantmom or herdic hazardous manorial
an dented Cup
de
d by�CupeNm Municipal Code,Chapter 9.13.and tie Health and Safety
ode.Section 25532(.)7 All roofs shall be inspected prior to any roofing material being installed.
Cl Y. EW
WIII tM+pplicant or future Wilding aecup+nt use equipment m devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit haxammus air comuminanu Is defined by the Bay Area Air Quality Monogamous all new materials for inspection.
Dimicl7 1
C Yes C7 vu
1 have reed the mand.ua materials requirements under Chapter 6.95 of the Califor.
ole Health&Safely Code,Sections 15305,25533 and 35534.1 unJcaand the if the building
docs am amorally have a Moore,that 4 is my respoulhility to nadfY the Occupant of mO
require nLa Iichmuubemmp' WumccofaCCNlkamofOc` "`� Signature of Applicant Date
�(u�/[.n•an.� 8/'�7� . All roof coverings to be Class"B"or better
Owner Or adipmrized+gm, Dam