05030251 CITY OF CUPERTINO
7777� ""r 71F. ......
BUILDING DIVISION PERMIT
BUILDING ADDRESS: W E O'NEIL CONSTRUCTION P""""o-05030251
.12.0500 TOWN CENTER LN ft 271
R'S NAME: PERMIT ISSUE DATE
SIVLERSTONE DEVELOPMENT 5245 PACIFIC CON OURSE DRIVE 08/29/2005
PHONE: SANITARY NO. CONTROL NO.
(510) 385-0121
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
a CC LICENSED CONTRACTORS DECLARATION
I hereby anon thal I am licensed under previsions at Chapter 9(commencing Job Description
with Section 70M)of Division 3 of the Business read Professions Code.and my license is
in full form anitaffect. NEW CONDOMINIUM
3H LDamm.CA17 LIc.#Comraews tt 743 SQ. FT. LIVING SPACE
,
ARCHITECTS DECLARATION
I unchannand my plans&hall W and as public records BMR UNIT, NO CONSTRUCTION TAX
lu
Licensed Prainficusimnal
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt foon the Conarricus's License Law for the
OOfollowing mason.(Section 703 1.5,Business and Professions Code:Any city or county
1which requires a permit to cnnsmxc4 altar.impunve,demolish,ar repair any senoctum
va prior to its bmxoC,xI,o potpuboadhe applicant r..u,l parball be file a,i,md statement
9 Sq.Ft. Floor Area Valuation
that he is licensed panniers to the provisions of the Contraclor's License Law(Chapter
(commencing with Section 7000)of Division 3 of the Business and Professions Cour)or $86009
that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Sec ton 7031.5 by any applicant for a permit subjects the applicant to a Civil penalty of APN Number Occupancy Type
not more dam Ran hundred dollars($500)
01'asowner.fthe iumpenty,orm ym � rA
pl �ithauftm
i,.I.C.Mp� do", - -- - ---- --
will do the work.and ft sumclumnot intended aroffered forsale(Sec.7044,Bumnes, VV
.it Preffesshms Code;The Conarammes License Law does net apply in in owner or Required Inspections
pmpny who builds orimpacraves domenno,and whodoessuchmarklumselforLbrosigh his
asso employees,provided that such improvements arm not Intended oroffered forsale.If.
however,the building or improvement Is mid within one year of completion.The owner.
builder will have the Woken or Proving tat he did not build lir Improve for purpose of
"]a.).
0 1,as owner of the property,am sucheively completing with Reamed contractors in
construct the panject(kc.7044,Business and Profession,Cade)The Conamor's Li-
cense Law does not apply in an owner of properly who Wilds or improviser career,and,
who contents for such prijects with a consooko(s)Retread pubstual in the Continuum's
Lace.Law.
0 1 am exempt under Sec. ..B&P C far this reason
RL, Data—
IW WORKERS COMPENSATION DECLARATION
I thereby affrin under penalty of perjury one of the following declaration
0
sation,as provided for by Section 3700 of use Labor Code,fix the performance of the
work for which this permit is issued.
r-1 I ban and will maintain Workers Compensation two==,as required by Section
3700 of the Labor CmIC,for the peffornarm of the work for which this point,is issued.
My Warloer',Compensation Insuromm carrier and Policy number are:
Canier:Zl/kQY-An&7illf-4,✓ Policy No.:U/7,1 r 7 7/6 1-0 —
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This=am need permit Is for onchuncired dollars(SIM)
or law)
I eerily that In The performance at the work for which this Permit is issued,I shall not
employ any person in any amene,an ax W become subject in the Workers'Compensation
Laws ofCalifumax Data
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
Income subject to the Worker's Compensation previsions of the Labor Cade.you must
z ramAwith comply with such provisions or this pannit shalt he dumped ranked.
z 0
CONSTRUCTION LENDING AGENCY
Thereby eM.that ft.is aconstroctim,binding agency far the performance of
> the work for which this permit Is issued(Soc.3097,Civ,C.)
Leader's Name
z Leader's Add.
U 0 1 modify that I have Mad this application And Sille deal the soon Information 1,
ECorrect.I agree to comply with all city and county ordinances and sure laws pietist;to
building construction.and thereby amborica rapacumadim of this city to enter upon the
above-mentioned poilanny for IMPCCUM PWPML
(We)agree to save,imIcniffy and keep harmless the City of Cupertino.9410t
liabilities,judgments,cams and expenses which may in any way accensix against said City
in consequence of the tiounfing;of this permit.
APPLICANT UNDERSTANDS AND W - COMPLY WITH ALL NON-POINT Issued by: Date
SOURCEREGULATI &
Re-roofs
Signmurp"pplicamXcina"Clor amType of Roof
HAZARDOUS MA AIS DISCLOSURE
Will the applicant or rut=building occupant store orhandle hazardous;material
fired by the Cupertino Municipal Code,Chapter 9.12,and the Health ad Safety
Smim.25532(a)? All roofs shall be inspected prior to any roofing material being installed.
Oyu Lai
Will the applicant or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air contsmina2ts;a/dacd by the Say Area Air Quality Management all new materials for inspection.
t
Distinct?
[I Yes
1 have mail the hazardous materials requirements under Chapter 6.95 or live Culver.
ria Health Is Safety Cade,Seen..2554 25533 sed 35534.1 understood U iftee Wilding
does not currently have a temant,Ong(is my responsibility in wooly ft occupant of the
mile,. v In W I f cmfi��_ Signature of Applicant Date
All roof coverings to be Class"B"or better
Lo.refIrmlivulacclaval