05030256 CITY OF CUPERTINO "' 71 r '`'-'
BUILDING DIVISION PERMIT X-ONTRACTM1%,C)
OR 'tMATItON
BUILDING ADDRESS: W E O'NEIL CONSTRUCTION PERMIT"005030256
&Q500 TOWN CENTER LN * 2RI
R'S NAME: PERMIT ISSUE DAM
SIVLERSTONE DEVELOPMENT 5245 PACIFI 05
PHONE: SANITARY NO. CONTROL NO.
(510) 385-0121
ARCHI'IECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
30o
LICENSED CONTBACIOR'SDECLARATION Job Description
I d I hereby effort that i am liemed under provisions of Chapter 9(commencing
with Srctlan 701X1)of Divigon Sof the Budnea and Profegmm Code.and my license Is
M faurameameffect. NEW CONDOMINIUM
HOZ Llmose, a Lic.N�Q%�C
8' D,ld cowmrior Gwc a �Ffc 743 SQ. FT. LIVING SPACE
5
ARCHITECTS DECLARATION BMR UNIT/ NO CONSTRUCTION TAX
y I understand my plane shall he used u public recnrN
5g� Licensed Professional
OWNER-BUILDER OEMs CommON
Q a 1 hereby.affirmSec that 11. exempt from No Conlnnofs License Law for Mc
O 0 following natoa Permian 703 1.5,Bualmaa and Professional Cole:Any city m county
$ which its issuance.
•pctmb m cngcwcL altar.Improve,demolish.i of ropNg any aaucturt
prior to MatMiuiusedpoilwrquirect sinthelMappnsoftant hr such eConrermitmescrom111c a Law(Chned temcn' Valuation
< NuheuliceecJputwen 7 00)ofDigouofNeComfiness Ucegclaw(Chapter, Sq.Ft.Floor Area
$ (mmeisexewittSection
refrom 00)and
eadafion rofMeBusinusandar.AniouCude)o $86009
Nat he b exempt therefrom and Ne bash fm dx gleged esempJm.My violation of
Seton 7031.5 by any applicant fm a permit subjects Me applicant se a civil penally of APN Number Occupancy Type
trot mom Nen five hundred dollars($500).
❑L uowner of the property,mmyemploycuwiN wgeude"u role mmpensatim, 150
winao lhework.ge Neawmart hmitinWtdederoffered forwe(sec.70W,Buvftw Required Inspections
and ProleeSaION The e Committees L imnm Law dace m m and apply Owner of 9 P
property who builds or improve thereon and whodoes uehwank Mmmlfartluaugh his
own employee.provided that such improvements Am notinterlded orof(ered forme.IL
however,the building or improvement h said within om yeu of completing.the owner-
Wilder will haw Me When of proving Mat W did not build or improve far purpose of
tile.).
I]1.as owner of No pronely,am exclusively conuacting with liegsed moumerm m
convect the project(Sec.7014,Business and Pmreslou Code:)The Contracmr's U-
ensu Law docs not apply An an owner of property who Wilds or improves Merton,and,
who camases for such projects with a mmactor(s)licensed pursuant to Ne ConMgrtnes
License law.
❑1 am exempt under Sec. .e&P C for this mason
r Data
WORKER'S COMPENSATION DECLARATION
I hereby e17bm under penally of perjury Am or the following decarations:
1 ham and will maintain a CCNBcna orcomentm self-Insure far Worke'sCompen-
ntion.As provided for by section 37W of the labor Code,for Me performance of Ne
work for which this permit is issued.
❑1 haw and will maintain Worker's CampemNon Insurance.As Acquired by Section
3700 of the Labor Code,for the performance of Me work fowhich Nis permit Is Issued.
My Workees Compensation lnmnnce carrier and Policy number art: _
GrrA,'&QyL HNo.:R/G 31 S331A I,-'O
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(nix mus annod setbucompleted If Me Permit is finenc hund¢ddoDna(5100)
or kaa)
1 certify that in Ne perforamom of Ne wok for which this permit u iumd.I"I not
employ any portion In any manner.u m become subject in Me Worker(Compensation
Law,of CalifoMa.Date
Applicant
NOTICE TO APPLICANT:If,after making Nb Ceniaca ,of Exemption,you should
Weems subject in Me Woku's Co rNmeatina prm'isions of Me Labor Cade,you mug
Q forthwith comply with such pmvislou or Mu permit mail w deemed evoked.
z y CONSTRUCTION LENDING AGENCY
(~ Iherohy glhm Net Mom is a construction lending agency for tie performance of
fYi Ne work far which this permit is issued(Sec.3M,Cih,C.)
W�Q LendcM1 Name
z Lender's Address
U 0 1 certify that I have read this application and sate that the above inforri Is
LL.!^. mama 1 agree to comply with all city and county ofdinaru and e laws posting u
0 SV' building conswetion,md hereby mthogn mpreenutiws or Nie cmhymemuuP0r1W
t17 above-mentioned properly for inspection purpases
(We)agree m save,indemnify and keep burning Me City of Cupertino Iii
s
In Ii,bllitiu,judimenu,cess and expeuu which may In my way acme against said City
V tzin conence:of the floating of th
" APPLIC NT UNDERSTANDS AtNDrmtc COMPLY WITH ALL NON-POINT Issued by:9 Date
SOURCE REGULA'g0NS.
A/ fs /S
4 / Re-roofs
sign. vpl;anUC ARD m & of Roof
HAURot. ALSDsion,.URE 'n'Pe
Will NeeCupentofuture buildings,ChaptgorooandM Heafdowmasedg
defined by Ne CupeNno Municipal Code.Chapter 9.11.and Ne Hexlth and Safety
Seeman 155314)7 �� All roofs shall be inspected prior to any roofing material being installed.
❑Ya,
Will the applicant or future building occupant use equipment m devices which If a roof is installed without firs[obtaining an inspection,I agree to remove
emit marmus Air contaminants As defined by Me Bay Area Air Quality Management all new materials for inspection.
Dhliict7 A��s/
❑Yes
I haw mW the hagodousmandau requlromemu underchapter6.95 of the Caliper.
nia H.IN&Safcty Coda S.W.25505,24533 and 15534.1 understand thullthe building
data not tonally hew a enanu that it lam nslbility m Autry the occupant of the
mqulrtmenu which mug he prior m' ofa Cmifcate of Occup my. S ignature of Applicant Date
Owner nr. odseJ agentAllC All roof coverings to be Class"B"or better