05030287 CITY OF CUPERTINO �5^6O,' •" yy'/''� /"�
BUILDING DIVISION PERMIT �XO
BUILDING ADDRESS: W E O'NEIL CONSTRUCTION FERMITNO.05030287
R'S NAME: FERMR ISU9 DATE
SILVERSTONE DEVELOPMENT 5245
PHONE: SANITARY NO. CONTROL NO.
510) 385-0121
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BUDiff T [n
imp 6p LICENSED CONTRACTOR'S DECLARATION Job Description
fv+� I hereby am that I am licensed under provisions oP
of Chapter 9(Commencing
with Section 7000)Of Division 3 of me Business aha Profusions Code.and my license u
immllfmsmdeffea D �( y e3 � NEW CONDOMINIUM
D27 cnuasor wF�A/EfL 1116 SQ. FT. LIVING AREA
` ARCHITECTS DECLARATION
a Cyt Iunderstand myplans shall Mused an public record, BMR UNIT/ NO CONSTRUCTION TAX
�LLp Licensed Profcuionel
3 OWNER-BUILDER DECLARATION
I I hereby sfllson that I am exempt from the Conlnctnes License Law for the
i.Oo following mason.(Secdun 7131.5,Business and Profusions Code:Any city or county
5$� which requires a Permit to washout,alter.Improve,demolish,or repair my shucure
_Z12 poor to its issuance.also requires de applicant rar such permit to file a signed statement
< Nat he is licensed purmmlm me provisions of the Contractors License Law(Chapter 9 Sq.Ft.Floor Area Valuation
�S (commencing with Section 7000)of Division 3 of the Business and Professions Cada)or $129188
But he Is exempt therefrom and the basis for Ne alleged emmpder.Any violation of
Section TOOLS by any applicantfor a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
tet mom than Bw hundred dollars(5500).
I.uowrer oflh peapedy.wmy wployv with wgu udu'umle eonpewtion,
will do theaeuk.aM UesuunumlsnelintendedoroReaW Torsos(Sec.7014,Busilw•• Required Inspections
and Profeasm
ions Cade:The Conumes License Law does Col apply 0 an owner Of q P
property who builds Unbalances mpmces durcon.end who does ouch work Mosel f m through his
Own employees,provided that such improvements arc not Intended oorterad for sale.If.
however,Ne building or improvement Is said within mu year of completion.me owner.
builder will have the burden of proving that he did not build or Improve foe purpose of
sale.),
0 1.es Owner of the property,am exclusively contracting with licensed enehmem m
construct the project(Sec.7014,Business and Professions Code:)The Conuaemes Li.
cense law does not apply in an owner of property who builds or improv duaeon.and,
who comment for such pmjeeu with a Contrsemt({)licensed pursuant In the Conl seloes
License law.
14M exempt under Sec. .B A P C feu this mason
Dau
WORKERS COMPENSATION DECLARATION
1 bm by affirm undo pensaty,of perjury aro of the following declarations:
❑I haw and will mainuin a CeNficateaf Consent to self-Insum far Worker's Compete
nation,an provided for by Section 3700 of de Labor Code,for the performance of Ne
work for which thin permit is issued.
❑1 have and will maintain Worker's ComPensNon lameanCC.an acquired by Section
3700 of the labor Code,for the per(armance of the work for which this permit is Issued.
My Worke es CompenutionnInsurance carrier
and Policy rummer are:
Careter.2f,11 efG'FOIRY No.:k/e-?S-33
CERTIFICATE OF EKEMFnoN FROM WORKERS'
COMPENSATION INSURANCE
(7Lismcdae need ant be cmnplcud lftie Perot is fmonchunbedda0an(5100)
Or esu.)
1 cenify the,In the performanw of the work for which Nis Pamir is meoed.I that not
employ any person in my summer an u e became subject to the Workers'Compensation
Laws of California.Dau
APPlleem
NOTICE TO APPLICANT.If.afar making this Cer ificae of Exemption,you should
become subject to the Worker's Compensation provisions of Use labor Code.you moat
.JO forthwith comply with such provisions or this permit shall M dccmcd revalmd.
z y CONSTRUCTION LENDING AGENCY
F I hereby affirm thatmere is connotation ending agency forte performance of
a de wish for which mu permit Is mused(Sec.3097,Civ.C.)
QLessees Name
=z Lender's Address
U O 1 comfy out I have rod this application and sum mu the thew information is
D. Fw cores.I agree to comply with all city and county ordinances nd sum laws reading to
0 SV' building conmuaion,and hereby summon representatives of this city to cater upon de
[Tj shave mentioned property for inspection purposes.
gL (We)agree to sew,indemnify and keep Aumleas the City of CuPcnino Against
y liabilities.judgments.coo and expenses which may in my coy accrue agsinst and City
U 7 in consequence of the grandng of this permit.
r1• APPLICANT UNDERSTANDS AND ILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIOO S.
Lin 8 �� Re-roofs
Signuu pPOcesctar ' ate
HAZARDOUS
of Roof
HAZARDOUS il ALS DISCLOSURE Type
WIII y t applicant w future building e.Chapter
hoc or handle Health and Safety ud
Oe0nes by du Cupertino Municipal Code.CMPer 9.13,and the Health and Satcry
Section 25532(x)7 All roofs shall be inspected prior to any roofing material being installed.
[],yes, ❑&1
Will the applicant or future building occupant um equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
colt hixardou aircwumiomu p defined by tho Bay Ama Air Quality Mmagcmcnt all new materials for inspection.
Cl
lYes
Yu
I have mol me hvardau materials requirements under Chapter 6.95 ofthe Califon
ria Health&SsfetyCade,Scedmu 25505,25533 and 25534,1 understand and lfde Wilding
dace net currently haw a meant that 11 lWhArponsibillty in notify tie occupant or the
requite nm It It mug be met prior umaearaeeruncaeofaapancy. Signature of Applicant Date
ownermamnadym assn, 2 ,e All roof coverings to be Class"B"or better
f.