05030305 CITY OF CUPERTINOt *gs9s+sat ,t
BUILDING DIVISION PERMIT CONTRA TORINFORMATION ,
0: 5; 'i
BUILDING ADDRESS: W E O'NEIL CONSTRUCTION PERMITNO-05030305
OWNER'S NAME: FERMrf ISUBDATE
milk NE DEVELOPMENT 5245 PACIFI 08/29/2005
NE: SANITARY NO. CONTROL NO.
(510) 385-0121
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDGO PLO MBCH
O
C LICENSED CONTRACT'OR'S DECLARATION
I hereby affirm Nat 1 anslimlucd under provisions of Chapter 9(commencing Job Description
with Section 7010)of Division 3 of the Business and professiom Code,and my Ikense is
^� in foil farce and effem A Y11 Z / NEW CONDOMINIUM
Z Lkenso Lk.I
Dam 2 conuamr //n EIL 1230 SQ. FT. LIVING SPACE
0
ARCHITECTS DECLARATION
I understand my plans shall be used u public nmNs
3
u tad�a
Licensed Prafcssional
Oe,14M attempt
m Ce Comr ON
1 hereby affirm Idem I one exempt from the Cerin,Co :Any c Law for the
p o following reuson.(Saito 7031.3,Business and improve.
demolish.
Code:Any city or roomy
Z� which requires a permit re ennerthe aimr,Improve,demolish,tare pair structure
f,Z sat thm heor i u issuance.ed pair iamquima thprovisions of for such amuccmil biccorsigned(Chapter
Chaps cm -
E{�zF< Nommerlicensed pursuant 70th)ofDv3tiehe Business
ain ssaixmc Lawwit Code)or Sq.Ft. Floor Area Val
65$ thammes examal iNSeeion rom and
of basis n3 of theeged exemton.Actio"Cede)of
l6`3 Net he h exempt Nem(mm and Ne buts for Ne alleged exemption.Any violation of
Section 7031.5 by any applicant fm a permit subjects the apple mt in a civil penalty of APN Number Occupancy e
not man Nm five hundred delan(f500). 36940002 . 00 p yTyp
❑I.u owner of the propmy or my employes whims"as their Ole mmpensadon.
will do the wad.and the auunure is not Headed or offered for ask(Sec.70".Business
and Frofasi mm,Cade:The Comanmrs License Law dma not apply to an owner of Required Inspections
popery w ho bui Ida or im prows themon.and who doessuch work Mma df or through his
own employers,provided that such Improvements are ant Intended mortared for sale.If,
however,the building or Improvement is sold within mm year of completion.the owner.
builder will haw tie burden of poring Nat he did rot build to improve fm purpose of
stele.).
❑I.as owner or the property.am exclusively centncting with licensed conclusion to
construct he project(Sec.70".Business and Professions Code:)The Conmcmrs Lt.
came,law does not apply an an owner of property who builds or Inform tiemon,and,
who comae,for such projects with a cmuscmr(i)licensed pursuant In the Contractors
License Law.
❑1 am"empt under See ,B B PC fm this mason
Owner Dam
WORKER'S COMPENSATION DECLARATION
I hereby sRrm under penalty of perjury mm of the following declarations:
]have and will maintain aCCNB"m of Co"em in self-insure for Wormrs Compen.
Milan.as provided for by Section 3700 of use Labor Cade.for the Performance of the
work for which this permit is issued.
❑I have and will maintain Walkers Compensation Insurance,as required by Section
3700of she Labor Code,for the performance of the work fmwhich Nu permit is issued.
nnce
My Workers Compensation lasuecru and Polity number are:
Cartier:7,1404# Policy No.:iaitf 3- —O
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This seem.need not bu complcmd trim permit lafmom hundred unit.($100)
mless.)
1 cerify that In the performance of Ne work for which this Permit is issued.10.11 nm
employ any person in my manner an"lo becomesubjecuo the Workcn'Cmnrrmatimn
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If.after making this CediR"m of Exemption,you should
became subject to the Workers Compensation provisions of the lahm Code.you muss
rJ O forthwith comply with such provisions m Nu permit shall be dccmed revoked.
FE V CONSTRUCTION LENDING AGENCY
l hereby crime that Nen its w
m" ctinn lending agency for the performance of
ai> tie work for which Nis permit Is issued(See.3097,Civ.e.)
GQ Landers None
z Usable,Address
U Q 1 certify that T have read this application and mm thin the shove information U
IA E coven.I agree m comply with all city and county mainm¢s and sum laws milling m
O !: building coosvection,and hemby auNoim repmeenmtives of this city in enter upon the
It7 above-mentioned popery for impecdmn purpmea
gg� (We)agree an sive,indemnify and keep harmless the City of Cupertim against 42 A
tq liabilities.judgmcnm.cosu and expenses which may in my my amine against said City
fJ 7 in consequence of Ne granting of this 't.
F7 APPLICANT UNDERSTANDS ILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULAT ONS.
81--7�0S- Re-roofs
SigiwnVConunenr Dile
HAZARDOUS MA RIALS DISCLOSURE Type Of Roof
Will the applicant or future building eccupanl ams or handle huardaus material
M de0ned by the Cupertino Municipal Code,Chapter 9.11•and the Health and Safety
Code.Section 25531(a)? /' All roofs shall be inspected prior to any roofing material being installed.
❑Yes d1Pt
Will the applicant or future building occupant use equipment or devima which If a roof is installed without first obtaining an inspection,I agree to remove
emit haramous air cunuminmm as deeded by the Bq Am Air Quality Management all new materials for inspection.
Gimlet?
0 Ycs u
I have mW the ha andou,materials nqulremcros under Chapter 695 of the Califon
no Hcal &Sarmycadc,5enia"73305. 73 wa173574.iundersmmdwiftM building
do"not curtently haw a tenant,Nal It y rupomihility m nobly Ibu oecupw of No
require ensu which. the mel issuance of and fiaa mor Occuancy Signature of Applicant Date
s All roof coverings to be Class"B"or better
Ocau mhodx agent DA.
t1
CITY OF CUPERTINOt *gs9s+sat ,t
BUILDING DIVISION PERMIT CONTRA TORINFORMATION ,
0: 5; 'i
BUILDING ADDRESS: W E O'NEIL CONSTRUCTION PERMITNO-05030305
OWNER'S NAME: FERMrf ISUBDATE
milk NE DEVELOPMENT 5245 PACIFI 08/29/2005
NE: SANITARY NO. CONTROL NO.
(510) 385-0121
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDGO PLO MBCH
O
C LICENSED CONTRACT'OR'S DECLARATION
I hereby affirm Nat 1 anslimlucd under provisions of Chapter 9(commencing Job Description
with Section 7010)of Division 3 of the Business and professiom Code,and my Ikense is
^� in foil farce and effem A Y11 Z / NEW CONDOMINIUM
Z Lkenso Lk.I
Dam 2 conuamr //n EIL 1230 SQ. FT. LIVING SPACE
0
ARCHITECTS DECLARATION
I understand my plans shall be used u public nmNs
3
u tad�a
Licensed Prafcssional
Oe,14M attempt
m Ce Comr ON
1 hereby affirm Idem I one exempt from the Cerin,Co :Any c Law for the
p o following reuson.(Saito 7031.3,Business and improve.
demolish.
Code:Any city or roomy
Z� which requires a permit re ennerthe aimr,Improve,demolish,tare pair structure
f,Z sat thm heor i u issuance.ed pair iamquima thprovisions of for such amuccmil biccorsigned(Chapter
Chaps cm -
E{�zF< Nommerlicensed pursuant 70th)ofDv3tiehe Business
ain ssaixmc Lawwit Code)or Sq.Ft. Floor Area Val
65$ thammes examal iNSeeion rom and
of basis n3 of theeged exemton.Actio"Cede)of
l6`3 Net he h exempt Nem(mm and Ne buts for Ne alleged exemption.Any violation of
Section 7031.5 by any applicant fm a permit subjects the apple mt in a civil penalty of APN Number Occupancy e
not man Nm five hundred delan(f500). 36940002 . 00 p yTyp
❑I.u owner of the propmy or my employes whims"as their Ole mmpensadon.
will do the wad.and the auunure is not Headed or offered for ask(Sec.70".Business
and Frofasi mm,Cade:The Comanmrs License Law dma not apply to an owner of Required Inspections
popery w ho bui Ida or im prows themon.and who doessuch work Mma df or through his
own employers,provided that such Improvements are ant Intended mortared for sale.If,
however,the building or Improvement is sold within mm year of completion.the owner.
builder will haw tie burden of poring Nat he did rot build to improve fm purpose of
stele.).
❑I.as owner or the property.am exclusively centncting with licensed conclusion to
construct he project(Sec.70".Business and Professions Code:)The Conmcmrs Lt.
came,law does not apply an an owner of property who builds or Inform tiemon,and,
who comae,for such projects with a cmuscmr(i)licensed pursuant In the Contractors
License Law.
❑1 am"empt under See ,B B PC fm this mason
Owner Dam
WORKER'S COMPENSATION DECLARATION
I hereby sRrm under penalty of perjury mm of the following declarations:
]have and will maintain aCCNB"m of Co"em in self-insure for Wormrs Compen.
Milan.as provided for by Section 3700 of use Labor Cade.for the Performance of the
work for which this permit is issued.
❑I have and will maintain Walkers Compensation Insurance,as required by Section
3700of she Labor Code,for the performance of the work fmwhich Nu permit is issued.
nnce
My Workers Compensation lasuecru and Polity number are:
Cartier:7,1404# Policy No.:iaitf 3- —O
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This seem.need not bu complcmd trim permit lafmom hundred unit.($100)
mless.)
1 cerify that In the performance of Ne work for which this Permit is issued.10.11 nm
employ any person in my manner an"lo becomesubjecuo the Workcn'Cmnrrmatimn
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If.after making this CediR"m of Exemption,you should
became subject to the Workers Compensation provisions of the lahm Code.you muss
rJ O forthwith comply with such provisions m Nu permit shall be dccmed revoked.
FE V CONSTRUCTION LENDING AGENCY
l hereby crime that Nen its w
m" ctinn lending agency for the performance of
ai> tie work for which Nis permit Is issued(See.3097,Civ.e.)
GQ Landers None
z Usable,Address
U Q 1 certify that T have read this application and mm thin the shove information U
IA E coven.I agree m comply with all city and county mainm¢s and sum laws milling m
O !: building coosvection,and hemby auNoim repmeenmtives of this city in enter upon the
It7 above-mentioned popery for impecdmn purpmea
gg� (We)agree an sive,indemnify and keep harmless the City of Cupertim against 42 A
tq liabilities.judgmcnm.cosu and expenses which may in my my amine against said City
fJ 7 in consequence of Ne granting of this 't.
F7 APPLICANT UNDERSTANDS ILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULAT ONS.
81--7�0S- Re-roofs
SigiwnVConunenr Dile
HAZARDOUS MA RIALS DISCLOSURE Type Of Roof
Will the applicant or future building eccupanl ams or handle huardaus material
M de0ned by the Cupertino Municipal Code,Chapter 9.11•and the Health and Safety
Code.Section 25531(a)? /' All roofs shall be inspected prior to any roofing material being installed.
❑Yes d1Pt
Will the applicant or future building occupant use equipment or devima which If a roof is installed without first obtaining an inspection,I agree to remove
emit haramous air cunuminmm as deeded by the Bq Am Air Quality Management all new materials for inspection.
Gimlet?
0 Ycs u
I have mW the ha andou,materials nqulremcros under Chapter 695 of the Califon
no Hcal &Sarmycadc,5enia"73305. 73 wa173574.iundersmmdwiftM building
do"not curtently haw a tenant,Nal It y rupomihility m nobly Ibu oecupw of No
require ensu which. the mel issuance of and fiaa mor Occuancy Signature of Applicant Date
s All roof coverings to be Class"B"or better
Ocau mhodx agent DA.
t1