05030306 CITY OF CUPERTINOwxswy,
BUILDING DIVISION PERMIT ',"P'.CONTRACTOR INFORMATION
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BUILDING ADDRESS: W E O'NEIL CONSTRUCTION paeM"'05030306
OWNER'S NAME: FEIRMIT ISSUE DATE
E; SANITARY N0,
CONTROL NO.
(SlO) 385-0121
ARCHITECf/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
c LICENSED CONTRACTOR'S DECLARATION lb Description
1 hereby af0nm dust I atm licensed under provisions o
of Chapter 9(commencing
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1230 SQ. FT. LIVING SPACE
,eQ ARCHITECTS DECLARATION
Y ccyy77 I underwnd my photo dull be used As public records
3
esti
Licensed Prolcuionat
q OWNER-BUILDER DECLARATION
En Z I nam affirm Nal 1 1. exempt from the Contractor's Licence Law for the
En p o fallowing moan.Permit
t 703 LS,Business and vee.de oli code:Any city n county
+�$ which ituss a a pmmit re cores ft alar,improv,demolish.or mash any structure
F-Z pat Ac is issuance.also requite theopponent for such Coments's emusfile a gad ateumcm
FF pursuant )ofDivionoftheConoaorrinuenselaw(Clupta9 Sq.Ft.Floor Area Va1*pi4tP384
6 $
that he
Section?and
Wait for
ofthe
egedaaand Profession Code)at
— that ha b compo Nemfrom and the bai,for the Alleged osemptloe.Any violation of
Section 7031.5 by any applicant for a permit subjects the Applicant to a civil penally of APN Number Occupancy Type
not roam Nan five hundred dollars($508).
❑L As owner of the property,or my wplayea with wages M tiuirsole compensation. 36940002 . 00
willdo thework,and dlemuatum 4notinundedoroffemdrorsm(Sm.704.Besirmss Required Inspections
end Poaraslan Calc:The Cammctoes Licenae Law does not apply or an owner of q P
property who builds or improws thereon,a nd who does such work himsel f err through his
own employes,provided Nal such improvements art not Intended oroRened forale.IL
however.the building or improvement is sold within ane year of completion,Ne owoer-
Wilder will have Ne burden of proving that he did net build or Improv for purpose of
tole.),
❑1,As owner of me property.am exclusively connecting with licensed contractors or A
construct the project(Sec.70",Business and profession Code:)The Cannanore,Li-
ccne taw doe not apply 0 an owner of property what builds or improv Merton,and.
who contracts for such projects with a eomnaorr(s)licensed pursant to the Contractor's
Lkene Law.
❑I am exempt under Seo. .B&P C far this maven
On'
Dau
WORKER'S COMPENSATION DECLARATION
1 hemby affirm under Fatally of perjury noe of the following dalan0on:
1 have and will maintain a Certificate ofcomenuo self-ivum for Worker's Compen-
ation.As provided for by Section 3700 of the Labor Cade,for Ne performance of the
work for which this permit is Issued.
❑1 have and will maintain Workers Compensation loarsna,As obtained by Section
3700.1fNe labor Cade.far Ne peRomuna of Ne woks for which this permit h issued.
My Warkees Compensation Insuranco art�i�e��ddPPoliq number toe:
Cartier.�t/�./G('/ A^F_'✓�'T'PEIIry N1.: W63-r a3-d
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Glob satin sued not b.completed lime pens it isforooehundred dollars(5180)
mks,.)
1 coolly that in the Performance of the work for which this Permit b iaurA,l Shall nm
employ anypevun In any manner an As At becomesubjett to theWorkers'Compensation
laws of califomia Dau
Applicant
NOTICE TO APPLICANT:If,After making Nis Car ibesm of Exbmpdon.you should
became subject in the Worker's Compensation provisions of the tabor Code,you must
O 0 forthwith comply with such prevision or this permit shall A deemed mvoked,
„zy CONSTRUCTION LENDING AGENCY
F k for which lm Ne NtR hsed(Sacl30 y?..ding agCayfmr thC perfOflllaee.f
�i> the wart rte wham this permit b issued(sat.J119'1,civ.C.)
qLanders Nuns
a z Lcnderb Addrtsa
U O I certify Nu 1 have rad this application and sum,that the show information is
ly eomea.I tree to comply with all city and county ordinances and mu lam misting or
O building construction,and hereby,uthatim mpresenudwa of this city to enter upon Nb
W above-mentiaoed property for inspection purposes
(We)agree to ave,indemnify and kap harmleas tie City of Cupertino against
.a M nabilWea,judgments.costs and expenses which may in my my aeeme agsinaseldCity
U in^ APPLICCANT UNDERSTequence of the Ing of ANDg AIN COMPLY WITH ALL NON-POINT Issued by: Date
SOUR EREGU S.
8 Z OS Re-roofs
Signature AdWpplicardu0mitactor Data
HAZARDOUS MATERI LSDISCLOSURE Type of Roof
Will dm applicant or future building Occupant a=or handle hvardon maurfal
As defined by the Cupertino Municipal Code,Chapter 9.13,and tiro Health and Safety
Cade,Section25532(q? All roofs shall be inspected prior to any roofing material being installed.
❑Yes tiro
WIII the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
cmil haardnus air comuminanu As defined by doe Bay Arta Air Quality Management all new materials for inspection.
District?
❑ye dam
1 have mad the hmaodnus mmriab tatuiremcnu under Chapter 6.95 of the Cslifar-
el.Hund"Safety Cade,Secdaes 25505,25573 25534.1 Ovenund thmifthe building
docs not currently haw A m.anl,that It b to nobility m notify the oauponl of dm
requirements which muss sect pian w' afACeniOcau of Ocw cy Signature of Applicant Dale
owner err atim a Ant oat All roof coverings to be Class"B"or better