05030323 CITY OF CUPERTINO 777777„may °i ''
BUILDING DIVISION PERMIT Cv,NTRA. T0RJNF"URr'YA•TIO1�;,"
BUILDING ADDRESS: W E O'NEIL CONSTRUCTION PERMIT NO.05030323
20500 TOWN CENTER LN ft 280
0 NM'S NAME: PERMIT ISSUE DATE
TOWN CENTER ASSOCIATES 5245 PACIFI 5
7PME: SANITARY NO. CONTROL NO.
(510) 385-0121
ARCHITECTIENGINEEK: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
3 o z LICENSED CONTRACTOR'S DECLARATION Job Description
rd u� I hereby affirm that I am licensed under under provision of Cromer 9(commencing p
with Sudan 7000)of Division 3 o the Business ad profession Code,ad my license is
+� in full in=and effect. / NEW CONDOMINIUM
31? Lkenm I Lies� f4 of /
pppppp Dam - Conuacmr r.�F e,iE/L 1349 SQ. FT. LIVING
Cq ARCHITECTS DECLARATION
GG 22 1 unlamented my phna shall he used u public records
6
5t;In Licensed Professional
3 OWNER-BUILDER DECLARATION
<X I hcmby M.that 1 am exempt from Me Contractors Leon::law for the
O O following mace.(swa on 7031.5.Busimas and Pmfesslon Code:My city or county
ISO! which cultures a permit to consumer.alas hnprow,damuluh,m opal,my someone
-Zto panrm its lat.M.also mqulla the applicants foremch permit in rile a signed statement
ixothat Ise ulicensed Pammantmthe pmvisle ,alaccomacArsUtenseUw(Chaper9 Sq.Ft.Floor Area Val$I1166160
y F (commencing with Snelon 7000)of Division 3 of We Business ad Profession Cade)ur
egg
.. Wt h u exempt therefrom send Me btu for Me alleged exemption.Any violelon of
Section 7031.5 by Ary applicant for a perch subjects the appllunt in a civil Penalty of APN Number - Occupancy Type
nut mart take Ow hundred dales,ISM 36940002 . 00
0 I,n ownes of dm papacy,m my employcu with wga u Neu mlc eompemu dw.
wig do the work and dm swctum u natimended orofremd forsale(Sa.7044,Ba.
ad profession Code:The Camacmr's License Law does an,apply b a owner of Required Inspections
property who bui Ida or im pow demon,and who does such work hlmsel f or through his
own employes,provided Nat such improvemmu w not intended croffered fo ale.It.
howews,the building Or Improvement is mid within aro yea of completion.Ne owner.
Wilder will have the burden of proving that he did not build or improve for purpose of
ale.).
0 1.as owner of the property,an exclusively contracting with licensed can dims mbs to
construct the project(Sea 7044.Business and Pmfassian Cade:)The Contractor's U.
cense law does not apply m an owner of property who builds or improv Merron,ad,
who contracts for such pm ijeeu wit a mntractor(O licensed Fonusm in the Contractors
LkAse Law.
❑1 am aempt under Sec. .B&P C for this wan
n Dam
WORKERS COMPENSATION DECLARATION
I hereby&limn under penalty or perjury one of Me fallowing declaration:
1 hawand will meinuin aCeNfinm of Consent m aclf-insure far WorkcM1Cnmpen-
ation,an provided for by Section 3700 of tae Labor Code,for Me performance of Me
work for which this permit is Wood
0 I have ad will mainuin Worker's Compensation Wurace,as required by Section
3700 of the Labor Code,for the performance of the work for which this pemtir is laced.
My Worker's Compensation Imummn artier and Policy number are:
caNer:2rRK1ut-4,4&A/eN-Iicy Na.:&,e_?f73/4
CERTIFICATE OF EMFI70N FROM WORKERS'
COMPENSATION INSURANCE
fThtssecticn bad nothcconplemd lithe permit Is foram:hundred dollar(SIM)
or Its,.)
I certify that in the performane of Me work for which ibis permit is issued.I shall not
employ any pcuon in my manner m as m becomesubject to the Worker'Campemation
Laws of California.Dam
AppBtent
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject in Me Workeh Compensation previsions of Me Labor Cada you must
vJ O forthwith comply with such provision or this permit shall he deemed mwked.
Z ti CONSTRUCTION LENDING AGENCY
[..t I hereby aRrm Mat then Is%constrction lending agency for Me perfumtane of
(tai the work for which Mu permit is Issued(Sec.3097,Civ.C.)
aQ Landers Name
:0 Z Lenders Addw
U 0 I scruffy that I haw read this applickd on ad sore that the abuw Information Is
D. F carecL 1 agree to comply with all city ad county ordinates and sum laws mladng m
QU building construction,ad hereby auNorim representative of this city to enter uPnn Me
W above-matron l property,for inpeci oo purposes.
(We)agree in saw,indemnify ad keep ham0ess the City of Cupertino against
y Habllides.judgments,ensu ad expenses which may in my M9 acme againsuaid City
U7' in consequence of the grating of this permit.
L7 APPLICANT UNDERSTANDS A D ILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
��7 /� 8/y /6s
I;iparri liwnVContracmr `rD _ RC-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the appliront In future building o cup rm ere or handle hexardous material
as defined by the Cupertino Municipal Code.Chapter 9.11.all the Health ad Safety
ode,Section 25531(07 All roofs shall be inspected prior to any roofing material being installed.
Dyer
Will the applicant or rutum building occupam use m ulpmem or dales which If a roof is installed without first obtaining an inspection,I agree to remove
emit Woudnus air cauminnts defined by Me Bay Area Air Quality Management all new materials for inspection.
District?
Y.3
u
I haw mad Me haallousmaterlau mquim=nu underCMpmr6.95afde Califor-
niaHexhh&Sa[MyCa ,Sv,o.25505.15533n 25334.lundcmmd MAlfdc building
den not cmrtntly haw a"ma"
Mu it seta respomihilllY in ally tic aceuPmt of dm
reyuiremenu whkn tensbumet issumte art.Ccnifinm area Penny Signature of Applicant Date
All roof coverings to be Class"B"or better
Owner&authorized agent Dau
C_