06080174 ;DE
Y OF CUPERTINO res 4rasa � �1`�"'�`�
BUILDING DIVISION PERMIT CONTR IAC �1R, � �ATj N
ZWW
INGADDRESS: W E O'NEIL CONSTRUCTION PE`"T"ND'06080174
ANZA I
R'S NAME: PERMIT ISSUE DAISSILVERSTONE DEVELOPMENT 5245 PACIFIC CONCOURSE DR VE 09/08/2006
E: SANITARY NO. CONTROL NO.
(510) 385-0121
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONRACIGR'S DECLARATION lob Description
1 he mby affirm that 1 am limme d under provisions of Chapter 9(commencing
;ZE with Smuan 7000)o(Division 3 orthe Business tnd Prafesdmns Code.and my license is
iafellfome.mdeffem REVISION TO ORIGINAL PERMIT 05030078
Igz Lice nseClm Lie.#
Omm REVISING EXISTING GARAGE -SHEE A 3 . 1 ADD 2 WALL
t- Dam
gg ARCHITECTS DECLARATION TO ENCLOSE 1 GARAGE SPACE
i 2 i understood my plan.Mall he used u public record.
Id
°8 Licensed Professional
s Oat lam exILDERempt
DECLARATION
I2 S 1 heresy.('firm Nil 11. ,Bumps from Nro Contractor's o License A.y.Law far the
Z20 following masa.(Section 7U31.5, also, mpr Ha@sdum Cale:Any city sir roomy
which requires a permit to construct,the
alter,improve,demolish POMIRh,of reach soy structuuatcamm
sit prior b its licensed
pursuant
require Novisio s;o for such penes m Ne se Law(msumem
< (co me licen¢Jpussoanu0the 0MofDivisioofothe tConmcmfalJcenmlaw(CCnptm9 Sq.Ft.Floor Area Valuation
(comets exe pthmefrn70nd of Divisionr of theBusiness
exeenJP,afessy vi Code)of �'0
a��
that he u exempt them(rom and use bleu for the ailgW eawptim.My violation of
Session 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
nm mom than five hundred dollars($500).
❑1,As owner of the property,or my employ.with wages u their sole cempemation,
wig do the work.and Ne swoum un or Intended or offered for Wc(Sec.70th,Business Required Inspections
And Professions Cade:The Conaacurs License Law deo rot apply In an mune,of q P
property who bui Ida or im prow thereon,end who does such work himself sir through his
own employee,provided Nat such improvements art net intended oroRered forWe IL
however.the building or Impmvement is sold within one year of compaction,the owner.
builder win have the burden of pmving that he did not bond or improv for purpose of
ami.
as owner of the property,ec.704 A.,Business nd con0aming with Ilayssed mnuumm .
mas La theespmjcanot (Sec.7014,wnofand Rofoen bul Codec)The Cpnuacmn. rid
cove law does not apply m to owner of property when builds m Improve Corton,and
woth forauch projects with utartwu the conus)licensed pursm te CContraContractorsaor'a
Llan 1cmus ClLaw.
m
❑laexempt undo See _ .B @PCfor this
r Dau g 0
VOR 9 COMPENSATIO DECLARATION V
I hereby aRUm under prnanY of perjury rote or the following deeluadonar
I have and will mainum a Condit of Consent to self-insum for Worker's Compete
swan,a provided for by Seed..3700 of the labor Cade.for tite Fort...of the
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,u imported by Session
37M.Ir d.labor Code.to,the perfarmtnen of the work fm which Nu permit is moseL
My Worker's Compensation humrance caner and Policy number arc:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This secOv reed not bu<ompleuJ if the permit is forme hundseddallm(SIM)
lir less.)
I certify dent in the performance of the work for which this permit u issued i Owl not
employ any person in any manrcrso a m b�otpc subject m tht Workmi'Compemanor,
Laws of Callfamia.hoe afterX66
NOTICE OA J'�wv
NOTICE TO APbjm e the .IL Compensation
N cion,of m Exemption.Cod you Mould
.,Zbecome mommy it Woher'oCemDewuonpmvitihall A meLabor Code,you most
. foMwith comply sobs rotes provisions or this permiuheliMdcemcd revoked.
zO CONSTRUCTION LENDING AGENCY
[-( I hereby affirm Nat Nem u...exh wd..lending agency for the performance of
R' >
she work for which this permit u issued(Sec.3097,Or.C.) ..
W� ganders Name
z Lender's Address
U 0 1 certify that I have read this Application And sou Na(the abuve information is
UL f-' cornet.l agree to comply with all city and county mn.and sum lawn heleung u
0 U building conswnion,and hereby aunhorim,eptemmatwmathisci"to cmc,upon sloe
I47 above-mentioned property far inspection purposes.
(We)agree to sxve,indemnify and keep harmless the City of Cupertino Against
i y liabilido,judgmemts.msu and expenses which may in any way accme against mid City /
U Z in consegmnee of rhe grroung of Nu
APPLICANT UNDERSTANDS AND ILL COMPLY WITH ALL NON-POINT Issued by: Date Y
SOURCE REGULATION
Smgoatum or�✓x: manor Dt Re-roofs
Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building omuparrt mom or Motile hamrdov mau sal
As deRned by the Cupertino Municipal Code.Chapter 9.13,and the Health And Safety
Section 25533(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yue Vie
Will the applicant of future budding occupant m@ equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it havmdnus.1,eontsminmu a defined by the Bay Arca Air Quality Management all new materials for inspection.
1511IC17
❑Yes
Ihave&Safct Nodc,Swsasmmtrials 05,255uiremenuumkr German 6.95 of Ne GAIIfuF
nisi HcalN@Safety Cadc,Sceuov]5503,335 anJ25334.1unJcrswd Nulfthc builJing
Jaca rot curem(y hoe a unam,that It u mildlity to notary the occupant of the
requimmcnu which most he net prior cofacenfificalcofoccurnv. ,
06 Signature aff Applicant Date
wrier lir,nth ..eJ.sem D.e All roof coverings to be Class"B" or better'