07120216 CITY
YOU
CUPERTINO ,
BUILDING DIVISION PERMIT " �UNPRACTOR INFUT.tMA.TION •.
a.P. 'F.n.., &w.4y "z .. ' r e 6A.."-_V".
BUIL.DINp ES ADORPERMR NO.
IUifI7 isV STEbT:,:I:NG RD LANDMARK DEVELOPMENT 07120216
NER'S NAME:' e0ftpt)RAT ion �M'r LSSUEDAIR
PALMAS STELIANG LLC 1307 S MARY AVE STE 120 09/03/2008
PHONE: SANITARY NO. CONTROL NO.
ARCH'TECTfENGINEER; BUILDING PERMR INFO
NEW TWO STORY TOWNHOUSE BLDG ELECT PLUMB MECH
0 0 0 0
O p ; 49 SF
LICENSED CONTRACOR'S DECLARATION '
'UEF 1 homily air.Nall am do"I'd leder pavirioa of C"Pur 9(commencing Job Description
with suction 70(YJ)ofl)="n 3 ofllu Business and Pmfessimu COde.t Qmy lic..is
in full roma ad IT L/
� 2 Licemue C Lic.a .
Conuacmr
ene ry ARCNITECfS DECLARATION
; U IuMmaanJ my TWuelWl bcmad!upublic m<oNs ct.A4
6
k LLa Licemed Pmfasrionat
3 OWNER-BUILDER DECLARATION
E 1 hereby a1Bmm that 1 am esempl from the Contractors LReense law for dm
i
00 following mason.(section 70313lass an
,Busd Pmfea csioCade:Any city or county
which us sms a per ail In construct.alter.imprmo,demur W,a repo,kay suumum
_Zy prior to its issuance.also minima the.pplim,for such Pamit m Bk a signed suumat
< Nulmulieeaedpur>u,amB,epmvimanrinecnn�ntorlueaeL,w(chapmr9 Sq.Ft. Floor Area Valuation
CO To
Sccdom7000)of bands n3 ofthe BurimmneMon.Myovi Codc)a '
Nat he u camps thue(sont aM the buss(a Ibo alleged exempdom My Notation of
section 7031.3 by ury applkut To,a permit nbjcc s the applicant in•civil penally of APN Number Occupancy
MI moa Nana Bw manned dollars(SWIM Pane Type
YPe
I,uomau of dm popeny,amY uoPloytta aiN nguu Ne'vsole emnpcwdan,
addo le moms and Neswctum B atimenEed sow du female(See.70M,Burials
pro arty wh ora cads TK Cauldurs I»"�Lav duo at apply m rt Tooth is Required Inspections
property oss. oAdmpot such ucon,and whodoessuch...,mounted
hiw.ficoll Nmough his
honemployeWiPmNdedthat sohtmpmtomauartnot res, aaReud fa nle R,
however.the bootingardso of rmmnl b oothwithin at Weldofmrumn6an.theowrcr-
builder wi0 hm tk burden of curing Nal he did MI build a impmw for Purpox of
ole.). -
1,as owns of the pmpeny,as udariwly conuacun[with liammed contractors;in
coauuet dm projM(Sec.7044,Bum.and Pro(ariom Cade:)The Gnlraeurs U. ,
ave Law does not apply to a owns of p spiny who builds or improv themon.and.
who conUacts(a such pmjeLV with aeMlraebr(i)licensed pursuanl in the Contractors '
Lice.-law.
❑lamacmptundm See .BdPCfarthismaun
rte Dau
WORKER'S COMPENSATION DECLARATION
I hammy air=under penalty of perjury one of the following decimations,
❑Ihsw and will mrinuin•CemtifiontofGmemmself-imumfmWmker.Compen-
uuon.as provided for by Section 3700 of the Labra Code.for the performance of the
work for which this permit is inued.
❑1 have ad will maintain Workers Compcmadon Imuranco,u myuired by section
3700of the lata Code,for On,pedommanc..f Ne wort for which this penton is issued
My Worker�/ir)Cmnpemshort Insumace carrier end Policy numbe
CER r am:
Grtkr. KQAIR4 G 2/ Policy No.:
MON FROM WOR ERS'
COMPENSAnON INSURANCE
('lhbsecdun aur notbccomplemd lithe permit is Intone hadmddoRan($100)
a Isar)
1 emdfy that in the performance of the work for which this permit is bound.I shall nm
employ any person in any mmomrso as To income subjat TO tint Women''Cmmpemadon
Laws of Glifomia.Dau
Applicant
NOTICE TO APPLICANT:If,alter making this Ccn rtca,of Exemption,you NouW
become subject in Ne WorWs Compenakdon pmvisiuna of dm Labor Code,you muss
.J O forthwith comply with such provbinm or this Tumult shall be dcomed mmkcd. _.
Z h CONMUCTION LENDING AGENCY
F Ihemby a(Brm dna Nem Is a construction lending agency for the perichromn of
FL Ne work fur which this pccom,is bound(Sec.3097,Ci,C.)
0 Landers Nauc
,a z Landers Md.
U O I cattily that I Mw mad this application al sou that circ show information is
[L.Pcorn:L 1 ague TO comply with W city aur county oNinaab sum:es tiIan mlating to
0 U building construction,and hemby mmodae mprommuuvcs of this city in enw upon the
W shove-menuproperty for impaction purpoxs
,r CL . (We)ague to nw,indemnify and kap hardn The City of Cupertino against
U z liabilidujudgmdgm enusht
.eu ad as Mc
mey'in nyacoma agaimiseid Cily
Inc col u of Nu it
^ A R ND C PLY WITH ALL NON-POIN1 Issued by: Date -a b
ULA s
ffkuF —03--o Re-roofs
gnuum olAppliaHAZA DOUS MATERIALS DISCLOSURE Dam Type of Roof
Will the appticut or fmum Wilding—Punt a.ahandm hazardous msmri it
as defined by the Cupenim Municipal Coo.Chapter 9.13,and Ne Halth and Safely
.Sermon 25532(1), All roofs shall be inspected prior to any roofing material being installed.
[:3y. o
If a roof is installed without first obtaining an inspection,ection,I agree to remove
Will the applicant or Now,building occupant manequipment a devices which
Di count a rka air caa u ummudefrmcd by dm Bay A.Air Quality Man.gco at all new materials for inspection.
❑Ya
I haw mad Neluraldaus mamriabmquimmrmmruumin Ch. ur6.95ofNeGli(m-
wHuhhs, ImyCod toms 5.25533 355 thaifdm building
dw rut jd mmom his it naily the uttup r,of Nc
V! mnax Prior rmsmoraapamy. Signature of Applicant Date
was or auNaioed agent 03 W All roof coverings to be Class'R'or better