07120218 CITY OF CUPERTINO
BUILDING DIVISION PERMIT „C,ON. TRA. CTO,R TNk'URMATION,
BUILDINGA DRESS: PERMIT NO.
: Oii. 9 N STFTA.:LNG RD LANDMARK DEVELOPMENT . 07120218
NER'S NAME: COIKPOKAJIUN PERMIT ISSUEDATE
I. 1AS PALMAS S9'i?LLt1:NG Ln1.tC1307 S MARY AVE STE 120 09/03/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHr1EC(ENCINEER: NEW TWO STORY TOWNHOUSE BLDG BUILDING PERMIT INFO MB MECH
u00 LICENSED CONTRACTOR'S DECLARATION ' 399 SF
JobDescrition
rd 1 hereby affirm Nat I am licensed under provision of Chapter 9(comrom.as P
with Secuan7IXMl)afDivi+ien Softhe Ruircss and Pmfeasiev Ctod/e,Ca}jW myliccncu
nfWl rarte,ndevrteYn. 33 T
j b— License
Cly, TS O
Da¢ GTTs— T Common OM
A HITECfS OECLARA710N Nf1/
< JUI
I uMcrsunJ my plw slWl be uxd u Pubik mcoNs �� /L�
t't;
y LIle11SJ PNrLV10NI
5 3 OWNER-BUILDER DECLARATIONeme
S<f 1 name alum that 1 1. exempt rmre Nc Centrumr'+ :My c ty o for Ik
L 2 o following mama.(Scotian 7011.5.Business and Professions dna oar tank:My city or county
rd$�i which sequins•permit re ennswcL alter.improve,de Permit
t or repair any munum
Prior mslcensedslatmgoims Nc provisions
for such Pcuer'mces,Law smearami
hapeng
< dw heisting with
pursuant to the pmrisiom of the oonuuwr' ndinselsw(cMptct9 Sq.FI.Floor Area Valuation
R�$ that(cohe nciag with Schon]0nd mi'tha basis for the eag d assumpt on.my vi code)of
Nat he U exempt themlrom and Ne bait for the sllegrA assumption.My Holation or
Schon 7031.5 by any applicant for,permit subjects the,ppl¢ant to a civil purely or APN Number Occupancy e
Int mare than flee hundred dollars(1500). P y •T]y P
wi Luewrc-oftheproperty.ormyerinWo dwithwageurh(v .co .Be amor
wad dothewont ands: he ComanormLaded,Law
stele(Sec.to an Baer of
and Pmteuiou Cade:The C d scmr's Lmcve oa,dues oro apply m an rough or Required IDSPCChOBS
proputywMbuild+orimpmea Nucor,andwW daes+uhwork himsel(or through his
awncmploym.Pov'iddd Wtsuch improvements ere not interhd oraQued foralu a.
powder.ere haw
the
improvement u cold within oro year of completion,the ore of
Wilder wi0luve ere When of peeing Wr be did ant build or improv for purpose of
uleJ.
0 1.u owrcs of that PSN'.w eatluuvelY comarnint with licensed cumbaclms he
construct the project(tee-7044,Business W Professions Cade:)Tie Contmcmr's U. .
ecus law dors not apply he an owner of property who Wilds or improves Neuron.and
who contracts for such projects with a contractor(s)licensed pursuant he the Commeter's
Licence law.
0 lamaaemptundertec. .B&PCror Nismuan
Per
Dam
WORKER'S COMPENSATION DECLARATION
I hereby affirm under purely of perjury enc or the following declantiav:
❑ r,ve and will mainuinaCrnircateef Cavernmxlf-imam far Worker's Compcn- '
anioon, pmvidhi for Section l]00 of Ne uWr Code,for Ne p:rfomume of the
work forr which this permit is issuM
0 I had mod will maintain Worker's Compensation Insurance,u mquimd by Section
3700 of the Labor Code,for the periformantt of Ne work forwhich this permit is Issued '
My Worker's Compensation Inatome 'er sod Policy number ane:
Canis: /�7 ,�-jh Policy Ne.:
--
-CERTI TE 0 M MON FROM WORK RS'
COMPENSATION IN U ANCE
. (ndssecumncndeetbccom 7whic
archu�ddoVan(1100)
oriental
1 certify that in Ne performance of t e worpermit is issued,l shall rct
employanypermninanYmanrcrmumbNe Workcm'Campevaum
Laws of California Data
Appl cant
NOTICE TO APPLICANT:If.after making Nu certificate of Eaemption,you should -
,m one+abject he Out Worker'.Compensation pmvisiov of the Lataw Cock,you menu
.J O forthwith comply with such provisions or Nu Permit shall W doomed m used.
z 7) CONSTRUCTION LENDING AGENCY
P:.. I hammy drtm dual them its construction landing.gamy for Ne Performance of
1.4 the work for which Nis Permit 11 issued(Scc.309T,Civ.C.)
Q I.cMer's Name
z Undoes Add. _
U O 1 mnify that 1 have read this application and sum Nu the shove trienniums is
G.,
contract.1 agate to comply with all city and county ordinances and sum laws relating he
>, Wilding cavmatien,and turoby andenre mpnucoutieet of Nis city he color upon the
W ,Wee-mesuaned ul.propertytet for impaction purpowhich ta
fly, (We)agree to save,indemnify and keep barrel the City of Cupertino+gamut -
fIl liabilidn,udgments.cesu end eapenma which any wyaaanc agaivtuid City o
V z arse granting of Jc--
A NDER LL OMPLY WITH ALL NON-POINT Issued by: Date
REGU
-3-d� Re-roofs
signature of Appi vaaor Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant er future Wilding occupant srom orhandle hvudou mstenal
as dclircd by the Cupertino Municipal Codc,Chapter 9.12,arta the Nesbitand Safety
. 25532(.)?25532(.)?0y. All roofs shall be inspected prior to any roofing material being installed.
❑me
Will arc, licantt or fumm buildin occa t rte If a roof is installed without first obtainin an ins action,I agree to remove
PP g pan equipmentor Mamswhich g P
Diumict udou air emuminE—ufic,qu
d by Ne Bay Arta Air Qwlity Management alt new mattfrials for inspection.
❑Yes
I It.real the sN kernewu rCh&Nm6.95ofdneCdirm-
maHcalN elyc 'ors 25505.25533 .Iundermvnd NatirNe Wading '
does ore• l Na Po bilky b noir,Nc occupant of the
m wnimm roan, racc,ur"rcorOccupncy. Signature of Applicant Date
—03_ eye
wrcrmauthenred,ge Date All roof coverings to be Class'W'or better .