07120224 CITY OF CUPERTINO
BUILDING DIVISI ON PERMIT
BUILDINGA DRESS: PERMIT NO.
U
108.�.. M STEL,L].NG RD LANDMARK DEVELOPMENT 07120224
NEWS NAME; CORPOrCTrT07— PERMIT ISSUE DAM
AS PALMS STELdANG LLC 1.307 S MARY AVE STE 120 09/03/2008
PHONE SANITARY NO. CONTROL NO.
ARCHITECTfENGTNEER: BUILDING PERMIT Iwo
NEW TWO STORY TOWNHOUSE BLDG ELECT PLUMB MECH
fop 23 9 9 SF OLICENSED CONTRACUOR'S DECLARATION
I hameby afford that I sout licensed under Provisions of Chapter 9 moreaderefing Job Description
3 fftB seadPoof Code�7:�py floareacts
H in full torte aha effect ��r/'
musew L
'ado
A I ELTS DECLARATION Ks'I
I understand my plans shall he used as public ressurels
x`at; Liccomed professional
OWNER-BUILDER DECI-ARATION
I lumby affirm that I am exempt from ft Canuourms License taw for the
fallowing...a.(scedi (n""Buouncess and ftfassm.Code:Any city.1 momy
which requires a .1ter.improve.cermAlst,area any shommare
Prior us its issuance.also requires the applicant for such permit us filea signed somadmal
me,Ise is licensed Potsdam to me Provisions of the Corrector's uccom Lsw(Chapter 9 Sq.Ft. Floor Are Valuation
with Sectict.700M of Division 3 of Um Business and Professions Coda)or
that he us exempt theatfrom and the basis for ft alleged catamption.Any violation of
Secured 7013 by any applicant far a Permit subjects an:applicant W a civil Penalty of APN Number Occupancy T�pe
.1 mom manfiva hundred dollstra ISM
0 i.nownerocNcpmputy.WMYMPIOYC"WiowagnuftbmkcamKmdon, I
Mlldoftwork.andthesv umil.tinlendedo,off..df..alm(Sac.7044,Busarestat
and Ponflessm.Com,IxCmurachm's License".don act apply to an—Of Required Inspections
property who buildiorienpornathemem,and w1bodocasuch work hicandalforthrough his
man employ=.provided that each improvements me not intended aroffiandi foram.If,
however.me building or improocradem.Issold within one yok,o(complamm.due owner-
Wilder will head that human of proving that he did an,muld or improve far purcm,of
[3 1,as owner of the Mprny,am exclusively contracting with liesemand comeacturam W
commods,the,project(Sax.7014.Business and Professions Code)The Com acmes U.
coma Use does not apply do an.of propen,who builds or imposes ft.,add,
who contracts for such prejeces with a contonsou(s)licensed presdam In the Contractor's
Lictrum law.
[]laudscumnap,anderSes, _.B&Pcfcddds..
fArnmr Dam—
WORKER'S COMPENSATION DECLARATION
I hareby affmat under pedualty of perjury arse of the following hcluuiorrc
n
sankar,as provided for by Section 37M of the labor Code.for the perfinumarme of me
work:far which this Permit is wood.
0 1 haw and will nine.Worse.Compearsolo.I...as ma,dined by Section
,37W.fft User Code.for the performance of Ne wort for which this Permit I.issued.
My Worker=Cmn.I or add Palm,number am,
Cartier. Policy No.: 0y,
S'" iQ
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Cf us auction dead not be compIctod if Ne permit isfor arc Imandral claflars(SIM)
or less.)
I camly Lhm I.um performance a the work for which this Nrrmh is bound.I sharl or,
..play a.,pawn in any andome,se as do become subject us ft WarkereCtencuunal..
laws of California.Dae
Apratman,
NOTICE TO APPLICANT.If.aner making this Certificate of Exemption,you should
become subject 0 the Workers compensation pronvisions,Of ft labor Code no mass
z forthwith comply with such movisiom,as this pasarnit shall be dicanned re,clead,
z 0 1
CONSTRUCTION LENDING AGENCY
Z7
I hereby anon that them is a cordsouracdon lending agency for the performance of
Ne work for which this Permit 4 hatted(sce,3097.Ch,C.)
LQ Lessees Name
D z hander's Add.
U C) I cardly that I havo read Bar applicand.and vau,that the above infarmad..is
LL, cammus.I agree at comply with all city and county ordinances and$law laws relating to
C) building constomfion,and thereby authorise representatives of this city to order upon the
LU abode-mentioned property for inspection purposax.
01. (We)agrece to ave,indemnify and keep harommaxi the City of Cupertino against
1habditesiodgmenroaccum,and Poems hits maym way.cine against was City
U z ca of team. this
A ca of DER 4D C PLY WITH ALL NON-POINT Issued by: Date
I
GMIX
Re-roofs
can
S.to Zf Appl'i ac
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will ft APPIhadd M future thelding cxcagllffltxara or handle,hazardsmat external
so defload b ft Cupertino
.a.M-7 1 Code.Claspic,9.12,tons ft Health andil Safety
'y
Section 25532 )?
or, CY. All roofs shall be inspected prior to any roofing material being installed.
Will ft.,Ii.t building decagonal,man equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
andithamokous.i,caramnern. r�n�dbyftB�yA.�AilQuaiLYMMISCMCRL all new materials for inspection.
Dwict?
0y.
Thaw malthte hes .mumm"on& "r6.95afthreCalifor.
ox" Col ff
3 1 a "
Hcxjm&S 39ul
me _gcay exims....251 5533 m ifft building
mr,
d h I 'am, I is any y th=amxad of ft
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z.foceaparmy.
0 t =I ora" 4 Signature of Applicant Date
All roof coverings to be Class'W or better
.are,m.utomixed7gdT