07120225 FNER'S
ITY OF CUPERTINO ��s,��
BUILDING DIVISION. PERMIT kVo1�-YV1''tl l�'cjteA�'yOfr�f'AIA/ s °
IN ❑ ES PERMFTNO.
iInflD� K STGLLTNG RD LANDMARK DEVELOPMENT 07120225
WNAME: PERMrr LSUEDATE
AS PALMAS STELLTNG LLC 1307 S .MARY AVE STE 120 09/03/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
NEW TWO STORY TOWNHOUSE BLDG ELECT PLUMB MECH
u00 169 GF
LICENSED CONTRACTOR'S DECLARATION '
aF!� I herebyaffirm that I w licensed under pmviaioas of Chapter 9(commosemil Job Description
�erZE with Section lle)ND'"'' 3hfthe Business WPrafesdw COVd�e[.)�gd myl,ecmeu
in full face antl effect. YC (J33 r(
CJZ Own, . J Lie.
meq Da¢ Cs DizcDECrL i✓1
7W '^ AR If1ECsLARATION DAU /wl
U I uMcrsanJ my plans Nall W used as PUM1Iic rsoNa Ga
s G� Licensed Pmfcsnional V -
5
OWNER-BUILDER DECLARATION -
.� f I hcmby aflrm that 1 am acmpl from the Conuanors Uccnw Law for the
00 fallowing reason,fSectiun 7031.5.Business and Pmfessiom Code:My city.11...1,
$Pi which requires a Permit to comrmm.slur,impmw,demolish.or repair any suverum
_Zy Prim an its issuance.star rectums the Applicant for such pemtit to fila a signed sum ical
pp
"ba is liccamd pursuant to tho Provisions Of ft Contracten"License Law(Chapser 9 Sq.FL Floor Area Valuation
y $ (commencing with Scedon 7000)of Division 3 of the Business and Professions Cook)Or
that the Is exempt therefrom and Ile basis(m the alleged eumption.Any violation of
Secdm 703"by any applicant for a permit subjects the applicants to a civil Penalty of APN Number Occupancy e
mat mare Ilan eve hundred dollms(5300). P Y +]�yy'P
E I,nmmroftbopmpmyormYemploywwiNmgmulhe mkcompenudon.
and tlo Newons Code:The ontumtuLia hrane does
a(Sec.in sur Bosuns
alta property
lu9as Code:The Conlracmrt and w1be law tach act apply lf an sums is Required Inspections
man enywho WildaorimProwachimprwments who doe samhwakhimalforNrough his
ownr,cr.metf,dovided pnat such imptmid wimin an[intended of ompletred for humn,
safe.If.
however.Ne building ft orimpmwmmn It mid ed did will haw Ile burden of taming Nos k did rot build or improve(m purpose of '
❑I.u owner of the property,am exeluiwly eoulMinL with licemud comma m s to
construct ft majM(Sec.701x,Beat..and Professions Code:)The Couu,esora Li- .
..law does not apply in an owner of property who Wires or impasses thereon.antl
who coupes for such projects with aconuacmr(O licensed pursuant m the Contractors
Licence U-
0'...."underSec. .B&PCfurlhisrenan
Data
WORKER'S COMPENSATION DECLARATION
I hereby air=under penalty of perjury one of the following declalNmcm
E I haw and will maintain a Ccnifinu of Conant to self-Iume fm Workers Continua.
sataun,as provided for by Section 3100 of the labor Code,for dm performers of am
work for which this Permit is wood.
E 1 have and will maintain Worters Compensation lamer nee.as required by Section
37Wo(me labor Code.for NC Performance of the wort forwhich this permit is issued.
My Wohrls Compensman Iwrvue carrier and Policy number ere:
Canis: R W_�G�1l;.I�Policy No.:
CEICfIFIGTE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE .
(Odsseemat head not be campkud if the Permit is forme hundrt9doll.(SIM)
muni)
I certify Nal in the performance of the work for which Nix permit is issued,I Nall ant
employ any person in my maonera as to become subject to do Workers'Compensation
U.of Califamis,Date
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should
become subject in Ne Workers Compensation provisions of Ne labor Code.you mum
.J O forthwith comply with such Fovisiom or Nis Permit shall W decmW mmkcd. ..-
y CONSTRUCTION LENDING AGENCY
(-+ Iherebyaffrm that ft.a.eomuucdm lemdingageney for the surfornametuf
C > Ne wale ran which Thu Permit Is issued(Ser.3097.Cir.C.) ..
QLanders Name
z Lenders Add.
U p 1 mtify that l law read this application and sera that On abuse information Is
LT. cones I agree to comply with all city and county ordinances and a=Iowa misting m
.0 building commuctum.and hereby suthoria mp,ematives of this city to calm upon tit
shave-nommand property for impeNon purposes.
CL Wc) Io sew.indemnify dkeephwksslhe Ch (Cuperlino,gainst
tjr/) liabilid gm .e ea which a it way agumisid Cuy
x me ling of
^ A LI ER A W OMP L ITH ALL NON-POINT Issued by: Date �c `]•a Zr
so GULATIo
Re-roofs w
ngnuure ofApplicaHAZARama Data
HAZARD SMATERIALSOISCLOSURE Type of Roof
Will ticappliant or forum Wll "n9 me IN.Thandkhaardoumaarial
ss dcfned by Ne Cape Mums Cadc.Gaper 9.13,and the Health and Safety
.scum zss3z(,n All roofs shall be inspected prior to an roofing material beim
❑tier P P Y g g installed.
Will On.pplicans (alae building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hwommus air cmlemin,nts dcfmd by the Bay Ama Air Quality Managcmenl all new materials for inspection.
D thiel?
Etih No
Ihawmwlthehasmmmrmkri qui a Ierb.93 of the Glife,
nu Health Codc,Scc' U rsund than Rthc Wilding
Jus y l nlil neof,the occupant of du
regniremcna ora ruampf 'Pency.� Signature of Applicant Date
G. or a aedagcm Dam All roof coverings to be Class'jg"or better