07120228 CITY OF CUPERTINO ��k��aa,,�g��-g� �y�� +�'T�i""�"�x�k,�
BUILDING DIVISION PEy�yygyT 9zC'0N'lr�� QR .Af�O I � IQ�
BUIIDIry�ilt DRESS PERMITNO.
STELLING RD LANDMARK DEVELOPMENT 07120228
NER'S NAME: PERMIT ISSUE DATE
AS PAI.IMAS STELLING LLC 1307 S MARY AVE STE 120 09/03/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMU INFO
NEW TWO STORY TOWNHOUSE BLDG ELECT PLUMB MECH
D O O O
LICENSED CONTRACTOR'S DECLARATION ' Job Description
F 1 hereby arBtm that 1 w licensed under provisions of Chapter 9(commencing
wiNS n7IX )ofDivision3afNCBudneuaot Profeaiom Cwey license is
n ran ra er and ercect 33`f7
�q_ "ice a:: Lr.•
n F q Da¢ Conuaner 1'N t
7WDECLARATION��
y 1 underunderstand my plans Nallit be be used as public msorN
e-0
6V
p
Licensed Professional
5
OWNER-BUILDER DECLARATION
CambaON
E f I thereby a1Rw that 11.exempt from He Cssim. o License Law o Tar He
p O following mason.(Sadat 1031.5.I.3,Business and on.dow-1 Cade:Any city or county
$ which mqufna a permit re ctrmmq pier,improve,demolish,or mash any uncture
prior m its issuance.p r also requires;the tiro applicant for such Permit to Lice s,signed(Ch.pucnt
O Holm islkgwitpurwantredoofDiviomofof Conuimea,a dProflsons;Co tcr9 Sq.F[. Floor Area Valuation
3
dust
me. with 70DO)of bou for of Useeged easaMPmfcssiomatim of
— Nu be u owpt thrsefym and the baso for the alleged eswptim AVY Nolauw of .
Section 7031.5 by airy,applicant fee a pewit subjects Ibe applicant to a civil penalty of APN Number Occupancy Type
haN
t mom an RK hundred sonars(5500). P Y YP
❑1,u owns of Ne property.m my wployw with wgo a Ue'v sok cvmpewtion,
arise dofowork.Code: nmemmawtkmotede aha do mruk(ser.toaa,Buttes
and property
case:The Cwvuers u.me Law dam or apply lf at owner er Required Inspections
property who builds or improve Hereon,and who daosuch work Mmselr edferule his
owe employees.provided Hu such impmwmwt in not mantled
ar cd cemoneyed(a sale.n
however,the building mdoutimprowereent imorinuhalt withinowyearerroomplcaw,deowar-
builder will haw the burden of prating that be did rot bulb or impmw for purpose of
uk.).
I,as sharer of He property.am exclusively convecting with licensed mntracers to
construct the project(Sec.]pea,Business and Pmrosdom Cade:)Tbe ContrxmYs V- .
owe Law doss not apply m an owner of property who builds or improve thereon,and
who contracts for such projects with a comractor(s)licensed pursuant m the Contractors
License Law.
❑lamexemptunda gee .BAPCrmddsronon
t Dam
WORKER'S COMPENSATION DECLARATION
1 hereby afriw doter actuary of perjury,arc or the fallowing decluukm:
❑IMndwillmainuinaCmufimmofComentwwlr-Imumfw Workers Compere
sa0on.a provided for by Section 3700 of the Labor Code.far He performance of the
work for which this permit u issued
❑I have and will maintain Workch Compensation Imursnce,as required by Session
3700o17 Ne labor Cade.for the perfawayseof the work for which this pewit is '
My Red Wmk ens Compensation Imuran.artier and Pol(ry number ice:
Cartier. QWM J4k11�Policy No.:
CERnFICATEOFE)(EMPIONFROMWO ERS'
COMPENSATION INSURANCE
(Thu section need not be completed irlhe pewit is forme hundred&It=(5100)
m kat)
1 wtify that in Nc performance of Ne weak for which this pewit is issued 1 Nall not
employ any penin in any mower so as m become subject rode Workcti Compensation
Laws of Califomla Date
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption.you Naubl
Weems subjeel m the Worker's Compematlon provisiom of the lahm Codc,you most
.J O forthwith comply with such prevism.m His pewit Nall be deemed mwkcd.
zt'-' CONSTRUCTION LENDING AGENCY
Ix> the work ferewhich this�permit is Wood
((Sm.�muaronknding agenry fm the performamm of
0.Q I.cndces Name Ser.3 3009],Civ.CJ
z Lodee.Address
U Q 1 certify that 1 haw rod His application and sou than the shote information is
LL conal 1 agree In empty with all city and county ordinances and state laws relating to
0 Wilding construction,and hereby authodmrepmsenuuwsofthis city tocow upon the
F WaMw-mentioned property fm impeniw puryo¢a
(We)agree to an.indemnify and kap hawlea the City of Cupertino against
to Itabilid. cuts,cons end expcma which may in wayucmeagaimtsaid City
V Z inco w r ng of Nu
A STA S AN LY WITH ALL NON-POINT Issued by: Date ,J�C
R TION
Date
uSu .o Appli
Re-roofs
14=71S
MATERIALS DISCLOSURE Type of Roof
Will tie applicant m future building occutmetuow or handle harudous material
as deMcd by Ne Cupertino Municip
❑y.Yes a otic,Clupur 9.12,and Ne Health and Safety
Or.Sc 255J2(a)? All roofs shall be inspected prior to any roofing material being installed.
a
Will the.Miami or form building asupout use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit ha'rudom air conZinanmucd by u e Bay Arta Air Quality Management all new materials for inspection.
❑YesIluwrootNe mquimmemumkr kr6.95ofdehlifor-
.iaHcol ctyeode,Seeaem sssos.0 7aW 235 lu round Nuif de huiiJing
d t ey h Nat' It wary tie occupant or Ne
wel I mora rcauor Signature of Applicant Date
�00
ncrorauthorvcd agent Dam All roof coverings to be Class'W'or better