07120230 CITY OF CUPERTINO
BUILDING DIVISION PERMIT +,SCO - ; i 'Q MAT'IdN
3 ...r
BUILDING ADDRESS: PERMIT NO.
Jl?113 N STE.I'.J.,ING RD LANDMARK DEVELOPMENT 07120230
W NER'S NAME: PEMOT ISSUEDATE
A`.-3 PALMAS STELLING LLC 1307 S MARY AVE STE 120 09/03/2008
PHONE SANITARY NO. CONTROL NO.
ARCHIIECDENGINEER: BUILDING PERMIT INFO
NEW TWO STORY TOWNHOUSE BLDG ELECT PLUMB MECH
O O O O
�O o 69 BF
LICENSED CONTRACTOR'S DECLARATION ' Job Description
1 booth,.Norm Nal I are Ikuvcd undcc ProviSons of Chapin 9(mm
mcrco
ing
m`uf with Sccaan 700)of Divi' 3af Nrs�u
e BusioM Pra(euimu Cade. x
andmYlicenu
^_ in full force and effccL3 9
Z Liccnm Class Lk.t
Conuapm�Nvt+
Q 7W RCHITECf'S DLl
ECLAR kmooi ;nAr/N
U
1 undenond my plans shall W used a public records AO
9��+� Licensed Pmfeumnal C_
5 OWNER-BUILDER DECLARATION
rye 1 bemby sperm that I am exempt from the Contractor's Ueensc Law for the
,no following won.(Seedon 7831.5.Bu mess and Professors Caddo:My city or County
5$ which require•permit no coosvcL star.improve.demolish.r¢pair any struaere
_Z< prior to is issuance.also trapdoor led applicant its such permit N file a signed mammon,
pp that he is licensed poroomn to the pmvisloru of the Canuacmra Ute se Law(Chapter 9 Sq.Ft.Floor Area Valuation
Y�9 (commencing with Section 700M of Division 3 of the Business and Prof'ons Code)or
that he is eaerept abortion and Us basis For the alleged eaumptrs MY violation of
Section 7811.5 by any applicant for.permit subjects the applicant to a civil penalty of APN Number Occupancy e
Cor Come than five hundred dollars(SSW). P Y TYP
O I,u owner Clubs property.or my employee with wage u theins role cvmpemation,
and pr the wart dna the he Com u rmtinLnded r offeree s n,apply 70an,Bust r of
dna professionsuMbu Case:The Conuecmrs rad he 4w sae err appy lf an owner is _ Required Inspections
own ertywM builds i improv chicon,and who meauchwandt motioa lthrough his
however.
miproNded Nawar improwmenu me Cut ear Oferoacrcd fray B,
however,ds Wilding or Wprawment is mW within arc year of c prove for the law,of
Wilde will have the Wrdu of proving Nat he did not Wild or improve for puryoe of
0 1.as owner of the property,w eclusiwly conoaa rtz with licensed contractors to
Comment the project(Sec.7040,Business and Professions Code:)The Conpxmra U.
Came Law does not apply b to owner of property who Wilds or improv thereon.md
who Contracts for lulls proplas with a contraaort+l licensed pursuat to the Contrumes
License Law.
❑lameumptundr5e, ,BAPCrrohisneamn
ere Due
WORKERS COMPENSATION DECLARATION
I hereby ape under penalty of perjury ane or the fallowing declarations:
❑I hew aM will mainoin•Cenifias of Consent mself-In+utr fur Warta'+Compem
salon,a provided fur by Section 37W of the Labor Coal.its the performance of the
work for which this permit is issued.
1 have and will rnmanin Workers Compenssuan Insurance,as required by ScC ion
37110 of the Lahr Cade.rr the performance of the wart for whin,this permit 4'Wand.
My Winter ectopemmon Instate carica and Poliry number ice:
Carrier, Poliry No.: 4
CERf1FlG O PnON FROM WORKERS'
COMPENSATION INSURANCE
(Thu section lead Out W complemd If oW permit is fronchundrtd dollars($1 00)
on,ma)
1 unify that in the performance of the,wmk for whish this permit is bound.l Nall not
employ any person in try manere,as in become subject to es Workers'Compensation
Laws of Caliromia.Dar
Applicant
NOTICE TO APPLICANT:If,after malting this Ccnifies of Facmplion.you should
become subject in the Workers Compenato t previsions of the Labor Code.you most
.,O fonhwioh comply with each provWC.r Nu permit shall W deemed revoked.
zVl CONSTRUCTION LENDING AGENCY y
[-� I hemhy alarm that there u a construction lending agency for the performance of
ce the well far which this permit is iasued(Sr.3097,Civ.C.)
WW Q Lemicrs Name
=z Lcndeh Address,
V C I curtly Nat 1 have rad this+pplicuion and male Can the shove information is
ls. crrcCL I ogre to comply with all City and County omit s and soon laws reladng to
.Q Wilding CanswNon.aM hereby suNria repmeautiv of this lily to enter Open the
W +bow-mrntioncd property for impeaion purypxs
" C
(WO)agree to ave,indemnify and keep humlm 8e City of Cupertino against
to liabilides,lud ments.cruand epense which maYN VY wyaarue agalnu+eid City
U z in ca of nnthn of Nu
^ APP E0. DSA OMP WITH ALL NON-POINTO Issued by: Date
ULA S.
SfIM
Re-roofs
um or ApplicaHAZA Dam
HAZAR use MATERIALS DISCLOSURE Type of Roof
WH LacapCu eanor nefuuuc Wilding .Chaptsmreor and Ch Hardow mamri+l
u honed by Ne CupeniCo Municipal Chapter 9.13,and ted Health and Safely
Section zss3z(.)7 All roofs shall be inspected prior to any roofing material being installed.
Yes u
If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicv r rectum Wildon oavpant sae cgWpmrnt r devices which g
emit hazardous air contaminants u by Ne Bay Asa Air Quality Management all new materials for inspection.
DiurictT
❑Ye No
Ibmwmalthe haaNmusmaterWix me on ChmtCr6.95ofthCCalifr-
nieHralNd:SdttyCode. Cd 2550 3 5 undersnd thuif Ne Wilding
a ntiyh icer is M itymnudfytheaaupatofdc
uu or 'fsatoroteuymal,.
Ir _ 0 Signature of Applicant Date
wncrraaNarirca gen, Data All roof coverings to be Class'%?."or better