07120232 CITY OF CUPERTINOk
BUILDING DIVISION PERAUT , C,ONTR"AACTUR I,1�I,ORMAT IOC'
q RESS: PERMIT NO.
BUILgING
O:rfl� N ST ELLING RD LANDMARK DEVELOPMENT 07120232
NER'S NAME: '
PERMD ISSUE DATE
iAS PALMAS STELLING LLC 1307 S MARY AVE STE 120 09/03/2008
7-H
ONE: SANITARY NO. CONTROL NO,
CXTIELT/ENGINEER: BUILDING PERMIT INFO
NEW TWOWO STORY TOWNHOUSE eLDc eLEcr PLUMB Mecx x
O O O O
11:746 SF
_O' LICENSED CONTRACIOWSDECIARATION ' JobDeacrition
Ot�F 1 beneby affirm that 1 sm licensed under pmrisions of Chapter 9(commencing P
ZZ wiNSeedon 7fO(l)af Divi' n3ofthe Bumneasan'd`Professions Coi.yUd mylicensO is
^jy in full(anceahacRcet 'T 37r /
qq
Data .— r' ConAR %'�1
DECLARATION n'-W ARCHf1ECTS DECLARATION
IuMcnsunJ my puns slWlhc Used as Public records
a
p Licensed Professional
OWNER-BUILDER DECLARATION
1 hereby aRrm Nat 11. exempt from the Cssions en l�Any c Law for the
Oa following mason.permit
17UDmm Business and va.dcsions Cents Any city Or County
S$9 which requires a pctmit to cnnswct tlmr.improv,dcmolbb,nr npoir any slmctuR
prior In its issuance.also nqui.don'PPlkant for such permit w film a signed statement
E C Na he is licensed purmant m the provisions of Ne Consomme,License law(Chapten9 Sq.Ft.Floor Area Valuation
(commencing with Section 700()of Division 1 of the Business and Pre(mians Code)Lir
$
that he b attempt memfmm and the l ssb for the almged easnptioo.Any violation of
Section 7011.5 by airy applicant for a permit subjects the applicant to a civil PcaILY Of APN Number Occupancy Type
not moss dun five hundred Mims(5500).
0 1,as mune,of Ne property.or my employees with wages as their sok ccroper admi,
will do the work.and thesomeone is not NRnded or Offered for sale(See.7046.Business Required Inspections
Nd Professions Cods,The COntraaon'.I.law dates rot apply m an owns,Of q P
pmpertywbo builds orimprowa Ihemon,and wbo doe.mch work himself Or Waugh his
own ampm,ecs,Provided Nn such improvements are not inmMed oroRened forsele.IL
however,do building or improvement is mid within Orc year of completion.ICs Ownen,
builder will Mw that buNan Of proving that M did rot build Or improve fn purpose of
ule.).
0 1.as Owner Of that p aparly,am saclourady conOssling with licensed rnnuanus m
construct the project(Sec.701x,Business and PmfeMom Cade)The Caamoh U.
cera law does out apply m an owner of property who build.or impsovet Merton.and
wow contracts far such projects with a contrawrt.)Iieensed p ossund to that Convector'.
Lorena Law.
0 lareeumptwdcr Sce40
.BkPCfn Nb reaaO
nu Dam
WORKER'S COMPENSATION DECLARATION
1 hereby affirm muter parody of perjury one of that following duclaations
0 1 haw:and will maintain a Certificate ofcoment to sslf-im u n fa Workefscompen-
salon,u Provided few by Section 1700 of me Labor Code.for the performance:of the
work for which this permit is issued.
0 1 have and will maintain WarkeYs Compensation Insurance,as Rqumod by Sectio
07000f the Lmor Code.fm the performance oftbo were fofwhich this permit is Wood. '
My weree' ompensation Luta/ran carom aha Policy numbs ae:
Canner. L('' L .,my No.: o e0 tx
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
('Otis section need not becomplemd ifthe Permit b Ensure hundred dollas(SIM)
or less)
1 cutih that in W prrfon at.of the work fa which this permit is issued.I shall uct
employ any person in my mannerm as to become mbjeet to the Worker'Compensation
laws Of Caliromia.Date
Applicant
NOTICE TO APPLICANT:If,all making this Certificate of Exemption,you should
become subject in the Worker.Compensation provisions of the Labor Code,you must
vJ O fOMW.O comply with such Provisions Or this permit Nall be dcemed nwW.d.
ZN CONsrRUCf10N LENDING AGENCY
I hereby Ilion that them Is a construction lending agency for the performance of
!Yi� the work mi
for which this Pert b Wood(See1191
1 ,Civ.C)
tg7 A landars Name
jz Landers Address
U O 1 certify that I have read this application and some that the above iNormatme b
gL correct I agree to cam Ply with all city arm county ONinasv ab sum larval relating m
8 building construction,and bembymNonR rep.matiwsofthbcilym cnmrupm 0e
above-mentioned property,for inspection purposes
W (We)agree to ave,indemnifyand lura hamlets tbo Cit of C
V Z Imbilitimjodgmenu.cosu aha nsesw icA ma man y 'wsrinoagaitW
inc of anti fNi. t. y yvny acctue agunusum city
I ERST D Y WITH ALL NON-POINT Issued by: Date
cU T
Re-roofs
um of App' vCon Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Wt0 the applicant or future Indicting aecYpantvore or handle hanard.macrid
Us defined by the Cupertino Municipal C .Chapter 9.12.and W Health and Safety
Section zsssz(,)7 All roofs shall be inspected prior to any roofing material being installed.
Tes O
If a roof is installed without first obtaining an inspection,I agree to remove
Wil:the appliaan or future building Occupant Olson equipment or devices which g
emit ham ndoes Lir commumnss u defined the Bay Ana Air Quality Management all new materials for inspection.
District?
❑Ys u
I have read thehaarel.materials rtElomuns purr 6.95 of me,Califor.
nbxcal"SafctyCade•Scctiats255113. 1 thairte building
does uct nth m mib' w notify the occupant of the
R must he cot 'Gram of Occupancy.
l Signature of Applicant Date
All roof coverings to be Class'n„„ or better
nor or rmhoris .gem Dam' g /'f