07120233 CITY OF CUPERTINO ��y��a,,gg�� '�7!`g�.'�,1• k /'�"�"y�k,��' '("� `�
BUILDING DIVISION PE1LLYuT �xCO;�ey1�L1G -QR InVt4�1,t, IV, mN,` Y
BUILDIN ORES ' PERMIT NO.
i ;Pr�9i sN ST
RD LANDMARK DEVELOPMENT 07120233
NER'S NAME: CORP )Fo�T TOM PEGhnT'IS UEDATE
I.r113 PALMAS STEi.LING LLC 1307 S MARY AVE STE 120 09/03/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
NEW TWO STORY TOWNHOUSE BLDG ELECT PLUMB MECH
0 0 0 0
fop LICENSED CONTRACTORS DECLARATION '
U 1 Whil AMM that i he licensed under provisions of Chapter 9(commencing Jab Description
with Section 7")of Division 3 ofthe Busineas and Pear scans Code, mylicenseu
n n in fun(onto sew effect
ZUeemoe lass Lie.
�- Dale Corer lar
ee A HI'IFCTS DECLARATION Q
t I understood my plans shall he used u public records
�yU iii�"f
g G Licensed Pre fcsrioml
jOWNER-BUILDER DECLARATION
<f I bemby affirm that 1 am uempt fresh the Canlnctars License Law for the
E,e o following reason.(Section 7101.5,Business and Professions Code:Any city or county
which requires a permit in conumm,alter,illative.demolish,or repair any stroctum
_ice prior te is issumcc.alio rryuires ate applicant for well Permit m file.signed summem
€ti his he.licensed p..art 10 Me pmvism.of Me Commeter'.Ixenee Low(air=9 Sq.Ft. Floor Area Valuation
(commencing with Section 7000)of Division 3 of doe Businw and Professions Cade)or
$ that k 1.exempt therefrom and Ne basis for the alleged exemption Any violation of
Section 70313 by arty applicant fora permit subjects the applkli n to a civil penalty of APN Number Occupancy Type
net roam thea Bre hundred dollars(5500). P Y YP
❑I,as owner of the property.or my employe"wit cages as their wle compensation,
will do tiro wok.and We struclum is not intended or offered for.ale(See.7014,Busiaees
and Pror"sio"Cade:TLB Cerebral License Law arcs not appy m an owrcr or Required Inspections
property who Wilds m improves Merton,and who does such work Moral through his
awn employees.Provided dist such improvements Mm not it m thud or offered for We.IL
however,the building or improvement is Mold within one year of completion,the owns.
builder will have de burden of proving that k did col Wild or improve for purpose of
We.).
13 L as owner of the prolmrtY•am"elusively connoting with licensed contractors m
construct Me project(Sec.7044.Business and Professional Code)The Contractors U.
ave law does oat apply to an owner of proper won Wilde or improv Memos.and.
wW connacs for such projrc s with.canuanor(s)licensed pumorl to the Containers
License law.
❑Iame.cmplunder See .B&PCfarthio..
Disc
WORKERS COMPENSATION DECLARATION
I hereby offers under penalty of pmjury atm of Mt following dxlntiome:
rl I haw and will maintain a CentiO"mol consent in self-Insure far Workerscampen- -
mark for wpnroiuh this
this by Section 3'1000!the labor Code.fm the perfonnaruz of do
permit is Wrcd.
❑1 have and will maintain Workers Compensation Insurance,as required by Section
37W of the labor Code.for the performance of the work fa which this permit is issued. '
My Workers Competition lasutm carrier and Policy number n:
Cartier. [n Policy No.: a
RTIP7CATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Detssection noted rot ocomplemd if the permit u forone hundred danarM($100J
or leu)
I century that in f perfmmance of the work for which MI.permit is issued.I Mail not
employ any person in my mannose as in beco is subject to the Workers'CompevWon
laws of Calirentia.Dam
Applicant
NOTICE TO APPLICANT:If,oder making this Comfe"m of Exemption,you should
Wcame subject he the Workers Compensation provisions of the La Wr Code,you most
.J Z forthwith comply with such previous.or this permit Mail be Msmed rowked.
Z0 CONSTRUCTION LENDING AGENCY
[—I I hereby alarm Mal Nem is a conBructinn lending agency,for 0.perfomtuce of
p:> the work for which Mia Permit ts issued(Sec.309].Civ.C.)
QLenders Name
.7 Z Leadars AaNess
U Q, 1 ceNly mat 1 have mad his application and sum that the Move information u
w eoml I agree in empty with Al city and county oNInNNea sell a=hom missing in
Wilding construction,and hereby auehonre repnerenufivet or this city to cou r upon the
Move-mentioned property for inspection purposes
F y (Wt)agree in sew,indemnify and keep harmless tiro City o(CapeloLo dChy
IA Iiabiliti", mcnts.cp Bend e.penw whim n yacemc agalmossvd CityI—
C)z Ac I DER DIM L C PLY WRH ALL NON-POINT -Issued by: Date J'G/
Ecuun
Re-roofs
egnuum or ApplinnVCan r Due / si
HAZAADous MATERIALS DISCLOSURE Type of Roof
Will tic a Cupertino
m(Muni building o,Chantnom or andWle Health
mamnal
o de0ned by tic Cupertino Municipal Colo,Chapmr 9.13,and Me HedM and Safety
Section Tss37.(.)7/0.445,
All roofs shall be inspected prior to any roofing material being installed.
Y.
Will Me applicant or Future building mzui nt sex equipment or devices which If a roof is installed without firs[obtaining an inspection,I agree to remove
emit haaallous air commninans as defined by 0.Bay Area Air Qualify M...limem all new materials for inspection.
DiMuia7
OY"
I have real the nation.materials eequirenc Eer Choral 6,95 of tic Califor.
nia H"hL@Safelycode,5 .n5O53�t 3 d.l understand Wt ifthe Wilding
tm2thm mond that It ibilily m notify Me rccupmt of theuRW t •ccnifcac serOc Date
it S-03 c7� Signature of Applicantar..Ma�y Dom All roof coverings to be Class'1�"or better