07120235 CITY OF CUPERTINO
BUILDING DIVISION PERMIT p C0„NTRACTORjNF0RMATION,
BUILDING D ESS: PERMIT NO.
N STELLING RD LANDMARK DEVELOPMENT 07120235
NER'S NAME: IVIN PERMIT ISSUE DATE
AS PALMAS STELA,.FNG LLC 1307 ' S MARY AVE STE 120 09/03/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHITEC rENGINEER: BUILDING PERMIT INFO
NEW TWO STORY TOWNHOUSE BLDG ELECT PLUMB MECH
X00 LICENSED CONTRACTOR'S DECLARATION '
O O O O
iI I hesch,affirm That 1 w licensed under provisions of Chapu r 9(Commencing Job Description
^Gwith section 7IXl0)of Di on3of lW Buslnea and Prafessbns Codc.aM my license is
„ in ren mr¢andeffect C.+CA33'f r/
g Z Liccnx s Lkg
t- Dam • Contractor
A CNf1ELTS DECLARATION JJ21A
O 1 undersand my Plans Nall W orad As public recortls
C—
ire
A G C; Licedu d professional
3 OWNER-BUILDER DECLARATION
a� f 1 hereby affirm Nal I am exempt fmm the Conlamoes Licnx Law for IM
00 following mason.(Sects 1031.5,Business and PmfeNOns Code:Any city or county
e$� which requires a permit to Construct,alms,is prow,demolish,or mpslr any..turn
°Zy prior on its issuance.also,requires the applicant for such pencil m rite a signed smmmcm
££
than he is licensed pursuant to Live pmvishav,Of the Contractor's IiceOC Law(Chaplv9 Sq.Ft.Floor Area Valuation
Y�$ (commencing with Section 70DO)of Division 3 of use Business amd Prornuons Code)or
that M Is exempt therefmrn and to Was for the alleged cxmptom Any violation of
Section 7031.5 by any applium for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
am.Ox than five hundred dollars(500). P Y YP
❑I.aawrcr of she laopmy,amY moPleyms with aagesalleisale compewton,
wiUdo IDCwVrk.NdIDaS uRisnnti=W wofferedfmY (SCC.7B .BYrllle9
and Profession Co lie The Contractors Uvne law does MI apply to an owmer of _ Required Inspections
pre,onywho Wildsorimpmws tMmon.and wWdassucDwork himxlrmthrough his
own employees,provided that such improvements art out imended oroRemd forsale.IL
however,the building or improvement is sold within one year of completion,the owner.
builder will have Are,burden of proving dust as,did not build or improve for purpose of
ate.).
0 1,As assn of to properly,am exclusively contruting with rimnscd conlracmn m
rm.I to projcm(Sec.7061.Business and Professions Code:)The Contractors U.
retie raw does not apply he an owner of property who builds or improves thereon,and
who Contracts for such projects with acontracmr(s)licensed pursuant in the Contractors
Liceme law.
❑lamexem"umaer Sec ,1181pcforNis won
nu Das
WORKERS COMPENSATION DECLARATION
I hereby affirm under penally of tendon,one of the following declarations:
❑Ihsw and w0l mainlaina Cmuriae ofConsenttoxlf-insure(ar Workers Compeer-
aura.a provided for by Section 3-/110 Of Ile labor Code.for the performs e,of the
work for which this pmnil is iaued.
❑1 have and will maintain Woft ea Compensation Insurer¢,As lequimd by Section
3700 of the labor Code,for the pouf..nee Of the wort forwhich this permit is issued.
my Workers com'pe'wuon law..artier and Poll,number art:
Cartier:�qMwf�/I Z"L.N n Polity No.:
CERTTRCATE''OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
nTisxeuon need not W coupIca d if the permit is forma hundred dit($IW)
Or leu)
1 ctnifY dust in Ne pnf°rmaacc Of Iba weals for which this permit is bound.l Nall am
employ any person in any manrerso as an become subject to lie Wortus'Cmnpen bsohm
Laws of Galiromia.Dae
Applicant
NOTICE TO APPLICANT:If,after mating this Certificate of Exemption.you should
become subject to the Worker's Compensation previsions a the LaDm Coda you mus
.J z forthwith comply with such provisions Or this permit Nall be deemed rewted.
z h CONSTRUCTION LENDING AGENCY
F Ihemhyafnrm that ft.is•ennsauctnn ternift.ganry for live performance Of
tYs s7 the work for which this permit is issued(S..3097,Civ.C-)
�W Q Lender's Name
z Iemices Address
U O 1 ewfy that I haw road TMs application and Sare Thu the AWw information is
`
Counsel-I agree m Comply with JI CITY And County CrIIt.and lam Tawe relating in
O[g�^ Wilding eonsuuction.W hereby Authorize xpwnuum of this city to encs upon the
W aWw-mentionedpmpent for Inspection purposes
•(We)agree to saw.indemnify and keep h Ik City of Cupertino Against
CA Iiebiliues.JWgments.costsand exprn5Z01PLY
nanYwayaccrueagaimtsad City
z inCo of u GastA 1 WITH ALL NON-POINT Issued by: Date 7�
FOU Uu
'O3^� Re-roofs
w
gum Of APP manU tractor 3
DOUS MATERIALS DISCLOSURE Type of Roof
Will Ne,pplicanl or future Wilding Occupant ase Orbardle bound.matente '
u dc0re i by Ik Cupeni. Monks W ode,Chapter 9.13,and the Health and Safery
Section 25532(.)7 All roofs shall be inspected prior to any roofing material being installed.
fin o
Will the applican or future Wilding Occupant use equipment Or devices which If a roof is installed without first obtaining an inspection,I agree to remove
Maori"?
it harardnn air contaminants u dcimcd by the Bay Area Air Quality Management all new materials for inspection.
❑Yrs NO
IhawmalthehuaNwsmamnal,m 'mm dcr .Chapmr6.95ofthe Califor.
ria Health& chy Code 'ons253f1 s 4.landersmndthaifthe Waning
don n II Aman A leility to..or,the occupant of the
muw k uCutifiraA of panty'^ 'r
� flJ Signature of Applicant Date
nor or,uthoro=d agent Date t All roof coverings to be Class'%¢"or better