07120236 CITY OF CUPERTINO
BUILDING DIVISION PERMIT rkCONTTRA5�gl,`
Rp,�.. ........
BU PE.R. r NO.
lm:li��,�Pjor"SNS: STELIA.NG RD LANDMARK DEVELOPMENT 0'7120236
VNERS NAME: PERMIT ISSUE DATE
AS PAIVAS STELL[NG LLC 1307 S MARY AVE STE 120 09/03/2008
PHONE SANITARY NO. CONTROL NO.
BUILDING PERMIT INFO
ARCHOTCT�GT?4EER: NEW TWO STORY TOWNHOUSE BLDG ELECT PLUMB MECH
�
a LICENSED CONTRACTORS DECLARATION 1, ;46 SF Job Descript I ion
U- I mmbyarione i[mi��u�rpmvwouorc�pwr9(commencins
xx with&cdm70(l0)ofDiisionSof tier Rusimv and NofcsdumCode.A mylicmmi3
n!".111.171V ell
coo
RCHITEC�DECI-ARATION
Imoknumd my plans mail W me
as Public onxtodis
'u.t; Lmossed professional
OWNER-BUILDER DECLARATION
:21 1 hereby afforn=N]"m exempt from me Contrxetm`3 Uccose Law for the,
C 110 1.5,Business and Professions,Code:Any city or county
In 0 following moan.(Section I
which reunres a Permit to commuct.alcor,Improve, Wrolish.or repair my structure
prior In its issuance.atm oxi.i.the."Inam for such permit in flic.ugood xWerno.1
thut Ise is licensed puratmen to the Provisions of Ise Contractor's Uccoce,Law(chapter 9 Sq.Ft.Floor Area Valuation
Res with Section 7000)of Division 3 of the Business and Profession Code)or
that he it exempt therefrom and the basis for the,alleged exemption.Any violad,an of
Section 7031.5 by any applicant for a permit subjects dim application in a civil penalty of APN Number Occupancy Type
net.moa live heafted dollars(55001
0 I'sts.rAtIbe property.orroyemployer with.,A astaceirammorepenchation.
and Poslemimu Cole:
Th.Com cause,
Lt..Law does hot apply to a...,,of Required Inspections
propenywho Wilda ori on,crou thereen,andwito doessuchwank himselfor through his
ovenernpl.,us,provided that mach intpomwormou antraw intended orrallexed forsk.If.
thowever.ft Wilcing or Wpm.,is sold within 0m year of emepteres.W.
Wilda will love the burden of proving that Ise did act Wild or improve for purpose of
sadc.).
0 1,"ame,of tio,property son exclusively contracting with licensed===is
construct the project(Sec.7W.B.Ameas and Powflesshms Cd.)The Combesema's U.
coom Law deo som apply in..of property who Wilda or improvest dhancon.me
who contracts few such projects with a coommunu)licensed purse oe the Committees
License Lan
exempt order See. _.B&P C for this resent
Date
WORKER'S COMPENSATION DECLARATION
I Inner,Alone under peruh,of perjury...of the following cledarsalmor:
E]I traw and will maintain a Cenificam ofConsent to self-loom forWorkers Compen-
sation.u Provided for by Section 3700 of the Labor Code,for the Performance of ft
work for which this permit Is issued.
Fl I have and will maintain Workers Compensation Insurance,as required!by Section
3700 of the I.Amr Code.for to Performance ofthe:work forwhich this permit is iuw&
My Workers Compensation Insurance carrier and Policy
PoliNo.:mntoare.
C.. A �CEi�CATS0EX&MON '
No
FROM WORKERS
COMPENSATION INSURANCE
(Tltia semon need sm Im compicool if the Permit is forms,hundred Mflent(SIM)
ar less)
I cenifY don in the pvfonearme of ithe worts for which this Permit 4 moved.I mail not
employ any person in my mannerst,as to beemo,subject in the Worlocra'Compensation
Laws of California.Dam
Applicant
NOnCE TO APPLICANT.If.Ater noticing this Ocnifiesse of Exemption,you should
become subject W the woran's Compensation provisions,of do,UW,Codc,you most
z forthwith comply with such provistano or this Permit 091 W deemed rocked.
Z C
I C0NsrpUcnON LENDING AGENCY
I thereby affora thart ft.is ammstionnots.lending agency for the petf(monamc of
ft were to,which Nis Permit Is Wood(Sex.3097.Cl,Q
Lenders Name
z Urnices Add.
U 0 1 CordlY Into I have road this application and sum that ft above iffoonation is
Ll, commes.I agree in comply with all city and county ordinances and sum laws routing m
Wilding chromosome,and hereby amborine representatives;ofthis city re come trims the
alcove-mcnitorml Miserly for Inspection Purposes.
93. (We)."..to save,indemnify and keep harmless the City of Cupertino against
liabilifles,judgmemns,cons and expenses which mryi
U in co f do,greenling of this iL y way..against said City
APP k—,r �, by: Date
�U6MSA Ds PLY WITH ALL NON- Issued
Re-roofs
S1g.mcofAp,IiZS.t/CmooW Date
HAZARbnu.q MATERIALS DISCLOSURE Type of Roof
Will tie applicantorfuture
as defined by ft Cupordi Municip Chapter 9.12.and ft Hestili and!Safety
(10 Section 25532(.)?
0 Yes All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or rotore building occopant nom equipment or devices which
Unit loommos A,ocasomminams as/defined by ft Bay A.Al,Quality Management all new materials for inspection.
DwctT
0 Yes
I have read ilm lemardoxontateriAs.�tpnoxrnoms ;W6.95aftheCalifor.
=. ILh ty �25305.25!D`3 madermand thatifft bodichng
th thern
G move that it mi y se really ft occupant or ft
req en ch moss ot Prior , of ficas,of rP - Signature of Applicant
ev Date
91"'f-
Qlafirc, aomuzo.,em Dow All roof coverings to be Class'W`or better