07120220 (2) CITY OF CUPERTINO
BUILDING DIVISIONPERMIT t#CONTRA CTUR"IIVI`QItMA.TION ' „
BUILDIGADDRESS: PERMIT NO.
`i...i N STELIANG RID LANDMARK DEVELOPMENT 07120220
NEWS NAME: PERMIT ISSUE DAIS
AS i'AIVAS STELL:LNG I',LC 1307 S MARY AVE STE 120 09/03/2008
PHONE: SANITARY NO. CONTROL NO,
ARCHITEC IFNGINEER: BUILDING PERMIT INFO
NEW TWO STORY TOWNHOUSE BLDG eLEcr PLUMB MECH
2399
upQ LICENSED CONTRACTORS DECLARATION ' O O
1 bmeby alUrto that I w li¢,vW under provisions of Chapter 9 frnmmcrring Job Description
with Swan 7").f Division 3.(the Based.and Pro(rssio,♦u`Code.and my Ikena 4
4 fullrand and cffec,. Z/83 3 T 9
n� License Clang Lie.#
e� Ds¢ g_n-n_-�P Carmner L dnO
Jar-1 IK WL W_
—c�ARCHnWrS DECLARATION�
V I mdcmand my plans shall he used n public records 1.0
EQ� Licensed professional
`y3 OWNER-BUILDER DECLARATION
ai i f I hereby alBon that 1 am cnmpt from dao Conaamo's License Law for Ne
p o following,comm.(Salon 70313,Busucess and Penfessiom Code:My city or county
e m whish requires a permit on cnmums after,improve,demolish.Or repair my suatum
prior to its issuance.amuquiru Ne.,licant fmsmb permit to file a signed uaNmcm
that he is licensed'urnwto the provisions of the Common's Ucense Law(charmer 9 Sq.Ft. Floor Area Valuation
1- (commcaing with Section 7000)of Division 3 of the Business and Profesiou code).,
that he 4 eaempt therefrom and an,buds for tiro alleged<xmptiaa.Any violadan of
Sermon 7031.5 by a"applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy e
rot mom dun five handout dollars(SMP y ZYP
L asowner and
phesunu , emY empleyees with segsorNeo03c.campeuzasts
will do fe workd..ands: swmum ds m's Licens or offered wa cat.(ps.70th,Buzwner o.
ma stoy whom Code:The canaxmn License Law does not apply lf an mvhar is Required Inspections
property who builds orimprovesch improvements
mp,arm who denssantwok himself ulNmugM1 his
Own employees.er.mWiprovided dun such imprm id wit am not intandW moeered for mover.
however.Neowth Lmimprovement4mid within at Wild or improse for the owhar.
Wilder will h.ve the WNen of provin6 that he did non build m impend for purpose of
sine.).
❑1,u owner of the property,am exclusively contracting with licensed mnaacmm N
construct than project(Sec,7044,Business and professions Code)The Contractors U. .
come Law does not apply N an owner of property who W ilos or improves daemon,and
who c.naams for such projects with a canamNr(s)licensed pursuant N the Canuacton
License Law.
❑lameaennin-mm5m. ,B&PCfm N4maon
ncr Data
WORKER'S COMPENSATION DECLARATION "
I hemby afBom under penalty of perjury ane of the fallowing declarations:
❑thaw andwill main Section
3dm of the
Lalarxcia,fumhe Wooten Compeer
nt(on,r provided for mi Section 3700 of tirc[sbm Cade,for the Performance of the
went far which this pcnlnil is issued.
❑1 have and will maintain Worker Compensation Insurance,as enquired by Sermon
3700 of the Labo Code,far d e pe,f..c..f the work fm which this pandit 4 issued. _
My Workers Compensation Insurance cassia,and Policy number son:
Caniv. %EM Peliry No.:Yr( L�L111
ERTI OF MON MOM WORKERS'
COMPENSATION INSURANCE
(This section hand rot be completed lithe Permit 4 fca n:AunNed d.Oan(5100)
or tas>)
I catry Net in the pesformaae of the work for which this permit is issued.l shall not
employ any person in my mamterm u to become subject to the Worktrn'Compon-don
Laws of Caifomia.Data
Applicants
NOTICE TO APPLICANT:If.spar making this Cenifiute of Exemption you should
become subject N im Wmkers Compensation provisimu of Ne LOor Cade,you mw
,7 Z fanhwith comply with such Pmv4loas as,this permit"I W damrA mroked,
Z O CONmucrION LENDING AGENCY
[-,,•+ I hemby slfrm that Nem is.,ch nhcdon lendingagahay far Ne perfmmaaeaf
Q: the work for which this permit is issued(Sec.3097,Civ.C.)
Lenders Name
z Landers Andress
U O 1 eerily that I have read that application aM sesta that the almm infmmation is .
[g. P emotes.I agree N cmnply with all city and county ordinance and sum laws relating no
OU Wilding construction.and hereby authorise representatives of this city to ohm upon Ne,
[A
move-cs,pea property for i hsea.
inspection whic
H LL (We,)agree to save,indemnify and kap homeless the CITY of Capcnino against
fn Iiabilities,jWgramenu.costs andexpeeses which may any my acLllne ajainst mid City
U z m co mote of grmting.(Nis i
F-t APP ER ANDS LL OMPLY WITH ALL NON-POINT Issued by: Date
esu 5.
�46
Re-roofs
dare of ApplianuCon l.r Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will tis applicant or far.Wilding occupant some or bundle basallous m,,r.1
u derhad by Ne Cupertim Municipal Code,,Chapter 9.13,and Ne Health and Safety
Saaan 25532(.)+ / All roofs shall be inspected prior to any roofing material being installed.
Yes �T.
Will the applicant orfutureWilding aceupanl tax cquipmenl ter devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hmirdom air commutations as de0had by Ne,Bay Area Air Quality M...gcamm all new materials for inspection.
District? P
Y. Nu
I have mad thehdmduus matarlalsmgvimmcntsu der .Chaptard.95oflbe Czli(or.
.I.Heal"SafclyCode,Sections 25505,25533 eoW 25 .I understand NU If the Wilding
dna anent a tan L tis m IIItyN notify tie oaupant of the
myquw u;hmhm mel asrcc aCcrvBcaN�JOOpanry. Ovt, Signature of Applicant Date
w..,.r,..benrcd aErnt Data All roof coverings to be Class'%T'or better