07120221 (2) CITY OF CUE
BUILDING DIVISION PERNIIT Ci1NTRAGTQRINTaURMATION`��
BUIIDIN ADORES PERMITNO.
STELL,]NG RD LANDMARK DEVELOPMENT 07120221
NER'S NAME: PERMIT ISSUE DATE
!AS PALMAS STELL.FNG LLC 1307 S MARY AVE STE 120 09/03/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHTIECDENGINEER: BUILDING PER O
NEW TWO STORY TOWNHOUSE BLDG ELECTPLUMHMECH
is o ii LICENSED CONTRACTOR'S DECLARATION r O O
r� 1 henny alarm that 1 am licensed Under provisiom of Chapter 9(Commencing Job Description
with Sccdon T0M)ofDiSof the Rudnev and Prolessms CUde, my kmu
e
m�a, in full Tarte tnM ercmt, K � ��j if �'
. o�z Lianx a .V LY.B
Dau Contractor
ARCHITECTS DECLARATION ✓�V
ed
1 uMersuJ my plans shall he Owed
a ruhlic mcnrJs
ley C
o
Licensed Profrstlonal
OW NEas exempt
from
m Ce Conte ON
Z O E 1 hertby alaect that 1 am exempt from the casiond O e:Any C Law for the
p o whichfollowing mason.(Serum 710M,Business and Pm4sdoli Code:Any city ar county
e m_ which its i ms a reit re k.disc.alar.improw,demolish, fi caput ed struma
uZy Prior itscened palso rtgo the the tnpions of Norwich rami'70filessLco(sutemmt
Y < that heullmmeJ pSeems 7000)Of Disioese theContractor'sLicemessionsuPa9 Sq.FI. Floor Area Valuation
y�rs 'hit he sc amp, Senfrom nd of base,nlofthe BusicosaaMon.Anyavilaaec)om of
$ that k V wmp'thme(rom and the baso fa er alleged ewnpdom Any violaum of
Section 70313 by any applicants for a permit"bjccu the applicant to a civil pmalty of APN Number Occupancy
.1.thanit.lundtwdeftness(M). TYPe
Q 1.u Owner of d0)property,or my employees with"am a their Win compensation,
will do thewode.and the,suUctum it nor intended or offered for ale(See.IDH,Real.
and Professions Cade:The co"xWrs U.Law does tel apply W m owns or Required Inspections
property who WLldeorimPowstheseon,and whodoessuch weak himvVor through his
macmployces,provided that,"h improvements are not inteMoW orofferod forsala It.
however.the Wilding or improvement usold within aco year mf completion,the ownes-
Wilder ,will kw the Inedon of proving cast he did not Wild Or improve for purpose of
sale.).
Q 1.u owcor of the PoPerry,w exclusively contracting with Eeeeued enactors W
Comtnc'the project(Sec.70ss,Beat.amd P lesak ne,Code:)The Contractors U. _
c.Law does no'apply 70 an owner of property who Wilds or improves iss.m.and
who Contract;for such pmjem with aeon.Wr(.)licensed puesuam 70 the Contractors
License Law.
Q lameacmpsundw See ,B&PCforthismalon
na Dau
WORKER'S COMPENSATION DECLARATION
I hereby alRno under penalty of perjury arc of the following declvadom:
Q 1 kw eM wVl maintain a Ceeufmau ofComent 70 self-ivsuu far W�rkersCompen-
Won,an povidW for by Section 3]W of the Labor Code.for the performance of We .
work for which that permit is issuM
Q 1 have sodl will maintain Workers Compensation Insurance,as ox,ftn l by Section
37o0Of the,labor Cade.for the performance of the work for which this permit is maucd.
My WortrYasa��Compens�ate"����Insur///ra�+nnc��e,,,,c�u�ria and Policy number ane:
Cartier. CL�IIl1•y�]J[�Policy No.: - 4,r !jl
CERTI CATEO EKEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thisxcu"coed mtkconpleted lithe Knoit is forum hun&Ud dollars(SIM) .
or less.)
1 Certify cont in the performance of the rah for watch this Amit is bound.I shall not
employ any Person in any mamcrw as W become subject to the Wortrn'Cwnpwd"
Laws of ChArnmis Dale
Applicant
NOTICE TO APPLICANT.If,after making this Certificate of Exemption,you bmW
become subject W the Workers Compensation provisions of the Labor Cod,you mute
0 forthwith comply with such provisiom or this permit shall W deemed revoked.
Z y CONSTRUCTION LENDING AGENCY
(~ Ikuhy.affinm that there is a construction lending agency for the performance of
E
the work for which this Knoll is issued(Sec.3097,Civ,C.)
A Under's Name
0z Lenders Add.
U O I every that 1 have read this application tons state that the above infonoadon is
IL E' correct,I ague 70 comply with all city nd arorty oNiejoas and sou len missing 70
O Wilding Construction.W hemby authorise representatives of this city W em erupnn the
above-menuacod rs.propertyse for inspection puryaxs
F 4 (We)agem 70 saw,indemnify tib keep historical the City of Cupertino agutut
I,, liabllides.jutlgmenu.cosu and exKmes which ma yway atrnuagainst said city
U vZ inc of ung Nu h
^ AP esu RSTA PLY WITH ALL NON-POINT Issued by: Date -o
x_039 Re-roofs
M
nuuu of Appliw70r Dau
DOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant no(muni Wilding k.Chapter
tnom or hackle t hvsAoanmaterial
sa definer io rte Cupertino Municipal Code.�upur 9.13.and U0)Health and Safety
Section 15532(01
0y. All roofs shall be inspected prior to any roofing material being installed.
No
Win the applicant or fume Wilding occupant sax equlpmm'or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit Wandes,sir contamirunu aJefired by the Bay Am Air Quality Mamgemcnt all new materials for inspection.
Q Yes P.1"/
I have mW the babod.materials re'.. esun*rChepterti.95oftheCalifor-
oW4calth&Salcty Code,Sx 25 5 5}T.Iunecnunddwif NC Wilding
times not en a t nL rtspo ility 70 nary eat occupant of the
rtqu' 'ch mus en trism. .ccrufacaWartxmpme,. Signature of Applicant Date
nee sir mthovetl age Dau
—a3— �� All roof coverings to be Class'%?."or better
'