07120222 (2) CITY OF CUPERTINO �
BUILDING DIVISION PERMIT 4ACo 1�[1C�" It g✓<�Q. A ION q
BUILDING ADDRESS: PERMU NO.
10827 N STELLING RD LANDMARK DEVELOPMENT 07120222
NEWS,NAME: -- PERMIT ISSUE DATE
I„ S PAI.,MAS STELLING LI;C 1307 S MARY AVE STE 120 09/03/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: NEW TWO STORY TOWNHOUSE 'BLDG BUILDING PERO
ELECr PLUMB MECH
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u O a LICENSED CONTRACTOR'S DECLARATION ' Job Description
rd U 1 hme 0 dorm Division
1 am of
T a under provision of Chapmr 9(commencing P n
Z aim Sution 70(MB of Division J of me Budneu and Prafessium Cox.and my license is
n<G NfOII fO1CeaM en •
�� I3cer,se Clan Lle.g B 3 3 Y
Dau Cansastdr
££ ARCHITECTS DECLARATION JdGr-
W� 1 uMemand my Plots aNll de used u public msords ��. ✓J
g a� Licensed Professional
5OWNER-BUILDER DECLARATION
I hcrchy oRrnr,Nu 1 am exempt from Ne Conuacurs I-Ece.Law for the
00 following mumn.(Section 7031.5.Business and Pretentious Cade:Any city or county
e
291. which residues a permit to coneu t.alter.impm e.demolish.or minor any urectum
u=< pd.,he its ismaM..also requires thcapplieant far such permit o fleasigned comment
that hcialicensed purm.mtothsprovisions ofinecondacteraLicense LswChapter 9 Sq.Ft.Floor Area Valuation
r�s (commencing with Seetion]000)MDivbion7 of me Bminessam Profesainm Cadc)or
e5R that he is commit than.fmm and the basis for this alleged ssemPdon.Any violuian of
Section 7071.5 by M applicant for a Permit subjects the applicant to a civil pcoalty of APN Number Occupancy Type
rot mart man five hundred dollars(S500). P Y YP
Q 1,a ownm or the property.or my employes wish wages as their mle compensation,
wiummewart wmemm
dmmw
eismotExcitednfferedfore(Sec.70".Bushim Required actions
and Pmfcsdmrn Cade:The Contractors License Law dam ant apply to attm an wof q p
pmpeny wbo bdlds m improves mmeon,and who des such work himself or through his
own employees,provided that such improvemanu art not Exhaled!straitened for sale.B.
however,the building or Improvement is sold within one year of completion.the owner,
buildu will have the bidden of proving that he did not build or improve for WTnse of
sale.).
❑I,as caner of tiro property,am inclusively consisting with Bcomed conoacton b -
constmct me project(Sec.7064,Business and Profession Cade:)M Conuaemr's V.
ceNe Law dean not apply b an Owner of property who Wilds or improve;meman,and,
who comma for such pro scut with a conuactoga)licensed pursuant he the Contractors
Le..Law.
EI lameaemptundm See .08PCformbreason
Peter
m Dan,
WORKERS COMPENSATION DECLARATION
I hereby affirm miler peaty,or perjury one or the following decimations
1 kve.M wBl mainuin a Cenifiam of Cement mself-Insure fa Wmters Compcm
sation,as provided for by Section 3700 of he labor Cade,fm me pnfomanee of the
wad[for which this permit In broad.
❑I ban cab will mainum Worgeh Comper cation Immranco,as twined by Section
37W of the labor Cox,for,me performarom of me were For which thin permit is issued.
My Woke s Co pewtian Imm�ana curio and Policy number art:
Grsicr. wen Polity No.:
CERTIFICATE FEXEMMONFROMWORKER3'
COMPENSATION INSURANCE
(Tbbmcdw need not becomplemd time permit is Teens hundred dollars(5100)
or less)
I sonify,Nat in tiro scife ape or me work for which this permit b issued.l shad rpt
employ any peen.in any manner.as b become subject tome worach'Compensation
Laws of Califamia Dau
Applicant
NOTICE TO APPUCANT:IL after making this Cenilicau of Exemption,you,should
because subject m me Wade rat Compensation provisions Of Eve,tabor Cade,you am
.J O faMwim comply with such pmvisimu or mus Permit"I he deemW evoked.
.'z., CONMUC71ON LENDING AGENCY
r
(•+ I hereby which nmchumcrt is a d(Sec.30 lending agency for the performance of
Cru L e work for which rob Permit b issued(See.lfM,Civ.C.)
6Wi Q Lenders Name
a � l.cndeh AAdrcsa
J Q 1 cmtify chat 1 have mad this application and sum that me above information is
ty E•' comma I ages to comply with all city and or,,aNinupca and sum laws relating u
.Q V building connotation.and hereby mthauve mpressnuGvts of mu city to cnwupan the
r[27 shove-mendaned pot for inspersion purposes. —
1••,w (we)agme to YK,indemnify and keep hannl we City of Cupertino.gaiat
rat liabilities.judgments,tofu and estimates which at anywayamueagafmisaid Gty
t-)2 ineom merienofinegramingafmb
APPLI ER N OMPLY WITH ALL NON-POINT Issued by: Date
so' cud S.
3 B Re-roofs
Ssure of Apyli N�RDOUS MATERIALS DISCLOSURE Dam Type of Roof
WIII the applicant an room Wilding .Chaps ata1orand Halload Safety a de0ncd by me Cupid no Muni” 1 Cade.Cbepmd 9.13.and the Hcalm and Safeq
Section 25572(.)? All roofs shall be inspected prior to any roofing material being installed.
❑Y Na
If a roof is installed without first obtaining inspection,I
Will me applicant or future building occupant use eyuipmcnt car devices which g an agree to remove P
CD"�lu�nun all conwninants u x0ned by the Bay Area Air Quality Management all new materials for inspection.
❑Yq /jdi9u/
I have real me]EM94f> iab mldimmc rClup.6.95ofdmCalifm-
nbHMImBSafcryCax.Sccdmu25505 533 36.1 urrticnaand thaif dm building
Ell ata mIY a 'hility b notify me axupantof the
nw�
;=-mu am r.Ccmi zoracapamY' Signature of Applicant Date
erar.d'06.dagE.t Dam I All roof coverings to be Class'%W'or better