07120226 (2) CITY OF CUPERTINO �a,� rn + '4* aaht �"�T�Tg� "n'*"'�,k ,:^
BUILDING DIVISION PER COI�t'I'RA cTQVNFORM T Nr „
BUILDING AgDRE55: PERMR N0.
; Utes N STEL,Ii:LNG RD LANDMARK DEVELOPMENT 07120226
NEWS NAME: PE ISSUEDATE
AS PALAAS STELLI:NG LLC 1307 S MARY AVE STE 120 09/03/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHrfECUENGINEER: BUILDING PERMIT INFO
NEW TWO STORY TOWNHOUSE BLDG ELECr PLUMB MECH
2169 GF
X00 LICENSED CONTAACI00.'S DECLARATION ' O O O O
F 1 bomb,affirm that 1 atm Boosted umkr proviso—of Chapter 9("mmeaing Job Description
with Section 7")ofDlvision 3 ofthe Business and Profesdoru Code.ad my license is
in full fame and effecs. 1F .
Lice,nse m Lic I
trcmr
AR r1EC1'S DECLARATION
U uodaatanJ my plans shall W used a public.sordaDI
g G Licensed Professional -
5 OWNER-BUILDER DECLARATION -
.� N 1 lemby&films that I em eaempl from the Comminors Licmx Law for the
COO following mvoo.(Section 70B 1.5,Business and Profess .Codc:My city or county
I$Pi werch¢quires a permit to conswq alter.improve,domsll.h,nil repair any watts.
prior in its issuance,tlw.quires the applicant for such permit to rile a signed a sh ment
< thatWislicensedpursuanttotheprovisionsofNeComnctoriLwxvelswchapter9 Sq.Ft. Floor Area Valuation
x�$ (commencing with Section 7000)of Division]of the Business and Profcaim.Cade)or
that he ts exempt tMuefsom and the baso for hire alleged eaempf.An,Anita.of
Semon 70313 by any applicant for.permit subjects the applicant to a civil penalty of APN Number Occupancy e
not more than lin hundred Man(g500). P Y 17 pry'P
❑1,as oww of the property,or my employe.with wagbs as their sole compe.won,
will do tee weak,need thCstrwlon,ts not imem@d or offered for rale(Sat.7014,Bud.
and Pro(eWo.Cada The Conor lmrt Lunt¢Law does not apply m an own.d Required Inspections
property who buil&or im prows thaws.and who de.such work himself or through his
awn employees,provided that such improvements ere not intended oro@seA for We.If.
however,Ne Wilding or Improvement is sold within one year of completion.the owna-
builder .will have the Wrdem of proving thal hat did vel banal a improve for purpose of
ale.).
❑L as owner of the property,am exclusively contracting with licensed conuvaan at
wautmet the project(Sec.7014.Business and profound..Code:)The CWtousnh V-
«.e law does not apply in as owner of prop'my who builds or improves themes.ad
who contracts for such projects with awntranor(s)licensed pursuant to tho Contractors
Grenm law.
lomcamptundasee ,BBPCfarttsmason
Dat
WORKERS COMPENSATION DECLARATION
I bcmby same under penalty of penury oro of to following declarations,
i haw and will maintsin a Cedfi.m Of Conacm m self-imuR for Wurkcr!Campcn-
atim, Prwidc0 fpe Sation 3700 of tic Labor Code.fa to performsoce of the
wok for
which Nin permit ts'..,w
❑i have aod will mooted.Wohcrs Compensation I..,as reform!by Sccu.
3700 of duo labor Code,for the performance ofthe wort furwhich this permit is load.
My WorkertrY Compewua sod Poli..,210 :
Carrier: J Policy No.:
RCERTIFl F INROM
COMPENSATIONINSURANCE
,
(Thlsxdm need not be completed i(the permit u faow hundred dollm($100)
alas)
1 certify then in the performances,of the work for which this pond,is leased.I shall not
employ&.,person in any mannerso as in become subject to the Waters'Canpevaton
Laws of Celifomi,.Dau
App11.&nt
NOTICE TO APPUCAN..If,vier making this Certificate of Exemption,you should
berame subject b the Woh s Compensator p ovisimu of the labs Code,you mesh
.J z forthwith comply with such provisions,or this permit shot W doomed mveked. –
z y CONSTRUCTION LENDING AGENCY
(–a I hercby afRna that Nem is a cowucum lending agency for the performance of
IY' > the work I.whim this permit Is issued(Sec.3097.Civ.C.)
0 Lenders Name
.7. z Lenders Address
U Q 1 comfy that 1 have read this application aod serte that to above information is
g4 Pcorrect 1 at=x"reply with all city and centuryod ordinances astate laws misting b
D U Wilding construction.and hereby aeboris cep esenutives of this city m enter upon to
W
.1unn'-frentioned property far inspection puryases
Lt, (We)agree to an,indemnify ad kwp hlrmka the City of Cupertino against
Vrn Iiebiliti.,JdgmgmenU.coups adexpcnsrs which may in any y&carve&{alma said city
z inco o rating of this 'L Issued b
^ A 1 ERSTANDS 0 Y WITH ALL NON-POINT y; Date
sr cu s. D
S sr
'fl — Re-roofs
igtwuR ofAppli.naCon Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or Wfmmo building occupant voce or h&ndk health.d Sam'd
a dcOncd by to Cupe.ino Municipal Code.Chapter 9.13,and the Health and Slfcty
.Uyesn. z(,)7 All roofs shall be inspected prior to any roofing material being installed.
Y. No
Will the. lies. rmraR &din oav If a roof is installed without first obtainingan inspection,I agree to remove
pP g Wnt eras"uipment ail devices which P g
emit Itvardous air commini.nu dcfined by the B.y A..Air Quality Management all new materials for inspection.
Disuict7
❑Y. Na
I hew read the hu mmoria require cnuu pler6.95oRkCalifor-
nuHcalth&S ny ,Sccuo.8 .$5 d tenundthuifte building
has w n Y4hCt! l t' Ii coufY the acupat of the
Rq ' n a ora -re.ma «��D � Signature of Applicant Date
own or. roti. Dam All roof coverings to be Class'%&"or better