07120074 (2) CITY OF CUPERTINO
BUILDING DIVISION PERNIITCONTRAC�ORINEORNTATI®N`
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BUIL1 PERMIT NO.
9T�1 STEELING RD LANDMARK DEVELOPMENT 07120074 ,
OWNER'S NAME: PERMITISSUEDATE
CUPERTINO DEVELOPMENT 1307 S MARY AVE STE 120 01/29/2008
ONE - SANITARY NO. CONTROL NO.
(408) 733-9693
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLOC ELECT PLUMB MECH
Sop LICENSED CONTRACI'OR'SDECLARATION 7obDescription
1 hereby aflinn that 1 an decided!under provisions of Chapter 9(commencing
with Sudan 70110)of Dlvidon 3 ofthe Business ask Prafassiuv Code,and my he..is DEMO
^ � m ritil fora sad effect.
�'g 3 Liccna w ' L¢.
Dam •�ComrEC
e As mailed ea DEC 0 f
undersand my pins shall W icon d public rtcnrd.
6
yo Licensed Pmfessiona
OWNER-B empt from
DECLARATION
�0 f I Waso .(Su that I IJ exempt seam the Cather, o Licence Law for the _
p O following won.(Section ID313,Buaass,and Pro(wr-1 Calc:Any city ser county
5$ which agWrea a parch te emLrvc4 aur.improve.arh Perlin li rt.1g aY ueunure
ZLa priarmiu iduance.aa aqo due pdic owism a for smhpemi'ro.a.L w(Camment
�< that he 4 licensed pasusur pmviaom of doe Conuamr'a Liana law(Chapter9 Sq.Ft. Floor Area C Valuation
9 (commencing wild Semon7000)ofDivision 3ofthe Busbtessand ProfwionsCook)or $28000
dm W u exempt thesefrom and the basis for the alleged exemption.Any violation of
Seaton 7031.5 by any applicant for a permit subject.ate applicant to a civil penalty of yp�f Number Occupancy Type
not mom the fin hundred dollar(5300). 3 2 6 0 7 0 3 7:\J V'
0 I,as owner of ted property.a my employes with"Par as their ale compensation.
will do ate work,and destruction isnot intended or offered forum(Sec.7014,Bu.ircu
and Proletariats
Cada,The Carmichael License saw does,em apply mr mesas aof Required Inspections
properly ushm Wildaorlmprovesdwnan,ond IOW deseah workhuovJf or INough his
awn employer,provided dal such improvemau art not intended antitrust foraale.If.
however,the building erimpmament based within ane year of urepledan,doe owner-
builder will have the burden of paving cut he did net Wild or improv for puryose of
sale.).
0 L as owns of the property.am mtlmively conducting with Iiamed anvuctan in
cotutrun she project(Sea 1014,Business and Rafuaam Code:)TW Cououcues Li-
ana law doesion apply ha a owner of property who Wilda or Improves thereon,ad
who contracts for such projects what a condacmr0)Homan pursuant to the Conductors
Lice.law.
0lare aemptunderSee ,BRPCfathl...
Owner
Data
WORKER'S COMPENSATION DECLARATION
1 hereby sic lam under penalty of perjury ane of ea following dociarulom:
0 1 have and will main Wn a Cenifi surf Conant to self-Wum faworkeea Camper.
dtlon,sm provided fm by Sudan 3100 of the labor Cade.for the perforaom of the
wart for winch this pundit is added.
0 1 have and will maintain Workers Gmpemaeon Imwnce,as required by Sudan
3700 of da labor Code,for doe performance of lde wart for which this permit 4 bound.
My Waukee Co penwlon distance cartier.and Policynum r:
Gmler lY{{9Y Palley No.:
cwiir,ICATEOFEXEMPnONFROM WORK S'
COMPENSATION INSURANCE
muds mNa need roe W completed If doe .it Is foroahundred dellw($100)
or less
1 certify this,in ted perforaeco d IW wart for which this peril 4 issued,1091 am
employ any person in any manrcr a d to become abject in es,Workers'Campemadon
4ws,of California.Data
Applicant
NOTICE TO APPLICANT.If,after making this Canificnm of Exemption,you should
become subject to the Worker.Compecucon previsions of the Tabor Cade.you mw
.,O foMwiat comply with such provisions or this,permit skull W m
docad avoided.
Z CONsntucnON LENDING AGENCY
(-y
t IWreby affirm that there is a annotation lending agent for dte performance of
> Ne work for which this permit bnormal IS=3097,Civ.C.)
W�25 Lenders Name
Z) Lenders Addw
U 0 I certify that 1 have read this application and num don the above information Is
IL ;'! cora 1 agree ha comply wild all city and county oMnanaa and sum laws mbling in
Wilding cotuwc0on.and hereby allorim repwnullves ofthis city in enter upon Ne
above-mentioned property for impaction purposes
(We)agora m dve,indemnify and kap hamlw the City of Cupertino againstfa/d Ihbllides Judg .eotu and expemm which may in eery way aura against said City
U APPLICAa oNDERMIt NOSth No WILL COMPLY WITH ALL N N-POINT Issued by: Date ZQy F'
sou cE dun s.
{ Re-roofs
arc of AppliandCam ram, Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or funded Wilding oceupat soma an,berkl.bauNoes materia
u droned by the Capenion Municipal Code Chapter 9.12.and doe North and Safely
Code.section 25s3z(.)7 All roofs shall be inspected prior to any roofing material being installed.
O Yea air
Will ft applicant or future Wilding occupant saw equipment ser levies which If a roof is installed without first obtaining an inspection,I agree to remove
emit ha>aknns air comunimnb a derim d by the Bay Area Air Quality Management all new materials for inspection.
District?
0ym e+4�
I have mad the has kiEkk.materials requirements under Cltspmr 6.95 of the Caliper.
n4Health&Safety Cal 6w 25505.25533 and 25334.1 undersand don ifde Wilding
docs not cm an 1,hal see that my audibility m road the as ant err the
mquirtmenuw nth tWmel°f�r�i, ceafa Ceetifeau of Ocap Signature of Applicant Date
!l All roof coverings to be Class"B"or better
0 sat egad egenl Dam' '