08050163 (2) CITY OF CUPERTINO �y*,�
BUILDING DIVISION PERMIT
BulLgIrJQ,ta�l�ResS; STELLING RD SIERRA PRECAST INC 08050163
IR'1S12NAME: N PERMIT ISSUE DATE
LANDMARK DEVELOPMENT 1 LIVE OAK 07/22/2008
NE: (408) 779-1000 SANITARY NO. CONTROL NO.
ARCNRER/FNGIN7:ER:
BUILDING PERMIT INFO
BIDG ELECT PLUMB MECH
0 0 LICENSED CONTRACTOR'S DECLARATION O O O O
w. 1 hereby affirm that 1 un licensed under provisions of Chapter 9(e msec ming Job Description
-xx� vied gatian70(N)ofoivisiou 3 cruse
Ne BusiressaM Prortssimu Code.and my licenseu ADD APRX 430LINEAL FT PRECST CONCRT WALLS FRM
^=IS in fall force and ena
i9: LlmnmClay Lic.0 8 'TALL TO 13 ' &ALL W/5 ' OF SOIL RETAINNG CAPCTY
nt-p Da¢ Comoro,
i j7W ARCHITECTS DECLARATION
U I undersand my Pkm shall be used u public record$
yG Licensed Proposal...
y3 OWNER-BUILDER DECLARATION
rj i IF I hereby air,.that 1 am mem,I from the Cmtrxctors License Law for N,
p o following moon.(Stenon 1030.Business and Profetions Cods:Any City or county
$ which require$a Permit to Cowmct.arm,.imprme.dcmolkh,ur mPw any amem.
i< prior to its is.,A.requires the ap,limt fursuch Permit to III easquad sua+ncnt
xx NatheislicomedpursuanttotheProvisions,ofinecontromwesLianselatw(Chapw9 Sq.Ft.Floor Area Valuation
F� (commencing with Seedon 7130)(0)of Division 3 of One Business and Prefeuiom Codc)Or $82600
3 Nm he u cumµtherefrom and the basis for Ne alleged esempuan.My violation of
Schon 7031.5 by wry applicant fm a permit subjects the applicant o a civil penalty a( Occupancy
not mom Nan fin hundred doll.ISM 32607037��NumberT'Pe
❑I.aswxu of lle propaty,amy wployeu wash wagau Nc'v mk mmpenutim,
and Pr Newosk Code- he Comla not InUsers,Law
701x,Bualnm Required Inspections
and ertyw1mbu Code:The Contractor's and
who Law does Out apply to an owner of q p
mapenywnso,ims a impow nhmm�,aM wW dasuuehw led onoelfar through his
oro err.the
orl Nat shah imPmvemtats are nes ear ofc monered for ask r, m
builder.Ne Wildin8trimpmvemmt4hallwithinane year or enmove fardmowner-
buildv will tive the Wrdcn of proving that he did ms build or improve far purpose of
as owner of the property.am exclusively contracting with licensed contractors b
tract the project(Sec.7 ,Business and Pm(mm sloCoale:)ThLi
e Contractors -
bract
dao rot apply 0 an owner of pmputy who Wilds Or improves thenwn,and.
whO comaacts for meh projttt with a mnVYNn(s) d pmsamt to the Contrusces
Lice e
lam Se 4z F, BB P�/C far
�d7d�s museum
Dace�_
V K- OMPENSATION DECLARATION
1 hereby,Perot under penalty of perjury oro of Ne fallowing dmluuions
❑1 ban and will maintain aCertificate of Convent to mll-imme for Workers Campton
cation,u Provided for by Section 3700 of Ne Labor Cade.fa Ne Performance of the
wank for which Nis Permit o issued.
❑1 have and will maintain Workers Camµmnion Insurance,u required by Session
3MCf the Lahr Code,far Ne penfesmarmc of ils,wort for which this permit u issued.
My Wok z Compensation lrtmranee carrier sad Policy number am:
timer. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
fads mcnon need not N completed i(Ne penitis forma,hundred dollars(SIDO)
or less)
1 certify that in tic pmfmnence a the wank fn which this permmussed,l shall nm
employ any Noon in my mannerha berm bjec och�e/y/�ormeri Compensation
AppLaws of C .Till'—a1T�71 .
li
NOTICE A A f,afteru C i0mu Exemption.you shouldbmome ubiM to the Worked Comµmatlon provisions of the labor Code,you most
.,O faMwith comply with such provisions w Nu permit shall c chemeln
reted.
'�" CONSTRUCTION LENDING AGENCY
F l hereby affirm Nat Vert k romouction lending agency for six Performance of
a the work(a which nus permit 4 i$snwA(Sm.3097,Civ.G)
f2t 0 tenders None '
D z Lenders Address '
U C) I aniry,that I have natal ora application and awe that the abort inmfomatim is
IL inns t.l agree to comply withall City and county oNlmmes and cute law totaling to
8 Wilding construction,and hereby mthosiu mprtaenudvu of this city to comer upon Nc
Lu anon-me tWnmI proµrty,for Inspection purymes
(We)agree to ave,indemnify and kap hayyway...ginststud
cur of Cupertino against
UZ Ii�APP�LIUN
masm,jWgmenu,cmts and upcnus whiCltyU z ortsegneme of tic granuf NWITH ALL NON-POINT Issued by: Date
—22-obRe-roofs
ter ppl' UCan
Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding ocmpants ore or handle hauNous material
-Bred by Ne Cupenine Municipal Cole.Ouptor 9.12,and the Health aM Safety
.Sraim sss3z(.)7 All roofs shall be inspected nor to an roofing material beim
❑Yon pNo- P P � Y g g installed.
Will the applicant or furore Wilding aseupant um equipment m devic s which If a roof is installed without first obtaining an inspection,I agree to remove
emit harardnm air contaminants u deBnel by the Bay Arms Air Quality Management all new materials for inspection.
District? P
❑Yon
I have read the has mcerialsrequiremen mler hper6.95ofNe Califon.
O.Hulth afnyc 25505,2553 N.IondcrsundthatifNe Wilding
don e n nor a 'hility to mufy the aeupant of the
hon aCerificacofOceopenry. Signature of Applicant Date
-OSS
0 r W autharbe/agent Dow All roof coverings to be Class'A:s'or better