08100013CITY OF CUPERTINO
BUILDING DIVISION PERMIT cow"', ' 'MR IWO
BUILDING ADDRESS:
10819 N STELLING RD
OWNER'S NAME:
LAS PALMAS STELLING LLC
PHONE:
ARCHITECT(ENGINEER:
{ ooi zz LICENSED CONTRACTOR'S DECLARA71ON
iU F I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
Z c�� with Section 700O) of Division 3 of the Business afd Professions Code, and my license is
�< En full forte and effect
h � Z Lieem Class LIc. •
q Data Contractor
ARCHITECTS DECLARAnoN
I understand my plans shall be used as public records
)y
' u. Licensed Professional
y OWNER-BUl1.DER DECLARAnTON
I hereby affirm that 1 am exempt from the Contracoes License Law for the
00 following mason. (Section 70315, Business and Professions Code: Any city or county
4.9 which requires a permit toconstruct, -alter, improve, demolish, or repair any structure
z prior to its issuance, also requires the applicant for such permit to file a signed statement
= C that he is licensed pursuant to the provisions -of the Contractor's License Law (Chapter 9
F- $ (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
Q .. that he is exempt therefrom and the basis for the allcged exemption. Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars (S500).
❑ I, as owner of the property, or my employees with wages as their sole compensation,
win do the work, and the structure is not intended or ofreted for sale (Sec. 7044, Business
and Professions Code: The Contractor's License law does not apply to an owner of
property who builds or improves tbercon. and who does such work himself or through his
awn employees, provided that such improvements are not intended orofrered for sale. If,
however, the building or improvement Is sold within one year of completion, the owner -
builder will have the burden of proving that he did not build or Improve for purpose of
sale.).
. as owner of the property. am exclusively contracting with lictnaed contractors to
c truer the project (Sec 7044, Business and Professions Code:) -fine Contractar's Li-
cense Caw does not apply to an owner of property w o builds or improves thereon, and
who contracts for such projects with a contrxior(s neensed pursuant to the Contractor's
License Law.
❑ I am exempt u ec , B & P C for this reason
i
Owner' Dale
WORKEIK COMPENSA71ON DECLARAT70N
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a Certificate of Consent to self -insure for Workers Compen-
sation, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issue&
❑ I have and will maintain Workees Compensation Insurance, as required by Section
3700 of the Labor Code, for the performance of the work for which this permit is issued.
My Workers Compensation Insurance carrier and Policy number am:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPFNSA71ONINSURANCE
01is section need not be completed If lbe permit is for one hundred dollars ($100)
or lass.)
I certify that in the performance of the work for which this permit is issued, 1 shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject to the Worker's Compensation provisions of the Labor Code, you must
.J Z Forthwith comply with such provisions or this permit shall be deemed revoked.
z O CONSTRUCTION LENDING AGENCY
.w
F-c J7 t--� 1 hereby a(rirm that there is; construction lending agency for the performance of
lx > the waft for which this permit is issued (Sce. 3097. Civ. C.)
OW.h Q Lender's Name
Z Lender's Address
U 0 1 certify that I have mad this application and sate that the above information is
LL4 " cancel. I agree to comply with all city and county ordinances and sate laws relating to
Q building construction, and hereby authorise representatives of this city to enter upon the
U above -mentioned property for inspection purposes.
CL (We) agree to save, indemnify and keep harmless the City of Cupertino against
t) liabilities, Judgments. toss and expenses which may in any way scenic against said City
V Z in consequence of the granting of this permit.
LERSTANDS MPLY WITH ALL NON -POINT
S ATIONS.S une A IicanUCon r Dale
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store orhandle hazardous material
as rf�nod by the Cupertino Municipal Code. Chapter 91 Z and the Health and Safety
Code, Section 25532(a)7
❑ Yes oWill the applicant or uture building occupant rise equipment or devices which
emit hazardous air conaminans as fined by the Bay Area Air Quality Management
District?
❑ YesI have marl the hazardous materials requirement n aplcr 6.95 of the Califor-
hhia Ficgc
ode, tors 25505. 3 5 understand that ifthe building
does ny have ant. cats' icy to notify the hxtivpant of the
requirh be reel r t anco crtffi_ O(OCNp� rhry.
I
car or authorized agent Date
LANDMARK DEVELOPMENT
1307 S MARY AVE STE 120
(408)733-9693
PERMITNO.
08100013
PERMIT ISSUE DATE
10/17/2008
SANITARY NO. CONTROL NO.
BUfI.DWG PERMIT INFO
BLDG ELECT PLUMB MECH
Job Description
DEFERRED ROOF TRUSS - ORIG
#07120218,0217,0220,0219,
0223,0222,0224
Sq. Ft. Floor Area $8072 Valuation
32607037:
Required Inspections
Issued by:
Re -roofs
Type of Roof
Occupancy Type
Date //j
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
all new materials for inspection.
Signature of Applicant Date
All roof coverings to be Class 'A"' or better