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081000140z z0 P V) W ~ per Q .�- z UO C4 F_ O U ►r C!] W CITY OF CUPERTINO BUILDING D1V1510N PERMIT t/ n BUILDING ADDRESS: PERMIT NO. 10815 N STELLING RD LANDMARK DEVELOPMENT 08100014 OWNER'S NAME: CURPUHATION PERMIr65UEDATE LAS PALMAS STELLING LLC 1307 S MARY AVE STE 120 10/17/2008 PHONE: SANITARY NO. CONTROL NO. (408)733-9693 ARCHn'ECr/ENGiNEEPU BUILDING PERMrr INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that I am licensed under provisions or Chaptc 9 (commrsdng with Section 70M of Division 3 of the Business and Professions Code, and mylicease is DEFERRED ROOF TRUSS — ORIG#07120216 & 07120215 in full force and effect. License Class Lie. I Date Contractor ARC'H71ECI'S DECLARATION I understand my plans shall be used as public records Licensed Professional OW NF-R-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractors License Law for the following reason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure " prior to its issuance, also requires the applicant for such permit to file a signed staletoent that he is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 Sq. Ft. Floor Area Valuation (commenting with Section 70M of Division 3 of the Business and Profession Code) or $ 4 7 0 4 that he is exempt therefrom and ft basis for the alleged exemption. Any violation of AIR"Number Occupancy Type Section 7031.5 by any applicant for a permit subjecu the applicant to a civil penalty of not more than five bundred dollars (S5(l0). 3 2607037 ❑ 1, as owner of the property, or my employers with wages as their sole compensation, Required Inspections will do the work and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code The Contractors License Law dons sent apply to an owner of ply who builds or improves thereon, and who does such work bimself or through his own employees, provided that such improvements are not irtmaded or offered for sale If, however, the building or improvement is sold within one year of compaction. The owner - Wilder will have the burden of proving that he did not build or impmve for purpose of sak ). ot as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044. Business and Professions Code:) The Contractors Li-, _ cease Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such projects with a contractors) bcense rat to ft Contractors License Law. ❑ lam & PC! for this reason ddB Owrrer � {ate WORKER'S COMPENSATION D RATION I hereby affirm under penalty of perjury one of the following declarations: .E:14 hsve 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 Issued ❑ 1 have and will maintain Workers 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 are: Carrier. Policy No.: CERTIFICATE OF EXEMPi70N FROM WORKERS' COMPENSATION INSURANCE Crhis section need nol be completed If the permit is for one hundred dollars (SI00) ' or )rss) I unify that in the p anec of the work fox whit this permit is �d.1 shall not employanyp . lw work 'Compensation Laws of Califo Applicant NOTICE TO PLICANT: If, after making LhisrCertificatc of Exemption, you should become subject to the Workers Compensation provisions of the Labor Coda you most forthwith comply with such provisions or this permit shad] be decemed revoked CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C) Lenders Name Lenders Address I certiry that I have read this application and state that the above information is correct 1 agree to comply with all City and county ordinances and state laws relating to building construction, and hereby authorize mpresematives of this city to enter upon the above -mentioned property for inspection purposes (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in say way accrue against said Cily In consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WI ITH ALL NON -POINT Issued by: Date SOUR S. Re -roofs Type of Roof -i Sig sere of Applicanticontractor Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material " as damned by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Co.. Scct1on25532(a)7 All roofs shall be inspected to any roofing material being installed. ❑ Yes prior If a roof is installed without first obtaining an inspection, I agree to remove WBI the applicant or future building occupant use equipment or devices which omit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑ Yes I have road cite hazardous materials requirements under "" Cslifor- niaHcalth&SafetyCoda Sections25505,25533and2$ Ithe building K.P'1O=ccdu­pa01ncy. does not eurten0 a ten t it y upant of the mquimrn etprio b 6 �� Signature of Applicant Date All roof coverings to be Class'A" or better g Owner Date ' or lhornrd agent .