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CITY OF CUPERTINO
PERMIT��;�d
BUILDING DIVISION
BUILDING ADDRESS:
PERMIT NO.
10837 N STELLING RD
LANDMARK DEVELOPMENT
08100015
OWNER'S NAME:
PERMIT ISEUE DATE
LAS PALMAS STELLING LLC
1307 S MARY AVE STE 120
10/17/2008
PHONE:
SANITARY NO. CONTROL NO.
(408)733-9693
ARCHI'('ECr/ENC7NEI]t:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
9
Job Description
P
I hereby affirm that I am licensed under provisions of Chapter (commencing
with Section 70DO) ofDivision 3 ofthe Business and Professionts Code, and my licensc is
DEFERRED ROOF TRUSSES — ORIG#07120227 r 07120226 &
in full font and effect
License Class Lie. 0
07120225
Date Contra=
ARCHtT = DECLARATION
1 understand my plans shall be. used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am tarempt from the Contractors Licenso Law for the
following mason. (Section 70315, Business and Professions Code: Any city or county
which requires a permit to construct, alley, improve, demolish, or repair any suuc wo
prior to its issuance, also requires the applicant forsueh permitto file &signed statement
Contractors License Law (chapter 9
Sq. Ft. Floor Area
Valuation
That he is licensed pursuant to the provisions of the
Section 7000) Division 3 the Business and Professions Code) or
$ 4 9 8 6
(commcnc(ng with of of
that he is exempt tbcrefrom and the basis for the alleged exemption Any violation of
Number
3 26
Occupancy Type
Section 70315 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars (5500).
07 0 3 7. 3 E
❑ L as owner of the property, or my employees with wages as their sole comperlasdon,
Required Inspections
will do the work and the structure is not intended or offered for sale (Sec. 7044, Business
and Professions Code: The Contractors Lieu= Law does not apply to an owner of
property who builds or improves thereon, and who does such work himself or through his
own employees, provided that stub improvements are not intended or offered for sale. IL
however, the building or improvement is sold within one year of completica, the owner -
builder will have the burden of proving that he did not build or Improve for purpose of
sal
as owner of the property, am exclusively contracting with licensed contractors to
,fonstmct the project (Sec. 7044, Business and Professions Coda) The Contractors Li-
_
tense Law does not apply to an owner of property who builds or improves themop, and •
who Contracs for h Proje with a contractors) licensed p t to Conn c
License LL
❑ I an. ens , B C for this reasao
Owner —/ —0
VIORICEIVS COM A7TON DECI N .
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a Certificate of Consent to self-insum for Wooers Compen-
sation, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
❑ I have and will maintain Worker's Compensation Insurna, 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 artier and Policy number are:
Carrier. Policy No.:
CERTIFICATE OF -EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is foronc hundred dollars (S 100)
or less)
I certify that in the perfo tx of the work for which pe ' ' ns , 1 shall not
employ any person' y Apa"f as t ceomc o Compensation
Laws of Calirorn'
Applicant
ACANrF5_r1_f,
NOTICE TO ABF after making 7.1ccrtiCate of Esc tion, you should
become subject to the Workers Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed rcvoka
I
CONSTRUCTION LENDING AGENCY
1 hereby air= that there is a construction lending agency for the performance of
the work for which this permit is issued (See. 3097, Civ. C.)
Lenders Name
Lenders Address
I I certify that I have read this application and sate that the above information Is
'
' correct I agree to comply with all city and county ordinances and state laws relating to
building consuuction, and hereby authorize representatives of this city to enter upon the
above -mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless tie City of Cupertino against
j liabilities, judgments. toss and expenses which may in any way accrue against said City
in consequence of the granting of this permit
APPLICA A S AND WITH ALL NON -POINT
Issued by: Date
SOUR ON
Re -roofs
Type of Roof �—
Si re of Applic"t/Con Dal
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code. Chapter 9.12. and the Health and Safety
Code, Section25532(a)7
All roofs shall be inspected prior to any roofing material being installed.
❑ Yes
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contsminans as fined by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑ Yes
I have mad the hazardous materials requirements under Chapter6.95 of the Califor-
nia Health & Safety Code, Sections 505.25533 and 25534.1 ern d that if the building
does not torte ere t It is my bi ' o tify the occupant of the
require be 'oruiss of Occupancy.
Signature of Applicant Date
49
All roof coverings to be Class'}'' or better
Owd6rorauthmvsdagent Data