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BUILDING DIVISION
BUILDING ADDRESS:
PERMrr NO.
10849 N STELLING RD
LANDMARK DEVELOPMENT
08100016
OWNER'S NAME:CURPORAII-LON
PERMIT ISSUE DATE
LAS PALMAS STELLING LLC
1307 S MARY AVE STE 120*
10/17/2008
PHONE: -
SANITARY NO. CONTROL NO.
(408)733-9693
ARCHrrEcrrBNGTNEER:
BUILDING PERMIT INFO
BL.DG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
JObDescription
of Chapter 9 my license
i hereby affirm that I am 1 under provisiand
Professions
with stetson 7000) of Division 3 orthc Htnsinna and Professiora Code. and my icenae is
DEFERRED ROOF TRUSS, ORI G# 712 0 2 3 5, 0236, 0232,
in full force and effect.
L cause Class Lk. 0
0233
Date Contractor
ARCHITECTS DECLARATION
i understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
following reason. (Section 70313, Bossiness and Professions Code: Any city or county
which requires a permit to consfonict, alter, improve, demolish, or repair any structure
prior to its issuance. also requites the applicant for such permit to rile a signed statement
that he is licensed to the ofthe Contractor's License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
pursuant provisions
Stetson 7000) Division 3 or the Business and Professions Code) or
714 8
(commencing with or
that he is exempt therefrom and the basis for the alleged exemption. Any violation or
Number
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty or
not more than rive bundmd dollars (s500).
32607037
❑ L as owner of the property, or my employees with wages as their sole compensation,
Required Inspections
will do the work, and the structure is not intended or offered for We (Sec. 7044, Business
and Professions Codc. The Contractor's I icense Law does not apply to an Owner of
property who builds or improves thereon, and who does such work hjrnaesf or througb his
own employees, provided that such improvements are not Intended or offered for sale M
however, the building or improvement is sold within one year or completion, the owner -
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
I, as owner of the property, am exclusively contracting with licensed contractors to
concoct the project (See M44, Business and Professions Code:) The Contractor's Li.
cease Law does not apply to an owner of property who Wilda or improves thereon, and.
who contracts for such projects with a contractar(s) is p nt to the contractor's
Lice"Law.
❑ 1 am n !e - . B & PC,,,...for th��,i'''ss reason
Ow Dat
WORKER'S COMPENSATION DECIARATIOe
-
I hereby affirm under penalty or perjury one or the following declarations
❑ I hive and will maintain a Certificate of Consent to self -insure for Wodels Compen-
sation, as provided for by Section 3700 of the Labor Code, for the performance or the
work for which this permit is joined.
❑ I have and will maintain Worker's Compensation Insurance, as required by Section
3700 of the Labor Code, for the performa.nee of the work for which this permit is Issued.
'
My Worker's Compensation Insurance carrier and Policy number am:
cattier. Polity No.:
CERTIFICATE OP EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100)
or icss. )
I certify that in the performance of a work for which is pt-pitri a issued. 1 shall not
employ any ere n an ss to c t t Workers' Compensation
Laws or M. e _
Appi
NOTICE cA : If. after ng thts Ceniicatc of Exemption, you should
become stibject to the Wodcet's Compensation provisions or the Labor Code, you must
fonliwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
i hereby affirm that there is it concoction lending agency for the performance of
the work for which this permit is issued (Sere. 3097. Civ. C.)
'
Lender's Name
,
Lender's Address
I eetify 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
Wilding construction, and hereby authorim represraativcs of this city to enter upon the
above -mentioned property for irspcction purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
liabilities, judgments, costs and expenses which may in my way accrue against said City
in consequence of th ranting of this permit.
APP DS A OMP WITH ALL NON -POINT
Issued by: Date Q ^� 7,
UTAT7 S,
Re -roofs -- ��
Type of Roof
,lilignature of Applicant/Con r Date
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or Future Wilding occupant gore or handle hrnrdous material
as defined by the Cupertino Munio 1 Code. Chapter 9.12, and the Health and Safety
Code, Section 25532(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 contaminantsed by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑ Yes
I have read the requirements under Cha 95 or the Califor-
niaHealth &S#%.vCodc,;ecdms7,505,25533arSL755�t.1 hatifhebatlding
rco�i.,-ot�tut bc�rrel prior t so.esSusa(cc of'`rCcnifcatc nto,evoaoeevn pent of suer
Due
Signature of Applicant Date
All roof coverings to be Class'%." or better