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CITY OF CUPERTINO
PERNUT
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BUILDING DIVISION
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BUILDING ADDRESS:
PERMITNO.
10839 N STELLING RD
LANDMARK DEVELOPMENT
08100017
OWNER'S NAME:
PERMIT L4SUE DATE
LAS PALMAS STELLING LLC
1307 S MARY AVE STE 120
10/17/2008
PHONE:
SANITARY NO. CONTROL NO.
(408)733-9693
ARCHITECT/ENGINEER:
-
BUILDING PERMrr INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACT'OWS DECLARATION
Job Description
1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Budncss and Profossions Code, and my Ikensc is
DEFERRED ROOF TRUSS — OR I G # 0 712 0 2 2 8 r 0230, 0229
in full force and effect
License asss Lie. N
Date Contractor
ARCHrrECI`S DECLARATION
1 understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hcroby al7irm that I am exempt from the Contractor's 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 statement
he is licensed to the the Contractor's license Caw (Chapter 9
Sq. Ft. Floor Area Valuation
that pursuant prevision of
4 8
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
9 6
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
32607037 `.°� Number
Oe
ccu panC y T}'p
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars ($5M
❑ 1. as owner of the property, or my employees with wages as their sole compensation,
Required Inspections
will do the work, and the mcutre is not intended or offered for sale (Sec. 70", Business
and Profession, Code: The Contractor's Ucm= Law does not apply to an owner of
property who builds or improves thereon, and who does such work himself or through his
owo employees, provided that such improvements are not Intended coffered for sale. If,
however, the building or improvement is sold within one yew of 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
construct the project (Sec. 7044, Business and Professions Code:) The Contractor's U-
ccnse 11w does not apply to an owner of property who builds improves thereon, and,
who contracts for such rojeeu with a contiactor(s) IL ed
License 11w.
"
hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a Certificate of Consent to self -insure for Worker's 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 Worker's Compensation Insurance, as required by Section
3700 of the Labor Code, for the performance of the work for which this permit is issued.
'
My Worker's Compensation Insurance carrier and Policy number am:
Carrier, Policy Ne:
CERTIFICATE OF EXF-MPfION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit Is forme hundred dollars (f 100)
or Icss.)
1 certify thet in the
become subject to the Workers Compensado provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shill be deemed revoked.
- -
CONSTRUCTION LENDING AGENCY
1 hereby affirm that them Is a construction lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ. Q
Lender's Name
Lender's Address
I certify that I have read this application and sate that the above information is
cormc . I agree to comply with all city and county ordinances and state laws relating to
building construction, and hereby authorise representatives of this city to enter upon the
above -mentioned property for inspection purposes
(We) agree to save, indemnify and keep harmless the City of C rtino against
liabilitim judgments, costs and expenses which may in any way a against said City
In consequence of We granting of this permit.
APPLICANT UNDE S D WI ALL NON -POINT
Issued by:&�e Date
SOURCE
-roofs
Type of Roof
&-V-4b
signaW App ran nuactor Dale
HAZARDOUS ATIJtIALS 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. Section 25532(a)?
All roofs shall be inspected prior to any roofing material being installed.
❑Yes we
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant of future building occupant use equipment or devices which
emit haaardous air contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
District?
[]Yes No
1 have read the hazardous materials requirements under Chapter fi,95 of the Cali
nia Hcalih & Safety Code, Sactions 25505 3 and 25534. 1 rstand that ing
does not currently hoe msponsibl cif of the
mquircroem s whit