08070031 CITY OF CUPERTINO
BUILDING DIVISION pEj'j' C1�tT�ti�iCTaR� FORN�tk �f3 �•��
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BUILDING ADDRESS: PERMIT NO.
10815 N STELLING LANDMARK DEVELOPMENT 08070031
OWNER'S NAME PERMIT SUE DATE
LAS PALMAS STELLING LLC 1307 S MARY AVE STE 120* 07/10/2008
PHONE SANITARY NO. CONTROL NO.
(408) 733-9693
ARCHn=/ENGiNEER:- BUMMING PERMIT INFO
BL1Xi E.IECI PLUMB MECH
0 0 0
I!00 Z LICENSED CONTRACTOR'S DECLARATION Job Description
F 1 hereby
air
that 1 am licensed under provisions of Chapter 9(commcocing
��u`j wiLhScCtim%700IF)ofDi 'on7afthc usinessand (rasions mylicenscis SEWER LINE & LATERALS FOR 20 UNITS
,� in full force and effect. 3
j z License Clan LJe.i
F p Date n Coouwor
W7 ITEM DECLARAT10N
I understand my plansshall be used as public records
U
y G t; licensed Pmfesstonal
OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
00 following reason(Section 7031.3.Bnsinas and Professions Code:Any city or county
$li which requires a permit to e°n9nsL alter,improve,demolish,or repair any Wucture
Z prior to its issuane¢,also requirei the applicant rot such permit io file a signed s•anent
that he is licensed pursuant to the provisions of the Contractor's license Law(Chapter 9 Sq.Ft.Floor Area Valuation
(commencing with Section 7000)of Division 3 of the Business and Professions Code)ar $2000
W�-. that he is exempt therefrom and the basis for the alleged exemption Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a Civil penalty of jL�L- Number Occupancy e
not more than five hundmd dollars(x300). 32607037
.W L p y�p
❑L as owner of the property.or my employees with wages as their sole compenudon,
will do the work,and the structure is not intended or offered for sale(Sec.7044,Busiwm
and Professions Code:The Contramar'a License Law does not apply to an owner of Required Inspections
property who builds or improves thereon,and who does such work himself or through his
own employers.provided that Such impmvemena are not interhded at offered far sale-If. .
however.the bolding or improvement is sold within arm year of completion.the owner-
builder will have to burden of proving that he did not bold or improve for purpose of
sale-).
❑f.as Owner of the property.am=elusively contracting with licensed contricuns;to
construct the project(Sec 7044.Bu mm and Profadon Cade:)The COmracmr's Li-
came law does not apply to an owner of progcrty who bolds or improves theme n.and.
who contracts for such pmjm=with a conuaetaKs)licacxd puasoanl to the Contrawfs
I leee-se Lay.
❑1 am elcopt under Sec. B k P C for this won
Owner Dam
WORKERS COMPENSATION DECLARATION
I hereby affirm under penally of perjury am of the following deciamtic=
❑1 haft and will maintain a Cenirtcam of Consent to self-insure rot Warkees Campem-
scion.as provided for by Section 7700 Of the Labor Code-for the performance of the
wart for which this permit is Lssmd
❑I have and will maintain Worker's Computation lamranee,as required by Section
3700 of the labor Code.for the peRorn u cc of the wart for which this permit is iuued '
My Wo s Cpensatlo�n/inauric and auriand Policy number am
a
Curler �wo W Policy Ne-2�7.S V 0
CERTIFICATE OF EXEMPTION FROM W RKERS'
COMPENSATION INSURANCE
(This section reed not be completed if t e permb is foram hundred danau(x100)
or less)
I certify that in the performance of the work for which this permit is ismed.1 shall not
employ any person in any manner so as to I subject to the Worhsa'Compensatan .
Lan of California.Dam
AppBant
NOTICE TO APPLICANT.If.after mating this Ccniricae of Exemption,you should
bexome subject to the workds Compensation pmvirions of the Labor Code-you must .
.�Z forthwith comply with such provisions or Chia permit shall be deemed revoked
Z O CONSTRUCTION LENDING AGENCY
(+ I hereby affirm that tm is a construction lending agency for the performance of .
IYi tte work for which that permit is issued(Sex.7097.Civ.c.)
0 Lcndres Name
.7 Z Lmtdces Address
U O 1 ratify that 1 have rod this application and state that the above information is
Ly carted.I agree to comply with all city and county ordinances and ante laws relating to
0 building construction,and hereby authorise represcoatims of this city to enter upon the
w above-mentioned property for iaspecton purpn¢s.
(y (We)agree to save,indemnify and keep hannim the City of Cupertino against
liabilities,judgm am cost and expenses which may In any way accrue against said City
U Z in tonsequeue of to graving of this perMIL
.. APPLICANT UNDERSTANDS A M Y WITH ALL NON-POINT Issued by: Date
W
SO TIO
7'Id'Ob Re-roofs
SI ol'Appliemt/Con Dam
US MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hazardous material
as deRned by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? L All roofs shall be inspected prior to any roofing material being installed.
❑Yea Lynn
Will the applicant or future building Occupant use equipment or devices which
If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air conumirunt at sued by the Bay Area Air Quality Management all new materials for inspection.
Disuin7
❑ro 0
I have read the haundau mareriab tequbcmmu underChapter 6.93 of the Califor-
nia Halo Safcty C Scaions 23303.23 1�,Mt�+nd that in a building
does ver■ tut 1 ' y ity m notify the occupant of Um
hicbm met ° e1e°f°tt'�� Signature of Applicant Date
7
Owner or lutharisrd agent Date " � All roof coverings to be Class'n"or better
�
CITY OF CUPERTINO
5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . . 32607037 .ALL
DATE ISSUED. . . . . . . : 07/03/2008
RECEIPT # . . . . . . . . . . BS000005343
REFERENCE ID # . . . : 08070031
SITE ADDRESS . . . . . : 10815 N STELLING
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : LAS PALMAS STELLING LLC
ADDRESS . . . . . . . . . . : 10815 N STELLING
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : KEITH KOLKER
CONTRACTOR . . . . . . . : JASON CHARTIER/PRESIDENT LIC # 5999
COMPANY . . . . . . . . . . : LANDMARK DEVELOPMENT CORPORATI
ADDRESS . . . . . . . . . . : 1307 S MARY AVE STE 120
CITY/STATE/ZIP . . . : SUNNYVALE, CA 94087
TELEPHONE . . . . . . . . : (408) 733-9693
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 20 . 00 10 . 00 0 . 00 10 . 00 0 . 00
1PLMBLNCK HOUR 1 . 00 122 . 38 0 . 00 122 . 38 0 . 00
1PPERMITFE FLAT RATE 815 . 80 40 . 79 0 . 00 40 . 79 0 . 00
1PRSEWER UNITS 20 . 00 408 . 00 0 . 00 408 . 00 0 . 00
1TRAVDOC FLAT RATE 20 . 00 815 . 80 0 . 00 815 . 80 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 1396 . 97 0 . 00 1396 . 97 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 1, 396..97. -- VISA
---------------
TOTAL RECEIPT 1, 396 . 97
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
106 SEWER & WATER 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 400 SEWER/LATERAL
507 FINAL PLUMBING