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10030113 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10855 N STELLING RD CONTRACTOR:LANDMARK PERMIT NO: 10030113 DEVELOPMENT CORPORATION OWNER'S NAME: LANDMARK DEVELOPMENT 1307 S MARY AVE STE 120 DATE ISSUED:03/18/2010 .NER'S PHONE: 4087395446 SUNNYVALE,CA 94087 PHONE NO:(408)733-9693 ❑ LICENSED CONTRACTOR'S DECLARATIONI— BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# MECH r RESIDENTIAL COMMERCIAL r Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:COMMON AREA METER (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$4000 I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:32607037.00 Occupancy Type: APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply / with all non-point source regulations per the Cupertino Municipal Code,Section Issued bye'� � Date• 9.18. Signature Date RE-ROOFS: OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for I hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date: will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534. not employ any person in any manner so as to become subject to the Worker's Ow nth p4zed n Compensation laws of California. If,after making this certificate of exemption,I Date: '-1�—/0 become subject to the Worker's Compensation provisions of the Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lender's Name correct.I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter Lender's Address unnn the above mentioned property for inspection purposes.(We)agree to save :nify and keep harmless the City of Cupertino against liabilities,judgments, and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION granting of this permit.Additi Ily,the ap I' ant ers ds and will comply I understand my plans shall be used as public records. with all non-point s c lati s per, in unicipal Code,Section 9.18. % 1 R // Licensed Professional ��! Date-3-)6-/O r` O Signature Date CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 32607037 . 00 DATE ISSUED. . . . . . . : 03/18/2010 RECEIPT # . . . . . . . . . BS000009982 REFERENCE ID # 10030113 SITE ADDRESS . . . . . : 10855 N STELLING RD SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER LANDMARK DEVELOPMENT ADDRESS 10855 N STELLING RD CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-0352 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 ---------- ------------- ---------- ---------- ---------- ------- 1BCBSC VALUATION 4, 000 . 00 1 . 00 0 . 00 1 . 00 0. 00 1BSEISMICR VALUATION 4, 000 . 00 0 .50 0 . 00 0 . 50 0 . 00 1EPERMITFE FLAT RATE 1. 00 42 . 00 0 . 00 42 . 00 0 . 00 1ERT<200 UNITS 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00 1TRAVDOC FLAT RATE 1. 00 42 . 00 0 . 00 42 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 127 . 50 0 . 00 127 .50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 127 . 50 VISA --------------- TOTAL RECEIPT 127 . 50 CITY OF CUPERTINO CUPEI�TINO GENERAL BUILDING PERMIT APPLICATION FORM APN # 3 tob� 0 37 , t' 3 - /9 -/v Building Address: Mailing Address (if different from building address): Are Hazardous Materials being used as part of this project? Yes ❑ No HOA: (Exterior work only) Yes ❑ No 0--�If es, rovide letter from HOA Owner's Name: ,`` Phone�j_#: c� L, G-L� qV 6 '73 ( — : 7 �D Contracto Phone: yo C 7 33-- 9623 Fax: I'a B -73-S'— 9 Z � Contractor License#: 4-f 53 3 Y Cupertino Business License#: Phone: Contact: kl, 1A l� L -- Fax: — �� Lt-- Residential Y Commercial ❑ Job Description: e0"04 d rx A 12t yy` Building Permit Info: Bldg ❑ Elect 3 Plumb ❑ Mech ❑ Type of Construction(Usage Class): Occupancy Type: 1-A, 1-B F] IUIII/V-A ❑ IUIII B, IV-HT, V-B 0.� V :7"2— Square Footage: Valuation: � oad Project Size: Ex redn Standard ❑ Large❑ Major ❑ Green Building: Please complete relevant portion of the Green Building/LEED Checklist& attach it to the application or if applicable, include in plan set& the sheet index. Points Achieved: For help, contact Build it Green at www.builditgreen.org Revised 07/14/09 CITY OF CUPERTINO BUILDING APPLICATION CITY of GENERAL EDULE CUPEt�TINO FEESCHEDULE Fee Permit Type /Sf Fee ID Fee Description Group 1GENRES or Quantity 1GENCOM Stucco Applications (up to 400 sf) B 1STUCOAP additional stucco application B Replacement windows/sliding glass iWINREP door (ea 8 windows) B 1WINMEWSTR New Window-structural rdes plan shear fee) wall/ma nrY E IEPERMITFEE Electrical Permit Fee � M 1MPERMITFEE Mechanical Permit Fee P 1PPERMITFEE Plumbing Permit Fee and Alone Electric Pln Ck(hourly) E lELCPLNCK StM IME CK Stand Alone Mechanical Pln Ck(lu'lY) 1M P 1PLMBLNCK Stand one Plumbing Pln Ck(lulY) 1 STPLNCK-(3 Hr Min Standard Plan Check(when E/MIP) B no when not over counter) hourl -stand alone SC Commission Fee B ALL PERMIT 1BCB Cal Bldg Standards Comm TYPES B 1BSEISMICR Seismic Residential B IBSEISMICO Seismic Commercial IT DOC Travel &Documentation B / B IBUSLIC Business License /' �� 0 5 of 5 ® - 7 G7" ,�i�/ter ,�;1 TC'f���✓ C�-,�9G'� a APPROVED IN ACCORDANCE WITH THE G1F CUP . ANCE { DATE-- I SIG - This of plans and specifications MUST be; ept on the fob at all times and it is uniawA Ito make any than es or alterations on ' me without written fission from } the Iding Department, Cit i Cupertino. J 1 f c0 The s ping of this plan an ifications ^ * !!! SHAL NOT be held to per or to be an -. 1 apprc val of the violation of provisions of iny City 0r(jin,lni N,)r 18 Law. 1412 a 'i 1 tl �� Oz O-X/7� G� aE ©� Q � 9 F , l 1 = f 0 3 1 4 1 i�t � Y i { e � s i t i { � I S 4 > f i p � s CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 37540024 . 00 DATE ISSUED. . . . . . . : 03/25/2010 RECEIPT #. . . . . . . . . BS000010033 REFERENCE ID # . . . : 10030152 SITE ADDRESS . . . . . : 740 STENDHAL LN SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . . HUE PHUNG ADDRESS 740 STENDHAL LN CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4659 RECEIVED FROM . . . . : FOKE WAIN CHEW CONTRACTOR TBD - TO BE DETERMINED LIC # 00096 COMPANY TBD - TO BE DETERMINED ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . : FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 2, 050 .00 1. 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 2, 050 . 00 0 . 50 0 . 00 0 . 50 0. 00 1WINREP EACH 8 1 . 00 380 . 00 0 . 00 380 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 381. 50 0 . 00 381 . 50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 381 . 50 1093 --------------- TOTAL RECEIPT 381.50