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07100105 CIT!' OF CUPERTINO ` �} BUI4.DING DIVISIOIV PERMIT ����� ���� ����`�����* ,;;. ;, ; : _ . ..:._ : BUIL I G D ESS: PERMIT NO. 4 1� �� � N STELLING RD LANDMAF K DEVELOPMENT 0 710 010 5 . OWNER'S NAME: PERMIT ISSUE DATE LARRY GUY 130 S MARY AVE STE 120 10 15 2007 NE. SANITARY NO. CONTROL NO. BUILDING PERMIT INFO ARCHITECf'/ENGINEER: TEMPOR�.RY POWER POLE e►.DC ELECT PLUMB MECH 0 0 0 0 i p p LiCENSED CONTRACfOR'S DECLARAT[ON JOb DCSCi1�7tlOi1 : V� I hcreby a(fi[m that I am liccnxd umkr provisions oC Chapicr 9(commcnciog ; z� wiU� Sccuo� 7000) of Division 3 of ihc Busincss and Pro(cssiuns Codc, and my liccnsc is '� y in full Carce and effec� � v� z Licensc Claz L�. � ; �, � Datc J�• / ' - � ContraMr � ARCHITECI'S DECLARATION 7� e 1 undcrs�anJ my plans shall bc uscd as public rcconLs )yV ° u. y Liccnsed Profcssional � y � OWNER-BUILDER DECLARATION I hcrcby affirm �hat 1 am ezcmpt Crom ihc Comractor's Liccnu Law for thc � p O (ollowing rcason. (Scction 7(731.5, Busincss and Profcssians Codc: Any ci�y or county �,°, Pi which rcquims a pertnit w rnnstruc4 aitcr, impravc, dcmolish, or repair any swcturc ° Z} prior w its issuancc, also rcyuircs thc applicant for such permit to filc a signcd sta�cmcnt ��, Ft. Floor Area Valuation �_< that he is liccnscd pursuant to thc provisions o( thc Conuacwr's Li��cnsc Law (Chap�cr 9 •>q Y F- �(commencing wi�h Scction 7000) of Division 3 of U�c Busincss and Profcssions Cadc) ur L�� that he is ezempt Neicfrom and tAe basis Cor the aI►cgcd exemption. Any violadon of Section 7031.5 by airy applicant for a pertnit subjecu the applican� to a civil penalty of APN Number Occupancy Type not more ihan five hundred dollars (5500� ❑[, u owncr of ttie prnperty, ar my employces with wages as �heir solc compensadon, will do thc work. and the strvaure is not inrended or offend far satc (Sec. 7044. Business R� u ired Ins eCt1011S and Pro(essions Cade: The Conuacars License Law does noe apply ta an owner of q p prapeny who 6uilds or improves thereon, and who does such work himselCor through his own employccs. providcd that such improvements are not iniended or otlered Cor sala It, however, the building or improvement is wld within one year of compledon, tlte owner- , buildec will have �he burden oC proving that he did not build ar improve (w pmpose of sak.). ❑ I, as owner of the property, am exelusively conuacting with Iicensed conuactors w conswct the projen (Sec. 7044. Business aod Professions Code:) The Coauuwr's Li- ccnse Law dacs not apply w an owner of propeny who buiWs or improves tAe�eon, and , who conuscts for such projects with a conuactor(s) ticensed pursuant w We Convacto�s License Law. ❑ I am ezempt under Sec , B& P C(or �his rcason Owner Date _. . WORKII2'S COMPENSATION DECLARA170N I hereby afCitm under penalty o[ perjury one af the following declarations: �] t hsvc and will maintain a Cenificate of Conscnt to sel4insure [or Worker's Compen- sation, as providcd for by Section 3700 of the Labor Code, far the perfo�mancc o[ thc work for whicd ihis pertnit is issucd. ❑ I havc and will mainlain Worker's CampcnsaUon [nsunncc, u tcquired by Scction 3700 oC the labo� Code, for the performance of the work for which this permit is issued. My Worke�s Campensation ►nsurance arricr and Policy numbcr arc: _ . 5fi�f� FNMC1 • � ' Cartier. Policy No.: CERTIFICATE OF EXEMPITON FROM WORKERS COMPENSATlON INSURANCE (This scction necd not be complctcd if the permit is !or one hundrcd dollacs (S l IXl) ar IcssJ � I certify that in the perfo�nance of the work [or which �his pertnit is issued. ! shall not amploy any person in any manncr w u to bccomc wbject io the Workers' Compcnsation Laws o( Califomia. Datc Applicant NUCICE TO APPC.ICAM: [f, aftcr making ihis CcniGca�c of Ezcmptian, you shoukl bccome subjcct to thc Workcr's Compensation provisions of the Labor Codc. you mus� , O fortAwith comply with such provisions or this pecmit shall bc dccmcd ccvokcd. z '"" CONS7RUC1'ION LENDING AGENCY [- �-�. I hcreby a[lirtn that �here is a conswcaan Icnding agency far thc performance of p; � ihe wurk fur which this permit is issued (Scc:. 3097, Civ. C.) W Q Lendcr's Namc " ? z L.cnder's Addrcss (� � I certiCy iha� I havc rcad this applicaiion and sia�c �hat thc above infortnatiun is w � cortcct. I agree to comply with all city and county oniinances and state laws rclating �o � U building conswction, and hercby authori�e represema�ivcs of �his cily to cntcr u�n thc � W abovc-mcn�ioncd properly for inspccdon purposes. a (Wc) agrce to save, indcmni(y and kecp harmless the City of Cupertino against �,E"„� � liabilities, judgm . cosu and expenscs which may in any way accruc against said Ci�y (� z in conaequcncc C c granUng of Ihis permil. DSCC � ►-+ APPLIC DERS'I�AND ND ILL COMPLY WITH ALL NON-POINT Issued by: / SOURCE U TIONS. ' .s` Re-roofs �,��� Signaturc of ApplicanUC nttactor �e� T of R�of HAZARDOUS MATERIALS DISCLOSURE }�� Wi11 �he applicant or futurc building oaupant storc or handlc haiardous matcrial as defincd by the Cupertino Municipal Codc, Chaptcr 9.12, and the Heal�h and Safcty Cocic. Scction 25532(a)? All roofs :,hall be inspected prior to any roofing material being installed. ❑ v� .g�r� , �11 thc applicant or futurc building occupant usc eyuipmcn� or devices which If a roof i: installed without first obtaining an inspection, I agree to remove • , cmii harardous air conaminants as dcfincd by thc Bay Area Air Quality Managcmcnt all new m�terials for inspection. District? �/ ❑Ycs �rvo I havc rcad ardcws ma�crials rcyuircmcnts undcr Chap�cr 6.95 of thc Califor- nia Hcalth & Saf C, Scctians 25505, 25533 and 25534. I undcrstvid that iCihc building docs no� cu �ly vc a icn at it � my responsibility w notity �hc occupant af thc rcyuircm ch must be et prio issuance Ccnificatc of Occupan Signature �f Appl icant Date ' �� � All roof coverings to be Class "B" or better or authorizcd agcm ��� CITY � � • � OF CUPERTINO � 7 f (�C�IC� � TEM�' POWER +cu���T��� PERMIT APPLICATION FORM APN # Date: - D7 - D3 �o- Building Address: I • � i ,�l/ Owne 's Name: . Phone #: � �.�a � �,��� � - Contractor: License #: Contact: Cupertino Business License #: �� Building Permit Info: 1�,� �� ��_ ,� 6� Elect L� Job Description: . / Residential [� Commercial ❑ Cost of Project�' � � Qty. if A licable Fee ID Fee Descri tion Fee Grou BTEMP 'Cem ora Power ELECTRICAL EPERMITFEE l:lect. Permit Issuance ELECTRICAL BUSLIC Business License BUILDING CITY OF CUPERTINO 2 ITEMS OF 2 PERMIZ RECEIPT OPERATOR: nancyc COPY # : 2 Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 32E07037.00 DATE ISSUED.......: 10/15/2007 RECEIPT #---•.••••: BSC00002989 REFERENCE ID # ...: 07100105 SITE ADDF2ESS .....: 10�55 N STELLING RD SUBDIVISION ....... CITY .............. CUFERTINO IMPACT AREA ....... 04VNER . . . . . . . . . . . . . LAF RY GUY ADDRESS ........... CITY/STATE/ZIP ...: CUFERTINO CA, 95014-0352 RECEIVED FROM ....: TOrI ADAME CONTRACTOR .......: JA.�.ON CHARTIER/PRESIDENT LIC # 5999 COMPANY ..........: LAI�DMARK DEVELOPMENT CORPORATI ADDRESS ..........: 13C7 S MARY AVE STE 120 CITY/STATE/ZIP ...: SUi�NYVALE, CA 94087 TELEPHONE ........: (4C8)733-9693 FEE ID UNIT QUANTITY FMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BTEMP FLAT RATE 1.00 62.10 0.00 62.10 0.00 EPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT : 102.89 0.00 102.89 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 102.89 1706 --------------- TOTAL RECEIPT : 102.89 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 103 UFER 304 ROUGH ELECTRICAL CITY OF CUPERTINO 2 ITEMS OF 2 PERMI'I' RECEIPT OPERATOR: nancyc COPY # : 2 Sec: Twp: Rng: Sub: Blk.: Lot: APN ........: 32E07037.00 DATE ISSUED.......: 10/15/2007 RECEIPT #•-••--•••� BSC00002989 REFERENCE ID # •••: 07700105 SITE ADDRESS .....: 1Of55 N STELLING RD SUBDIVISION ....... CITY .............. CUF'ERTINO IMPACT AREA ....... OWNER . . . . . . . . . . . . . LP,F:RY GUY ADDRESS ........... CITY/STATE/ZIP ...: CUI'ERTINO CA, 95014-0352 RECEIVED FROM ....: TOP1I ADAME CONTR.ACTOR .......: JA:�ON CHARTIER/PRESIDENT LIC # 5999 COMPANY ..........: LATdDMARK DEVELOPMENT CORPORATI ADDRESS ..........: 13()7 S MARY AVE STE 120 CITY/STATE/ZIP ...: SUIdNYVALE, CA 94087 TELEPHONE . . . . . . . . : (4�)8) 733-9693 FEE ID UNIT QUANTITY i�MOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BTEMP FLAT RATE 1.00 62.10 0.00 62.10 0.00 EPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT : 102.89 0.00 102.89 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 102.89 1706 --------------- TOTAL RECEIPT : 102.89 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 103 UFER 304 ROUGH ELECTRICAL � I I"i..,... i.i�..�c.a I � �