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CITY OF CUPERTINO
BUILDING DIVISION PERMIT
BUILDIN gQRESS: PERMIT NO.
�c, 7 N STELLING RD LANDMARK DEVELOPMENT 07120216
OWNER'S NAME: TON PERMIT ISSUE DATE
:.�.S PA!,MAS STELLING LLC 1307 S MARY AVE STE 120 09/03/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHTIECC/ENGiNEER: NEW TWO STORY TOWNHOUSE BLDG BUILDING
PERP UMBO MECH
349 GF
00 LICENSED CONTRACTOR'S DECLARATION Job Description
i v F I hereby affirm that I am licensed under provisions of Chapter 9(commencing
Z w with Section 70W)of Division 3 of the Business and Professions Code•a my license is
<a in full force and effect. 4(
i z DLicense Class�Con q J
t- Date�` _ b Contractor L fa'1 ✓-Y�-`
,-4 ARCHITECTS DECLARATION Lrw eLD 41t7
i ¢ 1 understand my plans shall be used as public records Clt�
)yU
p
H Licensed Professional
y g OWNER-BUILDER DECLARATION
j<:9 I hereby affirm that I am exempt from the Contractors License Law for the
:p O following reason.(Section 71131.5,Business and Professions Code:Any city or county
e.9.1 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
zQ
that he is licensed pursuant to the provisions of the Contractor's License law(Chapter 9 Sq.Ft.Floor Area Valuation
t F (commencing with Section 7000)of Division 3 of the Businessand Professions Code)or
that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by arry applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more than five hundred dollars(3500).
❑I•as owner of the property,or my employees with wages as their Sole compensation,
will do the work and the structure is not intended or offered for sale(Sec.7044•Business
and Professions Code:The Contractors 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 employees,provided that such improvements arc not intended or offered for sale.If,
however,the building or improvement is sold within one year 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 Contractors Li-
come Law does not apply to an owner of property who builds or improves thereon,and
who contracts for such projects with a contractor(s)licensed pursuant to the Contractors
License Law.
❑I am exempt under Sec ,B&P C for this mason
Owner Date
WORKER'S COMPENSATION DECLARATION
I 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.
❑I 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�Compensadon Insuragce carrier and Policy number are:
Carrier: s gt . Policy No.:
r � d
CERTIFICATE EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars(3100)
or less.)
I certify that in the performance of the work for which this permit is issued.I shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Workers Compensation provisions of the Labor Code,you must
Z forthwith comply with such provisions or this permit shall be deemed revoked. _
7.�
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
the work for which this permit is issued(Sec.3097,Civ.C.)
WCL Q Lender's Name
Z Lenders Address
C�Q I certify that I have read this application and state that the above information is
�-+ corecL 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 upon the
W ahove-mentioned property for inspection purposes
(We)agree to save,indemnify and keep harmless the City of Cupertino against
,...4 sin liabilities,judgments,costs and expenses which may in py way accrue against said City
U Z in coP��
ranti of this it. r7
�-+ APS ND C PLY WITH ALL NON-POINT Issued by: Date
ULA S.
F-03—U Re-roofs
tgnaturc of ApplicanVCon Lor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant stem or handle hazardous material
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Cede,Section 25532(07All roofs shall be inspected prior to any roofing material being installed.
❑Yes o
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 contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes
Ihave read thehazousmatcrialsrequiremcntsunderCha 1cr6.95oftheCalifor-
niaHealth& clyCode, ctioas25505,25533 d2553 rstandthatifthe building
docs u tl tenan a��p
notify the occupant of the
re must be prificatc of Occupancy. Signature of Applicant Date
wnerorauthari�eaaeenl
7.o3
All roof coverings to be Class'}.`'or better
CITY OF CUPERTINO
NEW SINGLE/MULTI FAMILY DWELLING
OF
CUPE"kTINO PERMIT APPLICATION FORM
APN# Date:
3�?;, (a- 07- T
Building Address: 4a." — ='
/ oots- N.
Mailing Address (if different from building address):
Owner's Name: Phone#
Cont actor: Phone#: 44 -7
Fax #: i 1� -7 3 S 9"Z r 9
Contractor License #: Z-1 5 -3 .3`-t 9
Cupertino Business License#: 9
,., r
Contact: Phone#: L/-o
t f 1 Fax#: 409 7sS"—
Alternate Contact: Phone#: hG 0�j -7 3 3 J�.
d Yi r'
Ad Fax #: ���'`f7 '73S--
Single-Story
73S—Single-Story ❑ Two-Story Three-Story ❑ Basement ❑ Hillside. ❑
Multi-family Apartment ❑ Condo ❑ Townhouse
Sq.Ft. Living Area (Including Basement & Attached Garage: Sq. Ft. Garage ( etached Only):
2 3 Ll 9
Valuation:
.3 3� 7
Job Description: / J 'Tb,-.,.;VA
Type of Construction (Usage Class): Occupancy Type:
1 FR, I IFR ❑ 11, 111,V-lHR ❑ 11, 111, 1V V-N �
Project Size: Standar4lr
Large Major❑
YY`
Green Building: Must attach completed Green Building Checklist to the plans
Green Building Points Achieved:
For help, contact Build it Green at wwwr.builditgreen.ora