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CITY OF CUPERTINO
BUILDING DIVISION PE12N T +C 1 T G O INF AtTIUN.
BUILD.ING,sAgDRESS: PERMIT NO.
)L , r N STELLING RD LANDMARK DEVELOPMENT 07120217
OWNER'S NAME: PERMTT ISSUE DATE
AS !IAI,MAS STELLING LLC 1307 S MARY AVE STE 120 09/03/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHITECrrENGINEER: BUILDING PERMIT INFO
NEW TWO STORY TOWNHOUSE BLDG ELECT PLUMB MECH
O p LICENSED CONTRACTOR'S DECLARATION ' Job Description
U I hereby affirm that I am licensed under provisions of Chapter 9(commencing
Z awith Section 7000)of Division 3 0f the Business and Professions Code,and my license is
in full force and effect. ? �'
�v7
r z License Class LIC.
. 418
M Date — — Contractor J u_0kYvM
ARCHITECrS DECLARATION 2-1
II understand my plans shall be used as public records ea Y,Q
)ulU r
'n.!-, Licensed Professional
0.1
a OWNER-BUILDER DECLARATION
a I hereby affirm that 1 am exempt from the Contractor's Liecnse Law for the
❑C following reason.(Section 7031.5,Business and Professions Calc:Any city or county
which requires a permit to construct.alar,improve,demolish,or repair any structure
u Z>y„ prior to its issuance,also requires the applicant for such permit to file a signed statement
that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
rF (commencing with Section 7000)of Division 3 of the Business and Professions Code)ur
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 APN Number Occupancy Type
not mart than five hundred dollars(5500).
❑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 forsale(Sec.7044,Business
and Professions Code The Contractor's 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 are 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 or 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 Li-
cense Law docs not apply to an owner of property who builds or improves thereon,and -
who contract for such projects with a contraclor(s)licensed pursuant to the Contractor's
License Law.
❑I am exempt under Sec ,B&P C for this reason
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-insert 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 or the work for which this permit is issued
My Worker's Compensation Insurance
�carrier and Policy number are:
'7y
Carrier. r'),,/ �lV/1 Polity No.: 2614'�7a
CERTIFI OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(rhis section need not be completed if the permit is for one hundred dollars($100)
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.Dale
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
,Z forthwith comply with such provisions or this Permit shall be deemed mvokcd. -
0
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the Performance of
(Y.. > the work for which this permit is issued(See.3097,Civ.C.)
OW.r Lender's Name
a Z Lender's Address
Q Q I testify that I have read this application and state that the above information is
Vl correct I agree to comply with all city and county ordinances and state laws relating to
nU building construction,and hereby authorize representatives of this city to enter upon the
L) ahovc-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
Hto liabilities,judgments,toss and expenses which ay in y way accrue against said City
U z in conse c of grantin of this arm'
'--+ APP 11 ERST LL PLY WITH ALL NON-POINT Issued by: Date
ULATI
Re-roofs
rgnature of AppFicant/goWiractor Date
ARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or futurebuilding occupant store or handle hazardous material
as defined by the Cupertino Municipal de.Chapter 9.12,and the Health and Safety
Code,Section 25532(a)?
Yrs All roofs shall be inspected prior to any roofing material being installed.
❑ o
Will the applicanor 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 defy cd by the Bay Arca Air Quality Management all new materials for inspection.
District?
EJ Yes
1 have read the hazy nus materials requirements undcrChaptcr 6.95 of Uuc Califor-
nia Health&SafctyCode,Sections 25505,255 534.lunderstandthetifthe building
d arm ve ane, i nsibility to notify the occupant of the
;eh t be rss ec of a Certificate of Occupancy,
_ Signature of Applicant Date
Owner or authorized a ant Date
All roof coverings to be Class" ''or better
CI'T'Y OF CUPERTINO
NEW SINGLE/MULTI FAMILY DWELLING
CUPEkTINO PERMIT APPLICA'T'ION FORM
APN# Date: 13 6_7
Building Address:
v �
Mailing Address (if different from building address):
Owner's Name: Phone# :
Cc, 410 r '7'3-3
Cont actor: ��z�l s-li; ih��7` � 2. cvk�r�,� Phone#: 44� b -773-3 -
Fax #: Z/C, 4`3
Contractor License #: Z-/ ct 9
Cupertino Business License#: S '
Contact: Phone#: 4 o ' "3 - Ct - S
k� ff e4oE, �3 — � 5Lr3 -, c� Q_
f—�1 d ����� Fax #: L U V 7 .S''— Cr'
Alternate Contact: Phone#: 44 6 -7 3 3 -- Ao i�
Fax #: �--��' 7 3.5-— 9Z_% l
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):
Valuation:
Job Description: /Ve\,\) 1�-1-, 1 j� ,jZ,� T cis �;✓� �� j
Type of Construction (Usage Class): Occupancy Type:
1 FR, 11FR ❑ 11, 111, VAHR ❑ 11, 111, lV V-N 3
Project Size: Standard ig,
Large Major❑
Green Building: Must attach completed Green Building Checklist to the plans
Green Building Points Achieved:
For help, contact Build it Green at w`w.builditareen.®