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CITY OF CUPERTINO
BUILDING DIVISION PERMIT
BUILDING ADDRESS: PERMIT NO.
01819 N STELLING RD LANDMARK DEVELOPMENT 07120218
OWNER'S NAME: PERMIT ISSUE DATE
1 PALMAS STELLING LLC 1307 S MARY AVE STE 120. 09/03/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: NEW TWO STORY TOWNHOUSE BLDG BUILDING
PERO
PLUMB MECH
2399 SF
5 ce a LICENSED CONTRACTOR'S DECLARATION : 0 0 D
U U I hereby affirm that I am licensed under provisions or Chapter 9(commencing Job Description
a<a with Section 7000)of Division 3 of the Business and Professions Code,and my license is
in full force and effecl.(� 3^2 C/9
�n J J T
j i2Z License Cl Lic.0
+F a Dam Contractor 'JM ,
�- A HITECTS DECLARATION L' j2y11
U I understand my plans shall be used as public records
4 tiff
G H Licensed Professional
rn OWNER-BUILDER DECLARATION
`>3<g I hereby affirm that 1 am exempt from the Contractor's License Law for the
p O following reason.(Section 7031.5,Business and Professions Code:Any city or county
4 which requires a permit to concoct,alter,improve,demolish,or mpair any structure
n Z> prior to its issuance,also requires the applicant for such permit to file a signed statement
E < that he is licensed pursuant to the provisions or the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
=D
x h (commencing with Section 70D0)of Division 3 of the Business and Professions Code)or
y that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subject%the applicant to a civil penalty of APN Number Occupancy
not more than five hundred dollars($500). P Y Type
1,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(See.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 orthrough his .
own employers,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 of proving that he did not build or improve for purpose of
sale.).
1,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 taw 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 Contractor's .
License Law.
1 am exempt under Sec ,B&P C for this mason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 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(he Labor Code,for the performance of the
work for which this permit is issued.
1 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's Compensation Insurance ca 'er and Policy num her arc:
Cartier. Polity No..�n ��—C,1}Q( -
R I ATE OF EX PTION FROM WORKERS' ' .
COMPENSATION IN URANCE -
(This section need not be com le 'f tfu� i is rone hundred dollars($100)
or less.)
I certify that in die performance of the work for whit this permit is issued,1 shall not
employ any person in any manncrso as m become so ecl m the Workeri Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the tabor Code,you must
.J O forthwith comply with such provisions or this permit shall be deemed revoked.
z CONSTRUCTION LENDING AGENCY .
('•+ �r .I hereby affirm that there is a concoction lending agency for the performance of
(Y+ > the work for which this permit is issued(See.3097,Civ.C-)
aA Lender's Name -
Z Lender's Address
U 0 I certify that I have read this application and state that the above information is
ly '—' correct I agree to comply with all city and county ordinances and state laws relating to.
0 V building construction,and hereby aulhorim representatives of this city to enter upon the
W ahovc-mcndoned property for inspection purposes.
Q. (We)agree to save,indemnify and keep harmless the City of Cupertino against
t4 liabilities,judgments,costs and expenses which m - any way accrue againUsaid City
,()
U z in co nc - c grunting of .
A NDERS LL OMPLY WITH ALL NON-POINT Issued by: Date �r G�'
REGULA S
3--6 10" Re-roofs
Signature of Applicant/ tractor - Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicantor future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code.Chapter 9,12,and the Health and Safety
Code,Section 25532(a)?
Yes All roofs shall be inspected prior to any roofing material being installed.
❑ ono
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 dincd by the Bay Area Air Quality Management all new materials for inspection.
District?
Yes u
t have read the h ardous materials requirements u crChapter6.95 of the Califor• -
niaHc4fth ctyC ,Scc'on25505,25533 4.1undersrandthatifthe building -
9wner
art a ant,tha ' pc ibility to notify the occupant of the
which m m uan�f a Certificate of Occupancy. Signature of Applicant Date
>= - o
All roof coverings to be Class'r�}`'or better
uthorirsd age Date' � g .''T i
F16
CITY OF CUPERTINO
NEW SINGLE/MULTI FAMILY DWELLING
CUPEkTINO PERMIT APPLICATION FORM
71
APN# Date: . ,
, �,- L�- -7. /q I �2- 13 g.i7
Building Address:
�® S t g A) s Te, [�
Mailing Address (if different from building address):
13
Owner's Name: Phone#
Cont actor: Phone#: ` -7-3`3
L►�.,i D ivy r�
Fax 1 -35— "Z%7
Contractor License #: Z_ (a -3 .3 L-1 9
Cupertino Business License
Contact: / Phone#: 47�L, ' `7 1>3 - 9 S
ko Fax
Alternate Contact: Phone#: 4./,0 6 -7 3.3 --
AGA d
c-wkFax #: �- Ob 735 9Z"1" 2
Single-Story ❑ Two-Story Three-Story E] Basement E] Hillside ❑
Multi-family Apartment ❑ Condo ❑ Townhouse
Sq.Ft. Living Area (Including Basement & Attached Garage: Sq. Ft. Garage ( etached Only):
,8c-1)G,- F z 399 s'I-PT
Valuation:
Job Description: ��, � -7-� 5-7-66.,y T'�__\,vk 17\
Type of Construction (Usage Class): Occupancy Type:
1 FR, 11FR ❑ 11, 111,V-lHR ❑ 11, 111, 1V V-N 3
Project Size: Standard Lar1 e, Major❑
Green Building: Must attach completed Green Building Checklist to the plans
Green Building Points Achieved:
For help, contact Build it Green at www.builditareen.orQ