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CITY OF CUPERTINO
BUILDING DIVISION pERWHI
BUILQIi`!G ApfaR RMIT NO.
N PE STELLING RD LANDMARK DEVELOPMENT 07120220
OWNER'S NAME: PERbi1T MUE DATE
V-3 PAhMAS STELLING LLC 1307 S MARY AVE STE 120 09/03/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHr1ECfrENGINEER: BUILDING PERMIT INFO
NEW TWO STORY TOWNHOUSEBLDG ELECT PLUMB MECH
2399
O p LICENSED CONTRACTOR'S DECLARATION r
u I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description
.<c with Section 70[1(1)of Division 3 of the Business and Professions Code,and my license is
n
in full force and lass Liceffect 3 3 9
r�� License C .ri '
F,❑ Dam �' -� Coniracmr — l+'-'D.rttM-�
mA CHITECrS DECLARATION f
� �°�DJY�2c
7 < 1 understand my plans shall be used as public records / 2 -n
JyU C �
u.y Licensed Professional
rn OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractors License Law for the
❑O following reason.(Section 7031.5,Business and Professions Code:Any city or county
e 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
othat he is licensed pursuant to the provisions of the Contractor's License taw(Chapter 9 Sq.Ft.Floor Area Valuation
x F (commencing with Section 7000)o[Division 3 or the Businessand 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 subjects the applicant to a civil penalty of APN Number Occupancy Type
not more than five hundred dollars($500). p y yP
0 I,as owner of the property,or my employees with wages as their sole compensation,
will do thework and the structure is notintended or offered forsale(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 are not intended or offered for sale.If,
however,the building or improvement is sold within one year or completion,the owner.
builder will have the burden or proving that he did not build or improve for purpose or
sale.).
❑I,as owner of the property,am exclusively contacting with licensed contractors to
construct the project(Sec.704-4,Business and Proressions Code:)The Contactnr's Li.
cerise Law does not apply to an owner of property who builds or impmves thereon,and
who contacts for such projects with a conuactor(s)licensed pursuant to the Contractors
License Law.
I am exempt under Sec ,B&P C for this reason
Owner Dam
WORKER'S COMPENSA71ON DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑1 have and will maintain a Ccrtificamof Consent to self-insure for Workers Compen-
sation,as provided for by Section 3700 or the Labor Code,for the performantr of the
work for which this permit is issucd.
1 have and will maintain Worker's Compensation Insurance,as required by Section
My 0[the Labor Code,for the uranceperformance of the work fornu which re: permit is '
My Workers Compensation nsuance carrier and Policy number are:
Cartier. ,?Q^Polity No.:»Zvµ�D
_CERT1FTffATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This 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 Workcrs'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 or the Labor Code,you must
J® forthwith comply with such provisions or this permit shall be deemed revoked. -
Z CONSTRUCTION LENDING AGENCY
�+►^+ I hereby affirm that there is a conswctinn lending agency for the performance of ,
fyi , the work for which this permit is issued(Sec 3097,Civ.C)
Lender's Name
Z Under's Address
U 0 1 certify that I have read this application and state that the above information is
�1v — cortecL I agree to comply with all city and county ordinances and state laws relating to
OU building construction,and hereby authorize representatives of this city to enter upon the
Uabove-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City or Cupertino against
Hfn liabilities,judgments,costs and expenses which may/anyway way accnm against said City
U ,'� in crenae uencc o[th granting 0'this p rmit
r-+ APP ERSTANDS LL OMPLY WITH ALL NON-POINT Issued by: Date f G�,
ULA 5.
Re-roofs
nature of Applicant/Con ctor Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or 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)?
❑ All roofs shall be inspected prior to any roofing material being installed.
Yes
Will the applicant orrf(�'(`to 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?
❑Yrs No
I have read rhe hazardous materials requirements u,pdcr Chapmr6.95 of the Califor- -
niaHealth&SafetyCode,Sections 25505,25533 and 25534.1 understand that if the building
docs urcn a ten t tha' �7ility m notify the occupant o[the
ire r,hmust mel crtificamo(Occcuupancy. �� Signature of Applicant Date
'/+ All roof coverings to be Class'A or better
mare.
F16
CITY OF CUPERTINO
NEW SINGLE/MULTI FAMILY DWELLING
CITCUPEI�TINO PERMIT APPLICATION FOM
APN#3�(G'- C:7— C� �_7Z3 Date: 1 3 .y
Building Address: 7
Mailing Address (if different from building address):
so . P,1 (41 s 12-0 0 b?
Owner's Name: „ / Phone#
DeUZl(,; ihuL Z-/Ob _73^3
Cont actor: Phone#: ` b -7-_3F3 q Q-- �'_3
C �, ±�; est !)+ui ������- c • c.���t ren
Fax #: i3 `7-3S- .Z%9
Contractor License #: Z-/' 3 c-1 9
Cupertino Business License#: ���
Contact: / Phone#: 47�o ' -7 3 -
kFax #: 41 k =7. 5'- Cr' 2 5� 9
Alternate Contact: Phone#: 44 C -7 3'3 -- �� I
To Yi ;, A C-1 C�_wX -e— Fax #: /-/O b 735-- 9"Z i
Single-Story ❑ Two-Story Three-Story ❑ Basement ❑ Hillside, ❑
Multi-family Apartment ❑ Condo ❑ Townhouse
Sq.Ft. Living Area (Including Basement &Attached Garage: Sq. Ft. Garage (Detached Only):
Valuation:
335- 13 CQ 0
Job Description: /*/e,�-i -r\.-? . -�-fi y
Type of Construction (Usage Class): Occupancy Type:
I FR, IIFR ❑ 11, 111, V-IHR ❑ 11, 111, 1V V-N
Project Size: Standard Large[' Major❑.
Green Building: Must attach completed Green Building Checklist to the plans
Green Building Points Achieved:
For help, contact Build it Green at wrrw.buildit6reen.oru,