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CITY OF CUPERTINO
BUILDING DIVISION PERK [r
BUILDING ADDRESS: PERMIT NO.
-. 9827 N STELLING RD LANDMARK DEVELOPMENT 07120222
OWNER'S NAME: — PERMIT ISSUE DATE
AS PALMAS STELLING LLC 1307 S MARY AVE STE 120 09/03/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING
NEW TWO STORY TOWNHOUSE BLDG ELTPEA PLUMB MECH
I 399 9F
O P LICENSED CONTRACTOR'S DECLARATION O O
W C I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description
?Z w with Section 7000)of Division 3 of the Business and Professions Code,and my license is
i a a in full force and t IT
j — License Class Lic.#
F,a Date Contractor la-J
„ret, ARCHITECT'S DECLARATION
ce< I understand my plans shall be used as public records
�yU yr
4 O y Licensed Professional
nv
OWNER-BUILDER DECLARATION
a� 1 hereby affirm that 1 am exempt from the Contractors License Law for the
L
00 following reason.(Section 703 1.5,Business and Professions Code:Any city or county
,N„(Li 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
x
that he is licensed pursuant to the provisions of the Contractor's License Law(Chapin 9 Sq.Ft.Floor Area Valuation
(commencing with Section 7000)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 subjects the applicant to a civil penally of anC APN Number Occupancy
not more than five hundred dollars(E500). P Y Type
❑I,as owner of the property,or my employees with wages as thein sale 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 orimproves thereon,and who does such work himself or through his
own employccs,provided that such improvements are not intended or offered for sale,I.
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 Contractor's Li-
cense Law does not apply to an owner of property who builds or improves thereon,and
who contracts for such projects with a contractors)licensed pursuant to the Contractors
License Law.
❑1 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:
❑1 have and will maintain a Certiftcateof 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 Workers Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued. '
My Workers Compensation Insurance carrier and Policy number are:
Carrier.�C.1 W O t!d fS rZe Policy No,; d
CERTIFICATE F EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars(EI00)
or less.)
I cenifv 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 Califomia.Dam
Applicant
NOTICE TO APPLICANT:If,alter 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 permtit shall be deemed revoked.
C] —
CONSTRUCTION LENDING AGENCY
E-+�•+ I hereby affirm that there is a construction lending agency for the performance of
CLQ 5 the work for which this permit is issued(See.3097,Civ.C.)
W 0 Lender's Name
�
.7 z Lenders Address
U Q T certify that I have read this application and state that the above information is
correct I agree to comply with all city and county ordinances and state laws relating to
Ubuilding construction,and hereby authorize representatives of this city to enter upon the
W ahove-mentioned property for inspection purposes.
LL (We)agree to save,indemnify and keep harm) the City of Cupertino against
rte,. rn liabilities.judgments,costs and expenses which ma " eery way aceruc against said City
U Z in consequence of the granting of this it
APPL�ZER AND OMPLY WITH ALL NON-POINT Issued by: Date S
50 .
Re-roofs
S' nature of Applicant/Carfiractor IDate �_ -- "�--�—�
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Munie' 1 Code.Chapter 9.12,and the Health and Safety
Code,Section Z5532(a)?
Yes No All roofs shall be inspected prior to any roofing material being installed.
❑
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?
C)Yes u
Ihavcmad the ha7 r ousmaterials requireme rider Chapter 6.95ofthe Califor-
nia Health&Safety Code,Sections 25505 533 34.1 understand that if the building
does no oily a re 4 th m s sibility to notify the occupant of the
requ' i must me u or a Certificate or Occupancy.
Signature of Applicant Date
Date All roof coverings to be Class'"or better
CITY OF CUPERTINO
NEW SINGLE/MULTI FAMILY DWELLING
CITY OF
CUPERTINO PERMIT APPLICATION FORM
APN 4 07- �72_';7- Date:
13 6_7
Building Address:
I-
0 9 a-7 A) ,
Mailing Address (if different from building address):
Owner's Name: Phone
Ll -73-3 - ?!v 7 3
Cont actor: Phone ? (c
Lctor: -7-_3-3 -
V:� J D ry\ V-(o i2ili w-, 2,pwl _Ivi
Fax #: 9
Contractor License #: Z-/ �5 -3 3(-t 9
Cupertino Business License#:
Contact: Phone #: L, b -7��,3 9 -S
t4 0 E-, _-R 3-1 - I V L4 3 -
k� 0 Fax #: L10 F '73.5-- Cr' 2 ci 9
Alternate Contact: Phone#: q C`J5 -7 3_3 5,(c Crz
DO-T\ i, A J, e�_W,\. -e— Fax 9: r-/0b 73S 9'-Z-7 9
Single-Story El Two-Story Three-Story El Basement ❑ Hillside
Multi-family _ Apartment El Condo [:] Townhouse )<-
Sq.Ft. Living Area (Including Basement & Attached Garage: Sq. Ft. Garage (betached Only):
Valuation:
33 15 Ce o
Job Description: /V e� 7-A-,-, >7 'A >
Type of Construction(Usage Class): Occupancy Type:
I FR, I IFR ❑ 11, 111, V-IHR D 11, 111, lVV-N
Project Size: Standard Large Major Fj
Green Building: Must attach completed Green Building Checklist to the plans
Green Building Points Achieved:
For help, contact Build it Green at www.buildit2reen,,0_r(,y