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CITY OF CUPERTINO
BUILDING DIVISION PERMIT C�1I TIE ACTb 2 I A�Tjf�N.. '
PERMIT NO.
� I STELLING RD LANDMARK DEVELOPMENT 07120227
OWNER'S NAME: CORPORPPERMIT ISSUE DATE
,\,S PALMAS STELLING LLC 1307 S MARY AVE STE 120 09/03/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHTCECIYENGINEER: NEW TWO STORY TOWNHOUSE BLDG H EILECTG PERP O
PLUMB MECH
o p LICENSED CONTRACTOR'S DECLARATION O O O
u F I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description
U ..J//���with Section 7000)of D(vt 3 of the Business and Professions Code,/and my license is
in full force and effect % ! ?�3 �"7
2— License Class Lic.I
f„in Date .. Contractor --
ITECTS DECLARATION
iU I understand my plans shall be used as public records
O H Licensed Professional
h 0< OWNER-BUILDER DECLARATION
< I hereby affirm that I am exempt from the Contractor's License Law for the
in yO following reason.(Section 70315,Business and Professions Code:Any city or county
which requires a permit to construct,alter,improve,demolish,nr repair any structure
Z y prior to its issuance,also requites 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(Chapter 9 Sq.Ft.Floor Area Valuation
t-O (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
0 that he is exempt therefrom and the basis for the alleged exemption.Any violadon of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occas anC T e
not more than five hundred dollars($500). P Y YP
❑1,as owner of the property,or my employers with wages as their sole compensation,
will do thework,and the structure is not intended or offered forsa�(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 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 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 Contractor's
License Law.
❑1 am exempt under Sec ,B&PC for this reason
Owner Date
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
71 1 hs ve 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.
(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 C�ompensation Insurance carrier and Policy number are:
Carrier, 'WPolicy No.: O
CERTIFlCA F EX I'IION FROM WORKERS'
COMPENSATION INSURANCE ,
Jbis section need not be completed if.the permit is(or 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.Date
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
Oforthwith comply with such provisions or this permit shall be deemed revoked. -
z CONSTRUCTION LENDING AGENCY
(~... I hereby affirm that there is a construction lending agency for the performance of
pr+> the work fur which this permit is issued(Sec.3097,Civ.C.)
Lender's Name
Lender's Address
U C I certify that 1 have read this application and state that the above information is
IL " correcL(agree to comply with all city and county ordinances and state laws relating to
® U building construction,and hereby authorize mpresentatives of this city to enter upon the
W above-mentioned property for inspection purposes.
GL (We)agree to save,indemnify and keep harmless the City of Cupertino against
r/I liabilities,judgments,costs and expenses which may in anyyay accrue against said City
U Z m conseque the 'ng of this pc '
APPLI RSTA A O Y WITH ALL NON-POINT Issued by: Date
SO LATIO a
��
Re-roofs 2c�
Si tum_o[Applicara/Conurac)of Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hayardous material
as defined by the Cupertino Munici ode,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 o
Will the applicant r uture 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?
❑Ycs o
1 have read the baysous materials requirements under Ch r6.95 of the Califor-
nia Health&SafetyCodc,Sections 255 ,25533. 534.E tandthari(thcbuildin9
docs not cu a e�tcnth 'Tis my n' n •notify the occupant n(the
requimm ch p rtoi a rrateof tc2_c9p Signature of Applicant Date
All roof coverin s to be Class" `
Date g ,�'or better
Aa—la
CITY OF CUPERTINO
NEW SINGLE/MULTI FAMILY DWELLING
CUPEkTINO PERMIT APPLICATION FORM .
APN# Date:
32(P--0-7 -7 , 3q r2 - 1 -1 -oma
Building Address: f.
Mailing Address (if different from building address):
130 50- 1A4 ST'f— 12o S AV VO, CQ. CA 9Ci-087
Owner's Name: hone#
C 0PA->V4VV0 �ecM.-�o T C o ,� Clob X33-- 9i P,3
Co tractor: Phone#: e-IC)6
733 � g � �3
��,e,1a ,ter Cam Fax#: 4/v E -73s= 5 Z.
Contractor License#:Z_/$3 3 c f C�
Cupertino Business License
Contact: Phone#:y0 e ?33
Fax#: 4/o
Alternate Contact: Phone#: sA �
To r. Fax 4:
Single-Story ❑ Two-Story Three-Story ❑ Basement ❑ Hillside_ ❑
Multi-family ❑ Apart-nent ❑ Condo ❑ Townhouse ?
Sq.Ft. Li((ving Area(Including Basement &Attached Garage: Sq. Ft. Garage (Detached Only):
Valuation:
ZI-1q ss3S
Jo//b Description:
Type of Construction (Usage Class): Occupancy Type:
1 FR, 11FR ❑ 11, 111, V-1HR ❑ 11, 111, 1V V-N
Project Size: Standard KLarge Major❑
Green wilding: 11Zust attach comr leted Green wilding Checklist to the glans
Green wilding Points Achieved:
For help, contact Build it Green at www°.buildit6reen.ora
CITY OF CUPERTINO
NEW SINGLE/MULTI FAMILY DWELLING
FEE SCREDULE
Quantity Fee ID- Fee Description Fee,Group Permit Type
1R11NSP Apt.Bldg inspection,fee, B ' 1RIAPT
1RIPLNCK Apt Bldg plan check.fee .B
1RIREINSP Apt Bldg repeat unit B IRIAPTR
Inspection fee
1RIREPLNCK Apt.BIda repeat unit plan B,
check fee
1R3INSPDwellings hispection B 1123SFDW
1R3PLNCK Dwellings Plan Check -B
1R3REPINSP Dwellings Repeat B II23SFDR.
Z j G �• Inspection
IR3REPPLNC Dwellings Repeat Plan B
Check
1R3HINSP Dwellings Hillside B IR311ILL
Inspection
IR3HPLNCK Dwellings Hillside Plan B
Check . .
1R3HREINSP' Dwellings Hillside B
Repeat Inspection
1R3HREPLNC Dwelling Hillside Repeat B
Plan Check
1R3ALTINSP Dwellings Alternate B - R3SFDALT
Materials
1R3,ALTPLNCK Dwellings Alternate B '
Materials
1GARDTW<=1K Detached Garage Wood B
IGARDTM<=1K Detached Garage B
Masonry
I1B('.0NSTAXR Constax-Resi/Mobile B
113MITIGATR Residential Housing PL
Mitigation Fee-chrg only
(Q if lot is vacant or it is a
sub division-see'pl anning
l
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