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07120230- PUB Idl x U O x 0 a CD a a — O a v o 0 LO U) m 0 m " za kn F Pi O J O PG J 0 J' O O F co '-I O J W LO c H A O U O_ p a J LO 6 F ?n L+] H F J 0 •U to W W H FLO zW-- 0 V pa d O W O 'pa �7Ayi PL F F 9 Z pi a m pa m M W h '� U7 E W W O ,'3 W �. o N U a Z A to w ou cu Q n L %aa n y y I'D-- 2 5 � LJ Idl ,• 0 �4 a N •> Qt J 3 ll, a a s V cu U Idl' Ictl hdl! n f a a a cu O O O J r Jcm, U 3 W Ll J LLI a U r �N O w . CL 71 LLI vLLv11 Z t 0 O O O O W O W I C M l N N N 0 N >.c •� W J m m 0 (•= I LO C3 li _ N M C i' _ r O N _ N N m v _ i'.� a :Q �' 0 0 0 _ coo dl -' as CD ' O O fu O a y .W a m CL O x } o a -0 a 3 r> a m ~ a N rn rt E E K(D 2 Z _ a� > W as o o -- as a) a) o �_ _0 oC iq v �_` 2 a7 Q U dl %y y U o U U U , •.a 0 U kA U •� C O a, wl a� :° a a� E O Q LO U U o -� Q CL d. W L 0- Q ❑.. U U U E a a LL CTI Y'OF CUPERTINO n >> BUILDING DIVISION PERMIT �� Tfl INFJOn RiV.iATI41*J. BUILDING ADDRESS: PERMIT NO. 3-3!3 N STFLLING RD LANDMARK DEVELOPMENT 07120230 OWNER'S NAME: PERMIT ISSUE DATE '1S PALMAS STFLLING LLC 1307 S MARY AVE STE 120 09/03/2008 PHONE: SANITARY NO. CONTROL NO. ARCHITECTIENGINEER: BUILDING PERMIT INFO NEW TWO STORY TOWNHOUSE BLDG ELECT PLUMB MECH O p ±69 SF LICENSED CONTRACT'OR'S DECLARATION O O v f; I hereby affirm that I am licensed under provisions or Chapter 9(commencing Job Description Y with Section 7000)of Divi n 3 of the Business and Professions Code,and my license is a H in full fome and affect. : ? License Class it O Date 'c' - b Q Contractor 0,111Z %RCHITECI'S DECLARATION i K< 1 understand my plans shall be used as public records — )yU C� Q y Liernsoc,Professional rn OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the OC following reason.(Section 7031.5,Business and Professions Code:Any city or county e m which requires a permit to cnnstrucL,alter,improve,demolish,or repair any structure a Z} prior tat its issuance,also requires the applicant for such permit to rile a signed statement _< that he is licensed pursuant to the provisions or the Contractor's License Lew(Chapter 9 Sq.Ft.Floor Area Valuation YH (commencing with Scction 7000)of Division 3 or the Business and Professions Code)or y that he s exempt therefrom and the basis for the alleged exemption.Any violation or 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 ❑1,as owner or 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(Sec.7044,Business and Predessions Code:The Contractors License Law docs not apply to an owner or 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 or sale.). ❑I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractors Li- cease Law docs not apply to an owner or property who builds or improves thereon,and who contracts for such projects with a contractor(s)licensed pursuant to the Contractors License Law. ❑I am exempt under Sea ,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-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 Workces 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 Compensa'on Insurance carrier and Policy number am: Carrier. Policy No.: CERTIFICATE 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 or the work for which this permit is issued,I shall not emplcy 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 or Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you mast oforthwith comply with such provisions or this permit shall be deemed revoked. fj CONSTRUCTION LENDING AGENCY F•a o-. I hereby affirm that there is a concoction lending agency for the performance of the work for which this permit is issued(Sec.3097,Civ.C.) L.endur's Name — Z Lcndcrs Address U O 1 certify that I have read this application and state that the above information is — correct 1 agree to comply with all city and county ordinances and state laws relating to ©U building construction.and hereby authorize representatives of this city to enter upon the above:-mentioned property for inspection purposes (We)agree to save,indemnify and keep harmless the City of Cupertino against liabilities,jud ments,costsand expenses which may in anyway accrue against said City in corse of mntin of this APP ERS DSA OMP WITH ALL NON-POINT Issued by: Date ULA S. C�7, d Re-roofs n;nure of Appli&m/Contracpr, Date RAZAREFOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or handle hazardous material as de.frned by the Cupertino Municipal c,Chapter 9.12,and the Health and Safety Code,section 25532(a)? E]Yes o All roofs shall be inspected prior to any roofing material being installed. Will the applican r future buildin 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 do - by the Bay Area Air Quality Management all new materials for inspection. District? C3 Yes No 7 Ihave mad the hazardous materialsn ' me on ChapLer6.95oftheCalifor- nia Health&SafctyCade, trio 2550 53 5 understand that if the building dndy h ten is ns" ity to notify the occupant of the �(e u' w' ust a or crtificate or occupancy.ante o ccup . �. � _ x//, Signature of Applicant Date Date Y� All roof coverings to be Class° '`or better CITY OF CUPERTINO NEW SINGLE/MULTI FAMILY DWELLING CUPEI�TINO PERMIT APPLICATION FORM 07— 0 �:)_7 73 Date:C �2 r 13 ' Z: Building Address: a c Mailing Address (if different from building address): pvi 5 1 Zts _'S n V (x— L C C� ? Owner's Name: Phone# : Cont actor: Phone#: &,t k-, `7-3`3 '? Qc l Fax #: 4-/C 'v Contractor License #: Z-1 5 -3 .3`-1 9 Cupertino Business License#: C�� Contact: V Phone#: 47�o r L4 '{3�-4 — V4 3 �� C- �{� Fax#: 410 -763 5-- '?' 2— 5� � Alternate Contact: Phone#: 440 -7 3 3 -- (o l CIT AC! c,—h/\. 4--,— Fax #: 1-/0b 735— 9Z, Single-Story ❑ Two-Story Three-Story ❑ Basement [_1 Hillside E] Multi-family Apartment ❑ Condo ❑ Townhouse Sq.Ft. Living Area (Including Basement & Atta_Qhe d Garage: Sq. Ft. Garage ( etached Only): c.1 uCII y Valuation: Job Description: Type of Construction (Usage Class): Occupancy Type: 1 FR_, 11FR ❑ 11, 111, V-IHR ❑ 11, 111, IV V 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 www.builditareen.or6