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CTTY OF.CUPERTINO
BUILDING DIVISION PERMIT
BUILDING DD ESS: PERMIT NO.
1<�3 N STELLING RD LANDMARK DEVELOPMENT 07120236
OWNER'S NAME: PERMIT ISSUE DATE
\S PALMAS STELLING LLC 1307 S MARY AVE STE 120 09/03/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHT(lCT/EIVGINEER: NEW TWO STORY TOWNHOUSE BLDG BUILDING PERMIT p O
PLUMB MECH
0 a 0 0
c a LICENSED CONTRACTOR'S DECLARATION
i v I= 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description
Z with Section 70(111)of Division 3 of the Business and Professions Codc,an my license is
h a s in full force and erfec Y 3 3
? License Class Lic.#
F„c Date Contractor
RCHITECTSDECLARATION 1)2.&
c< 1 understand my plans shall be used as public records
hyU ,
y Licensed Professional
OWNER-BUILDER DECLARATION
<f 1 hereby affirm that I am exempt from the Contractor's License Law for the
:00 following reason.(Section 703 1.5,Business and Professions Code:Any city or county
%m which requires a permit to construct,alter,improve,demolish,or repair any structure
prior to its issuance,also requires dee applicant for such permit to file a signed statement
?<
e that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
F- (commencing with Section 7000)of Division 3 of the Businessand Professions Code)or
- .. 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
❑1,as owner of the property,or my employees with wages as their sole compensation,
will do dee work.and dee structure is not intended or offered for sale(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(See.7044,Business and Professions Code:)The Contractors Li-
cense Law dors not apply to an owner ofproperty 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 reason
Owner_ Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations: -
❑1 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.
❑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 carrier and Policy number are:
Carrier. �g-�C.0/3�rsr�.tC k P PolicyNo.: o
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or less.) ,
1 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
= O forthwith comply with such provisions or this permit shall be deemed revoked. -
CONSTRUCTION LENDING AGENCY
-+►-i I hereby affirm that there is a construction lending agency for the performance of '
:4 > the work fur which this permit is issued(Sec.3097,Civ.C.) _
QLender's Name -
= Z
Lender's Address
;)Q 1 certify that I have read this application and state that the above informatiun is ,
►-r correct I agree to comply with all city and county ordinances and state laws relating to
Vbuilding construction.and hereby authorize representatives orchis city to enter upon the
Uabove-mentioned property for inspection purposes.
y t'We)agree to save,indemnify and keep harmless the City of Cupertino against
�..q r/1 liabilities.judgments,costs and expenses which may( ywayaccrue against said Cty
in consequence of the granting of this it. /y^
APP NT ER ANDS PLY WITH ALL NON-P Issued by: Date
S ULA S.
�3- Re-roofs
hgnature of ApplicanVConua Date
HAZARDOUS MATERIALS DISCLOSURE _ Type of Roof
Will the applicant or future building occupant store or handle hazardous material
as defined by the CupertinoMunhchpa c•Chapter 9.12,and the Health and Sarety
Code,Section 25532(a)?
(--]yes All roofs shall be inspected,prior to any roofing material being installed.
No
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?
F1 Yes
I have read tha hazardous materials J
apter6.95 of the Califor-
niaHcaeaulhEarizcdage?nt
s 25505,2rstandthazifthcbuilding
dors nthat it' tify Ile occupant or the
req ' prior i or; cupan Signature of Applicant Date
All roof coverings to be Class'r�}"`or better
ncr Date� � +g �T'
r, Q,
Al CITY OF CUPERTINO
NEW SINGLE/MULTI ULTI FAMILY DWELLING
CuP2
ER.TINo PERMIT APPLICATION FORM .
a�2
APN# Date:
2(P - p-7 - 03'7 s/ o_---?
Building Address:
Mailing Address (if different from building address):
� y0�-�
Owner's 7V e: Phone#
Cowo 1� ,�� n.�-r C® ? v b
Con actor: Phone#: f-/0
PW AJa /K.QA7T COW, . Fax#: 1-108 735- 9 2 9 9'
Contractor License#:, /Q 33 V p,
Cupertino Business License#: Q 4 q
Cntact: < ( Phone#: !R/o tQ 731f,.g 3
p.0_1 Fax #: a b2 ?3 S'— 41
"Alternate Contact: Phone#:
Fax 4," : 45 p4
Single-Story ❑ Two-Story Three-Story ❑ Basement ❑ Hillside ❑
Multi-family ❑ Apartment ❑. Condo ❑ Townhouse
Sq.Ft. Living Area(Including Basement &Attached Garage: Sq. Ft. Garage etached Only):
Valuation: C
7
Job Description: 3.1-6A1-r �,r✓L
t�
Type of Construction (Usage Class): Occupancy Type:
1 FR, 11FR ❑ 11, 111, V-IHR ❑ 11, 111, 1V V-N k-3
Project Size: Standar 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.buildit6reen.orL
I
CITY OF CUPERTINO
NEW SINGLE/MUL'TI FAMILY DWELLING
FEE SCHEDULE
Quantity Fee ID Fee Description Fee.Grou ]Permit Type
.1RIINSP. Apt.,Bldg inspection.fee B 1R1APT
I
1RIPLNCK Apt Bldg plan check.fee .B
1RIR.EINSP Apt Bldg repeat unit _ B 1R1APTR.
Inspection'fee
IRI.REPLNCK Apt Bldg repeat unit plan B
,. check fee
1R3INSPDwellings Inspection B 1R3SFDW
1R3PLNCK Dwellings Plan Check B
IR3REPINSP Dwellings Repeat B 1R3SFI)R.
Inspection
lR3R.EPPLNC ; Dwellings Repeat Plan B
Check
IR3HINSP Dwellings Hillside B 1R3IIIIIL-
Inspection
1'R3HPLNCK Dwellings Hillside Plan B
Check . .
1R3HREINSP' Dwellings Hillside B
Repeat Inspection
IR3HR.EPLNC i Dwelling Hillside Repeat B
Plan Check
lR3ALTINSP Dwellings Alternate B I.R3SFDALT
Materials
IR3ALTPLNCK Dwellings Alternate F B
Material's
1GARDTW<=1K ! Detached Garage Wood B
1GARDTM<=1K Detached Garage B
Masonry
1BCONSTAXR ' ConstaxResi/Mobile B
1BMITIGATR Residential Housing PL
/. � Mitigation Fee-chrg only
lot is vacant or it is a
subdivision-see planning
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