07120215 CITY OF CUPERTINO
BUILDING DIVISION PERMIT C� T�A� TI?R � k '�If)N
BUILDING ADDRESS: PERMIT NO.
, 0::1.3 N STELLING RD LANDMARK DEVELOPMENT 07120215
OWNER'S NAME. PERMIT ISSUE DATE
!+S I)AL,MAS STELLING 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 o LICENSED CONTRACTOR'S DECLARATION O 0 0 0
U[= I hereby affirm that I am licensed under provisions of Chapter 9(commencing,
Job Description
Z U with Section 70(10)of Division 3 of the Business and Professions Code and my license is
r a a in full force and effect. /
O w `T
)�?
License Class el Lic.p '
p Date_�r�rr o3 Contractor VAn+OG
to ARCHITECTS DECLARATION .Qp ,1, r(
K< I understand my plans shall be used as public records 'Y
)yU
w0 y Licensed Professional
0. OWNER-BUILDER DECLARATION
-<:9 I hereby affirm that I am exempt from the Contractor's License Law for the
00 following reason.(Section 7031.5,Business and Professions Code:Any city or county
[i 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
that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Valuation
e F G (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
' that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type '
not more than five hundred dollars(E500). P Y YP
❑1,as owner of the property,or my employees with wages as their sole compensation,
will do the worm and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections
and Professions Code:The Contractore nss License Law does not apply to an owner of Q P
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.
❑I 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:
❑I have and will maintain a Certificate of Consent to self-insure for Workers 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 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�om,p�en�sation Insurance carrier and Policy number are: /
Carrier.J�It�.ey d Policy No.: a�/ 7 .
CERTIFICATE OF CEMPTION FROM WORKERS'
COMPENSATION INSURANCE
JItis section need not be completed if the permit is Intone 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
Z forthwith comply with such provisions or this permit shall be deemed revoked. -
'�OCONSTRUCTION LENDING AGENCY
[-r CA I hereby affirm,that there is a construction lending agency for the performance of
p; > the work for which this permit is issued(Sec.3097,Civ.C.)
aQ Lender's Name
Z Lenders Address
U Q 1 certify that I have read this application and state that the above information is,
(•L correct.I agree to comply with all city and county ordinances and state laws relating to
C> building construction,and hereby authori>a representatives of this city to enter upon the
aabove-mentioned properly for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
rA liabilities,judgments,costs and expenses wh'h may in any way accrue against said City
U Z in cone uence of c granting of this -
"-' AP ERSTAN ILL COMPLY WITH ALL NON-POINT Issued by: Date —` Z1�
GUL ON
Re-roofs
rgnaturc of Applicant/Cgdtracior Datc
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
❑�6
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?
❑Yes u
1 have read the hazardous materials Te uirem underChapter6.95 of the Califor-
nia Health&Safety Code,Section 2550-255 534.1understendthatifthebuilding - ..
dors notoifdend ve a ant t• nsibility to notify the occupant of the
requi ich m in rssu of a Certificate of Occupanry.
Signature of Applicant Date
nee or auffil5rized agcn Date'
All roof coverings to be Class or or better