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CITY OF CUPERTINO
BUILDING DIVISION ,PERMIT C� ITR.�iGTt?R . RMAITTQi1.
BUILA7T .
�+gffES� STELLING RD LANDMARK DEVELOPMENT PExMI
07120219
1 .. I
OWNER'S NAME: PERMTT(SSUEDATE
1� PALMAS STELLING LLC 1307 S MARY AVE STE 120 09/03/2'008
PHONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING NEW TWO STORY TOWNHOUSE BLDG CTTPERMIT PLUMB MECH
0 0 a 0
o p LICENSED CONTRACTOR'S DECLARATION -
U GI hereby alarm that I am licensed under provisions of Chapter 9(commencing Job Description
.Z U with Section 7000)orDivision 3 of the Business and Professions Code,and Viccnse is ,
r<i in full force and effiecto
j Y License Class_ Lia n 7
F t, Date Contractor 4—A0 P/c
t'`'tj AR H CCS DECLARATION V�e(
I understand my plans shall be used as public records
2 < ,``'�Qq''��- _-
>y U Cyz"R
H Licensed Professional
OWNER-BUILDER DECLARATION
<� I hereby affirm that I am exempt from the Contractor's License Law for the
p O following reason.(Section 7031.5,Business and Professions Code:Any city or county
< which requires a permit to ennswct,alter.improve,demolish,or repair any structure
Z} prior to its issuance,also requires the applicant for such permit to rile a signed statement
E=O that he is licensed pursuant to the provisions of the Contractor's license law(Chapter 9 Sq.Ft.Floor Area Valuation
4 h (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
i 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.af. APN Number Occupancy Type
not more than five hundred dollars(1500). P Y YP
❑I,as owner of 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 Professions Code:The Contractor's Licertse 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.).
❑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-
cerise Law does not apply to an owner of property who builds or improves thereon,and
who contracts for such projects with a conuactor(s)licensed pursuant to the Contractor's
License Law.
❑1 am exempt under See ,B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penally of perjury one of.the following declarations:
❑I have and will maintain a Certificate of Consent to self-insure for Worker'sCompen-. ,
salon,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 Sceuon
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My WorkgeeC_q)mpensauo)ns{urranee carrier and Policy number am:
Cartier. V$4-1�'ll +h PolicyN AL1 �D�tS7 f�
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
CThissection need not be completed if the permit is for one hundred dollars($100)
or less.)
I certify that in the performance of the work for which this permit is issued,1 shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of Califomia.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
,J Z forthwith comply with such provisions or Nis permit shall be deemed revoked.
z O CONSTRUCTION LENDING AGENCY
f/)
1 hereby affirm that Ncre is x construction!coding agency for the performance of.
(Si > Nc work for which this permit is issued(Sec.3097,Civ.C.)
Lender's Name
Lender's Address
fJ 0 I certify that I have read this application and state that the above.information is -
Lt. •'+ COMM I agree to comply with all city and county ordinances and state laws relating to
C V building construction,and hereby authorize representatives of this city to enter upon the
LTa above-mentioned property for inspection purposes
HGy (We)agree to save,indemnify and keep harmless the City of Cupertino against
rn liabilities,judgments,costs and expenses which may'n any way accrue against said City
V in c nce g ting of rm' y
P DE A IL OMPLY WITH ALL NON-POINT Issued b : Date
RE UL
rf33�Q1 Re-roofs
Signature of A IicanV ntranor Date
AZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Munici Code,Chapter 9.12,and the Health and Safety
Code.Section 25532(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 eftned by the Bay Arca Air Quality Management all new materials for inspection.
District?
C]Yes Nu -
1 have toad the hazardous materials requirements unde Chapter 6.95 of the Califer-
niaHcalN ctyCodc ccdons25505.25533and undcrstandNazifNcbuilding
Ls cu tl' a Lena Nati ' nsib' Ly
to notify the occupant of the
reqs ch must el cc of crtifica c of Occupanry,
a Signature of Applicant Date
��nce or authornad agcm Date All roof coverings to be Class';q"or better
'
E
CITY OF CUPERTINO
NEW SINGLE/MULTI FAMILY DWELLING
CITY OF
CUPEkTINO PERMIT APPLICATION FORM
07002
APN 4Date:
13 6_7
Building Address: r
1082/ /V S —re—
Mailing Address (if different from building address):
Owner's Name: Phone # :
LIC (b '733 ?(u
Cont?actor: Phone #: L4 (c, F_-S
Y:� J ib, CO-
Fax #: 4/ _7-3 c/ "Z%9
Contractor License #: Z-/ L-1 9
Cupertino Business License#:
Contact: < Phone#: 4f�o b —733 k--,
3-4 — 1 -5 3 Cc-�
k� )k 0 Fax #:, Llo `73S'— C/
Alternate Contact: Phone #: 4�Ob -7-3-3 --
i
Fax #: 7 3.5--— 9 -Z_ci) 9
Single-Story El Two-Story Three-Story E Basement 0 Hillside ❑
Multi-family rJ Apartment El Condo E] Townhouse
Sq.Ft. Living Area (Including Basement & Attached Garage: Sq. Ft. Garage(betached Only):
L2>
3 79 3_T-�
Valuation:
8(a 0
Job Description: /Ve�
Type of Construction (Usage Class): Occupancy Type:
I FR, 1 IFR ❑ 11, 111, V-lHRE] 11, 111, 1V V-N
Project Size: Standard'?k LargeX Major F-1
Green Building: Must attach completed Green Building Checklist to the plans
Green Building Points Achieved:
For help, contact Build it Green at www.builditgreen ®rg