07120232- PUB I r l I 110 I I 1 1 IiN I r-;i-1 1`n 11 1 1 1 kv i k1 -l I TI
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CTT 'OF CUPERTINO
BUILDING DIVISION PERMIT
BUILDG, DRESS: PERMrr NO.
I,
>. o N STELLING RD LANDMARK DEVELOPMENT 07120232
OWNER'S NAME: PERMIT ISSUE DATE
�S 11AF MAS STELLING LLC 1307 S MARY AVE STE 120 09/03/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
NEW TWO STORY TOWNHOUSE BLDG ELECT PLUMB MECH
i o p LICENSED CONTRACTOR'S DECLARATION 1746 SF
Job Description
m C I hereby affirm that 1 am licensed under provisions of Chapter 9(commcncing
xU with Section 70(10)of Divi' n 3 of the Business and Professions Code,and my license is
Lu
in full foto and effect
1 n? License ClaIs Lic.#
i E„m Date— r--O' �'- Contractor L� t'n t
-ARCHITECT-S DECLARATION PCV•Q-(
2�< I understand my plans shall be used as public records
oy Licensed Professional
y OWNER-BUILDER DECLARATION -
�< I hereby affirm that I am exempt from the Contractor's License Law for the
❑O following reason.(Sccdon 7031.5,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 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
� $
(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 any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more than five hundred dollars(5500).
❑1,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 forsale(Sec.7044,Business Required Inspections
and Professions Code:The Contraes Conti-actor's License Law donot apply m an owner of (1 P
property who builds or improyes thereon,and who doessuch work himself or through his
own employers,provided that such improvemens 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 Wilds or improves thereon,and
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's
License law.
❑1 art,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. .
❑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 compensation_Ins�u]ane carrier and Policy number am: .
Cartier.
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Clhis section need not be completed if the permit is for one hundred dollars(S1OD)
or las.)
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 California.Dam
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.
Z OCONSTRUCTION LENDING AGENCY
[-.Cn I hereby affirm that there is a coast ucLinn lending agency for the performance of
LY+7 the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lender's Name
0 z Lender's Address
V 0 1 certify that I have read this application and state that the above information is
LL"-•t correct.I agree to comply with all city and county ordinances and state laws relating to
.0V building construction,and hereby authorize representatives of this city to enter upon the
Uabove-mentioned property for inspection purposes
(We)agree.to save,indemnify and keep harmless the City of Cupertino against
„may rn liabilities,judgments,Coss and rises w ieh may in any way accnu against said City
V Z in con n of th rami f this ' L '
1 ERST DS Y WITH ALL NON-POINT Issued by: Date
C GULATI . t
-�3—� Re-roofs
g ure of App i6ni/Con r Dam -
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or futtuc building occupant store or handle hazardous material
as defined by the Cupertino Municipal C de.Chapter 9.12,and the Health and Safety
Cole,Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed,
[]Yes
If a roof is installed without first obtaining an inspection,I agree to remove
Z
Will the applicant or future building occupant use equipment or devices which
emit ha'ardnhs air contaminants as defined a Bay Area Air Quality.Managemem all new materials for inspection.
District? -
❑Yes o
1 have read the hazardous materials requirementsdo hapmr 6.95 of the Califor-
nia Health&SafetyCodc,Sections 25505, San 4 dcrsrandthatifthebuilding
docsnot and Lana th nsib' m notify the occupant of the
re� c must be c n cc of :rrifcatc of Occupancy. Signature of Applicant Date
' �te
Dam All roof coverings to be Class" {°'or better
.....,.....,h.,,.,.�a��,.,.,
-, CITY OF CUPERTINO
t
NEW SINGLE/MULTI FAMILY DWELLING
CUPElkTINO PERMIT APPLICATION FORM
z0'2-3:P,
APN#3-AGI- 07-- () -,�)_7, 5' Date:F-2_ , ' 6
Building Address: -
bo ca q 5 /v
Mailing Address (if different from building address):
Owner's Name: Phone #
Cont actor: Phone #: ` -7-3"3
Fax #: _7 3 S— a"2-9;'
Contractor License #: Z-I Y3 3 .3`1 9
Cupertino Business License#: S ��
Contact: Phone #: 4 e `7 3 3 t- 1 S off'
f t4 --;?3-4 — 1 '64 3 ce-C-4-
Fax #: 40 73.5-- `r 2 5� ci
Alternate Contact: Phone #: 14 C -7 3 3 -- T(6 2✓
To, 1, A G <_wx e Fax #: 1-/0 b 7 3 S— 9,Z i
Single-Story ElTwo-StoryThree-Story ElBasement ❑ Hillside E]
ID
Multi-family Apartment ❑ Condo ❑ Townhouse
Sq.Ft. Living Area(Including Basement &Attached Garage: Sq. Ft. Garage (Detached Only):
Valuation: ��(e
Job Description: /11 elt _rklS 0 �'�' / T cg �,✓� �� S�
Type of Construction (Usage Class): Occupancy Type:
1 FR, 11FR ❑ 11, 111,'V-lHR ❑ 11, 111, 1V V-N
Project Size: Standard Large Major❑
r�
Green Building: Must attach completed Green Building Checklist to.the plans
Green Building Points Achieved:
For help, contact Build it Green at www.builditareen.org