08050163- PUB � IMI ;II : I I_ IMI IR' I1F�v.IluII II t=II# II � ,
(til'
' a x
a a)
F
m O
i u v
Fx4 d
W 0
H Q
N a H
Q It) a U L J
lJ C7
� CJ
F
CD c4
U-)
0
O H
Q F
(5 uFi a I
w a
c4 H an
o toi o
LO
W O 'Zi -4-I O
MZ h a 0 .-I N
a. J O .o,' H 1
LLI ',Z ul L) N Co.
W �'-CO H �. W A A
co uai a
Z 0 Lr) U M a ,2; H a
Fw H
w O o CD Z n as
Z `r LO LO pa
Z ~ M c d w a) m H H
CD
�y O Z E IL -4-4 w
Lr)
o T O O a A a o w
_LO
C2 M a..
- - - - -
EL xO n
x _
J a) yo u a)
v
t o y _0
U Q J O 4 U
i
ldl 0
-0
•
itis, •- Q, m o '
a OL
xo CO
-e [) Z
9
z Illi 'Icsl Icr C Q
^- _ n a
CL i a n n m —, c
a) O O O w
1Z coo `_# I', ~ I a c
`� �C a � m M c
>I Q J Za. o -
�r� Li wd , z
w � Z c
M v CD o rn w z [n O o �
w w _
C tiJ t0 N N O O 'E 1 W c ;0- v •R
a v o Z — m O - C
LO w cv n`�i '- 01 N w Lf) -
EL
O w (0 C7 O v __ __ __ _ M
!+ a) Cl C
-0 a) (L) x a} C
a) a) n O y a) '° CL x o
Z-u 11
V E E " Z -._ S, U 7 w a) o O .Q in c
41 �' c a) a) a) d ~ -D O �o w_ yr O
_ z x Z 0 �' Q a) v c
0 0 0- U7 2 0- Q 0- U U U a
y } LL
CITY OF CUPERTINO
BUILDING DIVISION PERMIT
PERMIT NO.
BUII-QlI�, gTESlsv. STELLING RD SIERRA PRECAST INC 08050163
OWNER'S tNiAME: PERMIT ISSUE DATE
LANDMARK DEVELOPMENT 1 LIVE OAK 07/22/2008
PHONE: (408) 779-1000 SANITARY NO. CONTROL NO.
ARCHTTECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
1 ad O p LICENSED CONTRACTOR'S DECLARATION Job Description
ul I hereby affirm that I am limned under provisions of Chapter 9(cOnetng
�U with Section 7000)OfDivision 3ofthe Business and ProfessienCode,and mylicenseis ADD APRX 430LINEAL FT PRECST CONCRT WALLS FRM
t o• in full force and effect
Ow-
License Class Lies 8 'TALL TO 13 ' &ALL W15' OF SOIL RETAINNG CAPCTY
r- Date_ Contrutor
Lq ARCHITECT'S DECLARATION
' V n I understand my plans shall be used as public records
,0.
Cy Licensed Professional
y S OWNER-BUILDER DECLARATION
a I hcrcby affirm that 1 am exempt from the Contractor's License Law for the
no following mason.(Section 7031.5,Business and Professions Cade:Any city or county
< 9 which requires a permit to convect,alter,improve,demolish•or repair any structure
a Z N prior to its issuance,also requires the applicant for such permit to file a signed statement
z ao that he is licensed pursuant to the provision of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area $82600 Valuation
e,f-$ (commencing with Section 7000)of Division 3 of the Business and Profession Code)ur
c .. 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 3 2 6 0 7 0 3 7 AM 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 wordy.and the structure is not intended or offered for sale(Sec.7044,Business
and Profession Code The Contractor's License Law dos 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
salej.,
Nils owner of the property,am exclusively contracting with licensed contractors to
co s2roct the project(Sec.7044,Business and Professions Code:)The Contractors Li-
m Law does not apply to an owner of property who builds or improves thereon,and.
who contracts for such pmjects witha cantractor(s)I' d pursuant to the contrames
License
❑1 am :e ,B&PP CC for this reason
Ow Dau:7—.—22-6
K OMPENSATION 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'sCompen-
sadon,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 Workers compensation Insurance,as required by Scction \
3700 of the Labor Code,for the performance of the work for which this permit is issued �.\•
My Workers Compensation Insurance carrier and Policy number am:
Cartier: 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 of the work for which this perm} ued,1 shall oat
employ any person in any manner su beco mc&bjec o the Aorkers'Compensadon
Laws of C a.D I
Applican
NOl ICEf,after ets Crificate Exemption,you should
become fubject to the Workers Compensation provisions of the Labor Code•you must
O fonhwith comply with such provision or this permit shalt be deemed revoked
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a convection lending agency for the performance of
14 7 the work for which this permit is issued(Sec.3097,Civ.C) '
4 Q Lender's Name
=Z L.endcesAddress
J Q 1 cenify that I have mad this application and state that the above information is
coreit I agree to comply with all city and county ordinances and state laws relating to
Vbuilding 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 City of Cupertino against
'L4 r%j liabilities,judgmams,costs and expenses which may' way accrue against said City
J Z in consequence of the granting of thd iL
APPLI U I O LY WITH ALL NON-POINT Issued by: Date
SO 0 `2-fl�
Re-roofs
S' ofAppli UCon t Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building oavpant store or handle hazardous material
as defined by the Cupertino Municipal Code,Chapter 9.It and the Health and Safety
Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yee
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
erah hazardous air caniaminanu as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes
I have read the h materials mquimmen nderChapter6.95 of the Califor-
nia Hc Id i afctyC. /aL.
'n 25505,2.553 d 34.I wrderstand that if the building
docs c nt ere ibility to notify the Occupant of the
ere dchmuuan a Certificate of Occupancy. Signature of Applicant Date
X22-D9 All roof coverings to be Class'''or better
O ncr or authorized agent Date'
o?oac,o3
CITY OF CUPERTINO
CUP EKriNO GENERAL BUILDING
PERMIT APPLICATION FORM
APN # Date:
�Z (P Q `7 a 3.7,
Building Address:
I O g!SS .
Mailing Address (if different from buildi address):
Owner's Name: Phone#:
L ` q N 3-34(A3
Contractor: Phone: qo? 7'?9_1 pUU
- _ Fax: � --V-- IX t-
Contractor License#: 5 4710?
Cupertino Business License#:
Contact: Phone: qN -77q- 1000
Fax: �09 77
Residential Commercial ❑
Job Description:
r�-I- Q"`�
Is the project in the Wildland- Urban Interface Fire Are . Yes ❑ No ❑
Building Permit Info:
Bldg V Elect ❑ Plumb ❑ Mech ❑
Type of Construction(Usage Class): Occupancy Type:
1 FR, 11FR ❑ 11, 111, VAHR ❑ 11, 111, 1V V-N -
Valuation: Square Footage:
D. W
Project Size: Standard Ea,--1✓arge ❑ Major ❑
Green Building: Please complete relevant portion of the Green Building/LEED Checklist& attach it
to the application or if applicable, include in plan set& the sheet index.
Points Achieved:
For help, contact Build it Green at www.builditgEEtn.org