07120227 CITY OF CUPERTINO
BUILDING DIVISION PERMITON
T=I2ACTQR I1I ,ORMATION N
BUIIAIN D RFS PERMR NO.
15P�y � STELLING RD LANDMARK DEVELOPMENT 07120227
ER'S NAME: PERMrr ISSUE DATE
AS PAhMAS SPELLING LLC 1307 S MARY AVE STE 120 09/03/2008
PHONE: SANITARY NO. CONnIOL NO.
ARCHITECTIENGINEER: NEW TWO STORY TOWNHOUSE 'BLDG BUILDING PERP NFO
UMB MECH
m o p LICENSED CONTRACTOR'S DECLARATION ' O O O O
rd w 1 hemby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description
m iNSatwn]IXMl)of Divi' 3 of Ne Busirrss and Professions Code.andmylicense is
< in full Tome and cfftt 33 T/
?�? Licenm lav L Lk.
Dam � ConlracNr Z
e� ".-J�asAranERSDECblicme ON
DwdIundcwnd my PWu NillWusedu Public rta
W
g 0 L'cedsted Professiovl
5 A.
OWNER-BUILDER DECLARATION
a� f 1 hereby aRimd Nal 1 am exempt from the Cssions c license law forum
C e o following moon.(Satian]W I.S,Business and Professions Code:Any city or county
which requires a permit he construct.cher,Wprow,demolish,or repair Any suunure
°zy Prim in its issuance.also requires tW applicant for such permit or file a signed comment
< that be is licensed pursuant In the provisions of the Conmmar's Umnsm law(CMpter 9 Sq.Ft. Floor Area Valuation
zoo (commencing with section 7")of Division 3 of the Business And Professions Code)Or
y $ Nat he is exempt therefrom and the basis for tW alleged aumpuon.Any violation of
Section 7831.3 by AM applicant for a permit subjects Ne applicant to a civil penalty of APN Number Occupancy Type
not more Nu fist hundred dollars(S5WI. P Y )'P
0 1,a ownm of the pmprrty,m my mmployca withwsgv u their olecmnpewdon,
willda the work.and the swcturt is notimended or offered forsale(Sec.7044,Busbvss
utd Professional Code:The Communes Licerue law ares not apply to an owner or Required Inspections
property who builds m improve thereon,and who dues such work h W self or through his
own employees,provided that such improvements art not inuended oroffered for sale.If.
however.The Wilding or improvement is sold within one year of completion,the owner.
Wilde,win More the When of proving dust W did wt Wild or improse for purpose of
sale.).
0 1.As Owner of she property w exch aively consuming with famed ennuuon in
construct the project(Sec.7043,Business aced Profeeuav Cade:)The Conhavors U. .
cove Law does not apply As so nwuer of property who Wilds or imprews Nerean.caot.
who contracts for such projects with a contractor(a)licensed purauknt to the Conuatoh
License law.
❑I am eaempr under See .B A PC for this moon
Data
WORKERS COMPENSATION DECLARATION
1 hereby Nom under penalty,of perjury one of the Infesting declaralimts
❑INwand w0l milnalin aCenifiamof Coavntoself-iuurt lm Warkds
i (or Suon J]W of ds Labor Code.fm Ne RAamtuce O!Ne
CemRn-
woric for which this Rmit is issud
0 I It.And will maintain WmkL.CampNaation Insurance,ai Matured by Summ
37110 of Ne Labor Code,for the pcRmmance Or the work forwhich Nu permit is luueQ '
My W.'Ime. Pentagon lvum ce caricr and Policy number art:
Caller. Policy No.: 70�.
CERTIFlG FEKIRAN WORKERS'
COMPENSATION
INSUNSURANCE
(n6saumd need not he complemd iftk permit a face hunded dollen($10M
Orleans)
1 certify,Nat in the performance a Ne work for which Nis permit is issued.l shall ret
employ any person in any manuer m as m became subject in the Wodmrs'Compevauon
Laws of Califomia Dam
Applicant
NOTICE TO APPLICANT:IL after making this Cenincem or Eaemption,you should
become tubjat m the Wmrk j Compemduon provision a the labs Code,you must
.,- O forthwith comply with such pemu pmm
ovians Nu shall be domed revoked.
'�(n CONsmucnON LENDING AGENCY
(—m I hereby alfimt that Nem is a conxmoneden lending agency for the performance of
a Ne work far which Nu permit is issued(Sec.3097,Ci,C.)
Q Lender's Name
r7 z
Lender's Addrev
U Q I certify Nat I have rad this application add sans that the AWw infotmadun is
ty cormo.I agree to comply with all city and county on inaaxs and mm laws minting to
Q Wilding construction.And hereby audsonce mpeenuuw of Nu city m enter upon the
r G ahove-menudgra property for Ivpauom purposes _
(We)agree m caw,indemnify and kap harmless dm City of Cupertino against
r N liabiliva,Jndgments.case and WF
yaccmc agilrm sild City
U z in cOvrq Ne int
^ A fAT10 ANITH ALL NON-POINT Issued by: Date015
03 r O Re-roofs
SigAmmufApplicturVOominsepof pan
H OUSMATERIAISDISCLOSURE Type of Roof
Win Nc apPllant m future Wilding occupantsmm m handle hvudou mau'il
As dunned by the Cope mo Munici We.ChopNr 9.12.and the Health and Safety
'
Seed..es zss3z(.3] All roofs shall be inspected prior to any roofing material being installed.
Ya o
Will the applicant r utum Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hvsWou air conn.0 defined by the Bay AMA Air Quality Management all new materials for inspection.
D sal aT
Oyer u
I haw mad the hva rnumamnab requiremcty under rh.950fNcGlifw-
niaHalN&Sanely Cadc.Sccuom25 25533 534.1 dthuiltW Wilding
does oat cu A. d fumy n' n notifytWacuputnr Ne
mquirtm ha met rue a ,marCycupucy._()p Signature of Applicant Date
Owmro,authonedagcm ' 77 w All roof coverings to be Class';W'or better