07120074- PUB ISI ISI I ;I 151 IJ,I 1 �I I ill I, I I! I luI I°lI I,.11-,fl-,11--1 It
Idl
I
' x
3
a)
LO Q
LO
f1 C
� I
r
O
Lf'Y
M A
W
Cf A
W
x
U
L7
O �
z L7 0 .a
LL, H O
0 F N
J O pa OD
U O
O 0 wP.
try
w co c A
OH r�
Z w Z U .a
J � 0 ,U O O H
LLI H 0 p 0 O O. W \
Q r cn A A A
Z r- a a
Ln CO
J E 0- o a
co
c. ❑ = U CL CD to w u,
O 0 N
a a)_ xa
o — _t E
fu )
L
'O CJ) u:• c 0 a) Lo
O Cza) � 'w
- 's y,
Q U Q 0AD
Q U
Idl j
*,,B. O '� O
V) a
Q) o` o $ c - w
'Y0 0
— —
a a Cl a
z
O O Oc Lu� � � �1
IS
o
FA I
>I Cl j J andd ` LLJ�— c
i7 ii w I :zU w0 :zc
S
r—
co O Q M c
CD CD LL, CL
oa ,, m ow I Q �� �' � `a
w ,
N ,
CD Lu
CD c
() -0 Q) 4) i x 3 a) N
c. x a) .n a x v m a o 'c
c Ll c
E xa) z �-- (D ' U > w a) o o f LO o
Z ■0 a) Q q v v a) Q :3 CU a) a) a c
OL D
i, wl L a� fu a a b a� a� a� ZD Q Lo U CL o 0-
` p_ CL U7 c L Q CL U U U E 'a
wl a) c
C- LL
CITYOF CUPERTINO
BUILDING DIVISIONPERMIT �(ONTRACTO t�l�#F`L?RI NTION r
BU1Lp1I¢Ci,(+STSk STELLING RD LANDMARK DEVELOPMENT P07120074
OWNER'S NAME; N PERMIT ISSUE DATE
CUPERTINO DEVELOPMENT 1307 S MARY AVE STE 120• 01/29/2008
PHONE: 3(408) 733-9693 SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 a 0
WOO LICENSED CONTRACTOR'S DECLARATION
G ami(= 1 hereby a(Lrm that I am licensed under provisions of Chapter 9(commencing Job Description
<awith Section 7000)of Division 3 of the Business and Professions Code,and my license is DEMO
in full force and affect
n? License Class
3ga Date4 4 ` ;"- Contractor
a ARCHITECT'S DEC 10 r .
o6< 1 understand my plans shall be used as public records
7yU
U.F•' Licensed Professional
=�< OWNER-BUILDER DECLARATION
<� 1 hereby affirm that 1 am exempt from the Contractors License Law for the
p O following reason.(Section 7(13 L5,Business and Professions Code:Any city or county
K which requires a permit to construct.alter,improve,demolish,or repair any structure
y Z y prior to its issuance,also requires the applicant(or such permit to file a signed statement
E E< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
Y.r— (commencing with Section 7000)of Division 3 of the Business and Professions Code)or _ $28000
y 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 ofNumber
not more than five hundred dollars($500). 3 2 6 0 7 0 3 7ff Occupancy P Y Type
❑I,as Owner of Idle property,or my employers with wages as their sole compensation,
will do the work.and the structure is not intended oroffered for sale(Sec.7044,Business
and Professions Code:The Contractors License Law dors 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
constrw the project(Sec.7044,Business and Professions Code:)The Contractor's Li.
cense Law docs not apply to an owner of property who builds or improves thereon,and ..
who conuacts for such projects with a contractor(s)licensed pursuant to the Contractors
Liccnse'Law.
❑1 am exempt under Sec. ,B&P C for this reason
Owner_ Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm,under penalty of perjury one of the following declarations:
❑1 have and will maintain a Certificate of Consent to self-insure for Workers Compcn-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work forwhich this permit is issued. _
❑1 have and will maintain Workers Compensation Insurance,as required by Section TA
3700 of the Labor Code,for the performance of the work for which this permit is issued. '
My WorkeLr Co pensation Insurance carrier and Policy numb are• -
Carrier,7/[ Tri Policy No.: z .
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be'completed if the permit is forone 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 mannerso 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 Codc,you must
,J Z forthwith comply with such provisions or this permit shall be deemed revoked.
OCONSTRUCTION LENDINGAGENCY
F-r rn 1:hereby affirm that there is a constructinn lending agency for the performance of
�.; the work for which this permit is issued(Sec.3097,Civ.C.)
W M Lendcr':s Name
] Lendces Address -
U Q 1 certify that I have read this application and state that the above information is
LL— correct.I agree to comply with all city and county ordinances and state laws relating to
C U building construction.and hereby authorize representatives of this city to enter upon the
Ia. ahove-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
HrA liabilities,judgrgcosts and expenses which may in anyway accrue against said City
U,Z in conscquenet'o fthe granting of this permit 1
APPLICAI�{ NDERS NDS NO WILL COMPLY WITH ALL N N-POINT Issued by: Date
SOU 'E GUGUL_ATT S. / �/�
(`tare of Applicant/Contmctor Date Re-Goofs /
HAZARDOUS MATERIALS DISCLOSURE Type of Roof / v
'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, Oyes
Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
If aroof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which .
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
V❑Yes.
1 have madthe hazardo materials requirements under Chapter 6.95 of the Califor-
nia Hcaith&Safety Co0cp6ons 25505,25533 and 25534.1 understand that if the building
does not currently ha ant,that' ' my ponsih.1 to notify the occu t of the
requirements w rah st he mel p' r m i ce ar a certificate or a%p U Signature of Applicant Date .
0 tat rizcd agent Date
All roof coverings to be Class"B"or better
all ".1
CITY OF CUPERTINO
DEMO
CUPERTINO PERMIT APPLICATION FORM
M7
APN# n,/ o.3 Date:
Building Address:
/0 �
Mailing Address (if different from building address):
/ O 7 So . /It
Owner's Name: Phone:
410B 7333 ,!6 93
contractor: Phone :
�3 , -
l*4A7— 604./2 Fax: q 0 O 7 3s-- F Z ? 9
Contractor License #: ef f5:3 3 K
Cupertino Business License#: ✓ ` Lj 9
Contact: Phone: saq"k-4_ AS pvw,
"1 �b Fax:
Residential Sq Footage Commercial ❑ Sq Footage
Job Description:
Valuation:
000
Attach Green Building Checklist to demo plans.
Quantity Fee ID Fee Description Fee.Group Permit Type
1DEMORES Demo-Residential B 1SFDWL-DEM
B E Seismic
i S ISMICRE S smis B
1DEMOCOM Demo-Commercial B 1COMNIL-DEM
1BSEISMICOM Seismic Commercial B
❑ 1 BUSLIC Business License B