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CITY OF CUPERTINO
BUILDING DIVISION PERMIT GITRACTCIR INFC?RMTIOr
BUILDING ADDRESS: PERMIT NO.
;33:' M STELLING RD LANDMARK DEVELOPMENT 07120224
OWNER'S NAME: PERMIT ISSUE DATE
1 PALMAS STELLING LLC 1307 S MARY AVE STE 120 09/03/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: NEW TWO STORY TOWNHOUSE BLDG BELECT
GPERAPIT O
PLUMB MECH
399 5F
o p LICENSED CONTRACTOR'S DECLARATION 0 0
ul G 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description
?Z U with Section 70(X1)of Divis 3 of the Business and Professions Code,an license is
a a in full force and affect.
)12K License Class Lic.#
p Date n Contractor �l
=d h T���A ITEC 03 DECLARATION
e U 1 understand my plans shall be used as public records
CWFr
o a Licensed Pmfcssional
a y OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
q O following reason.(Section 7031.5,Business and Professions Code:Any city or county
e m� which requires a permit to construct,alter,improve,dcmulish,or repair any structure
a Z prior to its issuance,also requires the applicant for such permit to file a signed statement
a that he is licensed pursuant to the provisions of the Contracter's License Law(Chapter9 Sq.Ft.Floor Area Valuation
Ey.F q (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 violadan of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of anC
APN Number Occupancy
not more than five hundred dollars(5500). P y Type
0 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 for sale(Sec.7044,Business
and Professions Code:The Contractor's 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 employers,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,).
0 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 builds or improves thereon,and
who contracts for such projects with a contractor(&)licensed pursuant to the Contractor's
License Law.
0 1 am 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:
0 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.
0 1 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 Workee Compensator Inn,rance carrier and Policy number
tam- /
Cartier. 40'r,� 'YZ Policy No.: 1[Q Z,,54 LY
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
((his section need not becomplcted if the permit is for one hundred dollars(3100)
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 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 O forthwith comply with such provisinns or this permit shall be deemed revoked. -
CONSTRUCTION LENDING AGENCY
H �-+ 1 hereby affirm that there is a eonstructinn lending agency for the performance of
LL' , the work for which this permit is issued(Sec.3097,Civ.C.)
Lender's Name
a z Lender's Address
U Q 1 certify that I have mad this application and state that the above information is
U. "-° cormeL I agree to comply with all city and county ordinances and state laws relating to
® V building conuucton,and hereby authorize representatives of this city to enter upon the
a above-mentioned property for inspection purposes
(We)agree to save,indemnify and keep harmless the City of Cupertino against
w C liabilities,'udgmenls,costs and penes hich may in a way accrue against said City
U z in co qpE cc of grana f this t. 9
DERS D L C PLY WITH ALL NON-POINT Issued by: Date /--
R GULAT
Re-roofs �--�--—'
3ignaturc of Appl—imant/ConLricior Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hazardous material
as damned by the Cupertino Munici I Code,Chapter 9.12,and the Health and Safety
Code.Seatonz553z(a)?
❑vas All roofs shall be inspected prior to any roofing material being installed.
o
If a roof is installed without first obtaining an.inspection,I
Will the applicant forum building occupant use equipment or devices which g agree to remove P
emit hazardous air contain nants as fined by the Bay Area Air Quality Management all new materials for inspection.
District?
DYes o
I have read the haz ous material requimmcntsundcrC Ater .6.95 of tte Celifor.
niaHealth&S Code,Scctions255 533 an 3 rsrandthalifthc building
docs not an h�vy-a%icnant,th is my 'n notify the occupant of the
roqui is must be met or to a C fcate of Occupancy.
c� Signature of Applicant Date
O ar or authorizcd Date g ass
All roof coverings to be Cly�`'or better
agaihl �T'
CI'T'Y OF CUPERT'INO
NEW SINGLE/MULTI FAMILY DWELLING
CUPEkTINO PERMIT APPLICA'T'ION FORINT
APN# z Date: . ,
Q
�,- 07- �^7 3/ C - 13 - 6_7
Building Address: `
/ 0 (83/ PV , s7-e.-llIi*'�
Mailing Address (if different from building address):
Owner's Name: Phone#
CO-
Cont actor: Phone#: &,1` 6 -7-3`3
Fax#: 43 735— 5�"Z99
Contractor License#: c3 _3 -3c 1 9
Cupertino Business License#:
Contact: Phone#: 4 L, J;,� `7 3 3 t- Y 1 ems'
l l t �fu3�1
1 •�1�1 �/ ���c�� Fax #: Lf 0 9. `73.5-- 2 P �
Alternate Contact: r Phone#: �0 J5 -7 3 3 c
R G(
To Y\ r, Fax #: r-��' 7 3 S- 9-Z_f 9
Single-Story ❑ Two-Story Three-Story ❑ Basement ❑ Hillside. ❑
Multi-family ; Apartment ❑ Condo ❑ Townhouse
Sq.Ft. Living Area (Including Basement &Attached Garage: Sq. Ft. Garage ( etached Only):
0C_(.,o (" " a/ 399 s.Q ;: T--
V aluation:
33s' 8a0
Job Description: /lJek-J 7-\,,-, -o .57—t-'4 ,Y
Type of Construction(Usage Class): Occupancy Type:
1 FR, 11FR ❑ 11, 111, V-1HR ❑ 11, 111, 1V V-N\
Project Size: Standard Large Major❑
Green Building: Must attach completed Green Building Checklist to the plans
Green Building Points Achieved:
For help, contact Build it Green at w`vw.buildit6reen.ora