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CITY OF CUPERTINO >
BUILDING DIVISION PERMIT WTORI, nd
BUILDIN DRESS: PERMIT NO.
�rR N STELLING RD LANDMARK DEVELOPMENT 07120233
OWNER'S NAME: PERMIT ISSUE DATE
.\S PAL,MAS STELLING LLC 1307 S MARY AVE STE 120 09/03/2008
PHONE: SANrIARY NO. CONTROL NO.
ARCHITECT/ENGINEER: NEW TWO STORY TOWNHOUSE BLDG BUILDING PLUMB MECH
1446 SF
0 a 0 a
O p LICENSED CONTRACTOR'S DECLARATION ' p
wt Job Description
UP I hereby affirm that I am licensed under provisions of Chapter 9(commencing
Z w with Section 70(10)of Division 3 of the Business and Professions Code,and my license is
a a in full force and affect.
License lass Lic.6 U
O Dam Conlmclor ( �.�_
t A HTIEA DECLARATION Pl W
ne< I understand my plans shall be used as public records
C ti Licensed Pnifcssional
y OWNER-BUILDER DECLARATION
(a I hereby affirm that 1 am exempt from the Contractors License Law for the
:
20 following moon-(Section 7031.5,Business and Pmfcssions Code:Any city or county
which requires a permit to construct,alter,improve,demolish,or repair any structure
Z prior to its issuance,also requires the applicant for such permit to file a signed statement
x< [bathe is licensed pursuant io the provisions of the Contractor's License law(Chapter 9 Sq.Ft.Floor Area Valuation
t- (commencing with Section 7000)of Division 3 of the Businessand 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 penally of APN Number OCC
not more than fiOccupancy hundred dollars(5500). P y Type
❑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 does 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.).
❑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(s)licensed pursuant to the Contractor's
License Law.
❑I 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:
❑I 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
370D of the Labor Code,for the performance of the work for which this permit is issued.
My Workers Compensation Insurance carrier and Policy number arra:
Carrier. n CERTIFICATE 0__ Policy No.:. ZD
ERTIFICATE OFEXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is foronc hundred dollars($100)
or less.)
I certify that in the performance of the work for which this permit is issued,I shall not
employ any person in any manner so as to become subject to the Workers Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the labor Codc,you must
Z forthwith comply with such provisions or this permit shall be deemed revoked.
0 -
z CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
fY the work for which this permit is issued(Sec.3097,Civ.C.)
QLender's Name
Z Lender's Address
(�0 1 certify that I have rad this application and state that the above information is
GL '-' correct-1 agree to comply with all city and county ordinances and state laws relating to
0 H building construction,and hereby authorise representatives of this city to enter upon the
V above-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
'.y liabilitas,'u marts,cosy and expenses which n ay accrue against said City
V `� in con granttn f thi
"'" A IC DERST D$iAN L C PLY WITH ALL NON-` -Issued by: Date
0 REGULATI
Re-roofs
tgnatureol'Applicant/Con ctor Date v
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
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,S yes 25532(a)?r All roofs shall be inspected prior to any roofing material being installed.
Yes
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
emit hazardous air contaminants as defined by the Bay Area Air Quality Managcmcnl all new materials for inspection,
District?
❑Yes _E
Ihave mad the hazaN/nus—;m�atcrildsder Chapmr6.95ofthe Califor-
niaHcalth&SafctyCDdc,Sc 'on1understandtatifthebuilding
does molt+ ha rant. y to notify the occupant of the
ltificate of Occupancy.
Signature of Applicant Date
l Alroof coverings to be Class'r. "
m g or better
Da
J
CITY OF CUPERTINO
NEW SINGLE/MULTI FAMILY DWELLING
CITY OF
CUPEk ANO PERMIT APPLICATION FORM .
� / 3
APN# Date:
_O-7 - C)37. a ^ 13 07
Building Address: f
r,
.
Mailing Address (if different from building address):
Owner's Name: one#
C� �-T-%Wo le l r C o ti Ifo 16 733 -
Contractor: Phone#: [jo 7'3'3 (o 93
ZAAj'DMAi0c::� D�UI`o rrtkT Fax 73,�5'-- �P Z
Contractor License
Cupertino Business License#: 5-977
Contact: Phone#: qc) -733 (o ,3
ko �L Fax#: �ry t, 73.x= 9Z-9
Alternate Contact: Phone
7_0 N Fax#: J
Single-Story ❑ Two-Story Three-Story ElBasement E] Hillside. ❑
Multi-family ❑ Apartment ❑ Condo ❑ Townhouse
Sq.Ft. Living Area(Including Basement &Attached Garage: Sq. Ft. Garage Atached Only):
Valuation: (e 'L/ 7
Job Description: `
-T-w o T- 7c i v V%
Type of Construction(Usage Class): Occu ancy Type:
1 FR, 11FR ❑ 11, 111,V-lHR ❑ 11, 111, 1V V-N' 4�3
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 www.buildit6reen.orL
CITY OF CUPERI`INO
NEW SINGLE/MULTI FAMILY DWELLING
PEE SCHEDULE .
Quantity Fee ID Fee Description Fee Group Permit Type
1RIINSP, Apt.Bldg inspection fee B 1R1AP`T
1RIPLNCK Apt Bldg plan check.fee .B
1RIREINSP Apt Bldg repeat unit B 1R1APTR
Inspection fee =
1RIREPLNCK Apt Bldg repeat unit plan. B
check fee
lR3INSP Dwellings Inspection B 1R3SFDW .
1R3PLNCK Dwellings Plan Check B
1R3REPINSP Dwellings Repeat B IR3SFDR.
Inspection
1R3REPPLNC Dwellings Repeat Plan B
Check
1R3HINSP' Dwellings Hillside B "IR3MLL
Inspection
IR3HPLNCK Dwellings Hillside Plan B
Check .
1R3HREINSP Dwellings Hillside B
Repeat Inspection
1R3HREPLNC Dwelling Hillside Repeat B
Plan Check
IR3ALTINSP Dwellings Alternate, B 1R3SFDALT
Materials
1R3.,.LTPLNCK Dwellings Alternate B '
Materials
1GARDTW<=1K Detached Garage Wood B
1GARDTM<=1K Detached Garage B
Masonry
1BCONSTAXR Constax—Resi/Mobile B
1BMITIGATR Residential Housing PL
Mitigation Fee-chrg only
if lot is vacant or it is a
subdivision-see planning
2of3