07120113 CITY OF CUPERTINO �F;a
BUILDING DIVISION PERMIT ,dCUIY RAC'T, A FFFORMATI-0.
Bun.131y0§�o� AOME STEAD RD BLDG 61 'WEST BUILDERS, INC . 07120113
L'S NAME: PERMIT ISSUE DATE
VILLA SERRA APTS A CA LTD 1608 4TH ST STE 120 09/26/2008
PHO (510) 525-9378 SANITARY NO. CONTROL NO.
ARCH=fENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
Sop LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby affirm Nat 1 am licensed under provisions of Chapter 9(Commencing P
4 withS 6m70W)afDivWon3afdmBusmen"M feuiomC .Mad liecomis NEW APT BUILDING 1 A—D, 3, 219 '
^<y� in full Carte aha effect. S', Q
QFC DcnmCly LCo.ic0 ry 8/25/08 SEE #07120212 FOR SUBS.
e uuuy��� �[ ARCHITECT'S DECLARATION
< I undervand my plant strait W curt u public recoreb
Lu
ti Lkettmd Rufmional
'�
` OWNER-BUILDER DECLARATION
1 hereby aRnn that I am exempt from the Co nratemes Lkenm Law for the
y O O fallowing faro.(section HO i1 ,Business and Pmfessimu Code:My city,County
I3 V which requires a permit to cmMuc4 alter,improve.demniish,ar repa r any Current.
_I< prior on iu inuan4a.alw mquires Nnapplicust for such Permit to file a signed cummeni
pp that is Hamed pmmML to the Pmvisiovaf the Cmunnem'.hence Law(Chap.9 Sq.Ft.Floor Area Valuation
Y�$ (ammendng with Section 7000)"Division 3 of Ne Businessand Pmfeuions Code)or $555555
than M is exempt therefrom ted die bunk for the alkgCd caemptias MY violation of
Section 7031.5 by any applicant Ire a permit aubjecu the apPlicant in a civil penalty of Occupancy
nmmonedun OnhaMreddellars(L500), 32609029 :'fes Number P Y Type
❑i,uownm ofth pmputy,ermy emPl%ea with wagauthe'v wk mmpcwdon,
and dothework and the ohm onunotroundedawdofaroak(Sec.7061.Badness
and P try wh oro code:The.thencoh License wtlaw doh trot apply to an owrr of Required Inspections
.ornwho Wildsaid ase dmernprommwW dassuchwork o,.ffc rthmugh Mf.
awn emplayeh,provided Nat such impmnmau are not intended arolrered forum If.
Wsever,Neavete.arWodenro Moving tat amid but yworwmoveforNetrues-
.k.).r ,will hart the When of proving Nu ha did w,build m improve far purpose of
uk.).
D 1.u carw a the property am excludvely contracting with Heartened com actou m
comtruct the project(Sec.7044.Bushcaa and Professions Code:)The ContraCwh L,
are Law does not apply to an owar of property who Wilds or rmprons Merton,and
who contracts for such projects with a commuctur(s)Ileamd MRWat u,the Contractor's
Lken®Law.
Women
under See .B h P C for dds
Women muga
Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following decluadans:
D l hart and will m thoah a Cortifsau ofeomenuo mlfdhure for WrkeYSCamper,
s tion.as provided for by Sectio.3700 of the Lamr Cade,for the Md..of the
wort for which this permit is Issuer
D 1 have Md will maintain Worker's Compe,atian I...as required by SecGan
3700 of the labor Code,for the performance ofthe work for which this permit is hunted. '
My Wmk Co ewd//ov��II�nearamee Cerner and Policy number are:
Carne a` W Policy Na.: `,�000411
CERTIMCATEOF •rEMP ION FROM WORKERS'
COMPENSATION INSURANCE
(Ihkmetir coed Out bee mplevd lithe permit u foram huMreddaBus(S 100)
Or leu)
1 certify the in pct rmance o1lhe wail fa which this Permit V ivued,1 shall rat
emPloyaoy in n mantOt oOmbjectthdm Workers'Compe,ation
Lawaof Calif
AppOunt �
N=CE TO C :Ir.ager making that Ce ficaw of Exemption.You dwuld
become sup.a oheh Compcneco on provisions of the law Code.You must
.J O forthwith comply with such sim
Previu or thla permrer
it an W m
deeed revoked.
.z.m 14 CONSTRUCTION LENDING AGENCY
.�
E's 1,for whiby ch nc Wtthere laacon(Sm.3 len ding agenry for Nc performance of
av Ne wart for which Nis permit k raced(Sec.3(19'1,Civ,C.)
G Q Lcndes Name
D Z I<nde
es Address
.
U 0 1 cmify Nat I ban road Lois application and sunk that the aWn infmmatiun k
LU emrect.I igloo th comply with 91 City and County ardlrlYCf and mate Iaw3 relating to
w^ Wilding construction,and hereby wNarim mprhenutivu of Nu city to antro upon Nc
[t7 aWn-madalted ta,Cou for ilupemron pojapaawhichm6 _
e)agree to ssn,indemnify rill kap humleu the City of Cupertino alai,,
z NIX;TT�'o ,
niti jurtgmau,coauud expe.maof ihil oult. may in any way Accra agai,lsdd City
V z en�f tho DERSTANDS AND WILL COMPLY WITH L NON-POINT Issued by: Date /
u' Re-roofs
o(A i mehor
HAZARDOUS MATEMAIS DISCLOSURE Date T �y
ype of Roof
Will da:applicant Or forum Wilding acapatnom a handle hmNo,mauril
fined by de Cupertino,Municipal Calc.Chapter 9.12,and the Health and Safety
.
Section 25532p)?
❑Yh W/Ka All roofs shall be inspected prior to any roofing material being installed.
Will thea cant 0,future Wilding Occupant,e If a roof is installed without first obtainingan inspection,I agree to remove
PP 8 0 ea Air a or MAO. which P gr
emitict? air canuminanu u dcOlted by dte Bay Area Air Quality Management all new materials for inspection.
DisuictP f
Dy. 9
I haw hat the huardwsmaterials requiremcnu under Chapter 6.95 of the Cdifor.
our Head" .y de.Sectioe,n505.25533 and 25534.1 understand that if Ne Wilding
dont no a dr'ha a tenant dw It k my rhpondhilitY m rtifY the occupant of dx:
rcquiucnu hi m CmetpriortoiuuanaofaCcniRcateo�f0 �. Signature of Applicant Date
Owner or mNGWd agent Dara All roof coverings to be Class'%¢"or better