07120105CITY OF CUPERTINO
BUILDING DIVISION PERNIIT
CONTRACTORIIVEOItMATION
BUIL1 G 0 ESS:
MM6 N STELLING RD BLDG, 44
WEST BUILDERS, INC.
PERMIT NO.
07120105
'S AME:
FERMrr ISSUEDATE
VILLA SERRA APTS A CA LTD
1608 4TH ST STE 120
09/26/2008
PHONE:* nmws
SANITARY NO, CONTROL NO.
(510) 525-9378
ARCHITEKT ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0
LICENSED CONTRACTOR'S DECURATLON
Job Description
under provisions of apter 9 (cm unc Bing
barely aRrm that I w limruwnd Q
wid, Sued. 7000)afDividon 3ordn, Buvnev and Prafeariom Code, and my ii --is
NEW APT BLDG, BLDG 44 A -B, 1607 SQ
in full end ercttc Lk 'a
8/25/08 SEE #07120212 FOR SUBS
Dale Conlncbt
AR HIECI-S DECLARATION
1 undersand my pWu shall W usnd u public rasion
i Liccosed Professional
DER DECLARATION
OWNEom
exempt nm Law for the
1 Wrcby .(sero that 11- uussm from Ne Cssionso
A
i following massa 703 1-5, aircss and Cade: Any city as county
derhos
Improve, uraccuum
.rent t eL roan improv, d , or anY
which requires • prmlit re coon
e,.ir
permit tommul
the Laedialemanl
the applicant for each Contractor's
prlafbalcense License, r9
e wa COnuacbr's Ueceseaawnt
Sq. F[. Floor Area
Valuation
forms.,trequires,
thou Wuu punuany tithe
Com)
$555555
of Division
d(hatMI,cngwithSCNenTOW)oaDivuiafrofdreeincnmat ption,cssiamCode)of
iswit
. Thu io u campy thmefmm and the for ecempdan Any vi.laYon of
,
3 2 6 0 9 0 5 6 !�V
Occupancy Type
be cts the
per
Sad.h 700L5 by mry appl¢ant far a permit mbjttu the epplkanl In a evil penalty ofNumber
not mort dun five hundred dollars (5500).
D 1, u ewrca of Use pmpmy. a my employees with wag. u Noir role mmpenvden.
Required Inspections
will do the wart andthe structure is not lacerated or offered for We (S". 7Ou, Busiress
and Pmfessio. Cade: The Chanticleer License Law clear an, apply b an ownof
9 p
propcny, who builds or impmtea do m on, and who doessucll work himstlfar through his
owe cmployca provided Ihet such imuancro , art not inlrMe! mortared! ferule U.
howevm, Ne Wilding or improvement is mid within am year of completion. the owlw-
builder will haw Ile burden of proving Nat W did not Wild or impmva for purpam of
sale.).
D 1. u answer of that properly. am cocluvwly contracting with licensed commitments an
comeuct the, project (Sec: 7Uba. Business and Pmfamicas Code:) The Communes Li.
canon law does mat apply b an owner of praRrry who Wilda or imPmw Nemo n. and.
.an am= far such pmjecn with.cmusbr(s) ucenied pursuant an the Comranafs
Liceem Lane.
lom.emptundu See .Bd PClmthumss.n
Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under pcmlty of perjury ane of Ne following declarations:
1 haw ind will munuin •Cenifi.taof COnmm b Ylf-i.urt for WarkCf Compere
radon, or provided for by Section 3700 of the Latter Cade, fm Ne performance of not
work for which this Permit is issued.
D 1 haw and will maintain Workees compensation Issuances, as requirtd by Section
3703.1' Ne labor Cade. far the performanceofthe work far which this permit is issued
'
My Work`�ee�jCo_m��en_sa. ^llausance artier andpolieynumhvale: )-''g
Corti.:5. Policy No.: a� `�' 1
CERrIFlC W RK
A WORKERS'
ETON
COMPENSATION INSURANCE
COMPENSATION INSURANCE
Clbu scall. aced rot Wcompleud ifde permit a ie. hued Adoll.(SIM)
or los.)
L ceni(y that In the performam:c of that wart for which this Permit h issued I shell not
cmPby anypefmm In my maMar an an so become, subject b de WmIcan' L'OmpmWdM
Laws of California. Dam
Applicant
NOTICE TO APPLICANT: If, of c, making this Certificate of Exemption, you should
become subject on the Worker Compensation provisions of Ne labor Code you muss
v forthwith comply with such provisions, car this permit mail he drencd mated.
CONSON LENDING AGENCY
+a 1hrum Nalthem isacaleading agency for de pmformamu of
LEKdl
dVrk 1'.r which NY Permit i(Sm3097. GIY. C.)
Lander's Name
l<ndees Address
1 cetify, Nat L have and that application and mute this the above Warmadon is
.
+ cones. I agree to comply with all city and county orainsums and sun laws Mind, b
building construction, and hereby authorim mpmmnutives of this city to cnururn n the
a W s-mandmed property for inspection purposes
) ag. b saw. indemnify and kap hammers the City .f Cupertino aga ant
meY in anY stay acerae against sad Cly
j liabilid `Ipest{\menu. costa end eapSfANDS
t`
AND WILL
INT I NDERIND WILL COMPLY WIALL N N -POINT
Issued by: Date
SO kErU .ATI NS.
Re -roofs
Type of Roof
Si u Abell
HAZARDOUSMATEMAISDISCLOSURE Data
11 the m (mum Wilding aavpaptnom m handle hualloos material
tined by Ne CaptainsMuni al Calc. Chapter 9.11. and the H.Ith and Safety
. cy.us31(i)?
32(.)
❑Tu No
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
Will Nh applicant or future building occupant sax equipment or devices which
g
emll h.,man. air ... umi.nu dcrined by the Bay Arta Air Quality ManagearmL
all new materials for inspection.
District?
DYes Nu
Ih a nddta haaudo. maerlals mgnimmenu under(]upurd.93hfNeGli(m-
m2553a.l undeeund Wilding
Cade.Stttimuhat
doesSa�a(
it i myno e, P
da. t Thaw a enanl. that It u my msp.mihiliry m IwtifY Nc amvpanr of the
nequi m ,Ciel unbemetprior Iraismosecofa Ccruncau.1' crap y.
Signature of Applicant Date
� q ` �
All roof coverings to be Class 'W' or better
Owner, or w orisd agent Dau'