06090204CITY OF CUPERTINO
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CON TRACTORiINFORMATION "'
BUILDING DIVISION PERMIT
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BUILDING ADDRESS:
DEV RA CONSTRUCTION INC.
PERMIT"°. 06090204
0875 VALLEY GREEN DR
NAME:
PERMIT ISSUE DATE
WOODMONT - UNITS 420-428
VC
1040 COMMERCIAL ST IT
1 09/21/2006
r NE:
SANITARY N0, CONTROL NO.
(408)441-9598
ARCNnECTIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hemuy, air,. Out I and, licensed under proviionu of Charts 9 (commencing
with Section 70(10) of Division 3 of NC Business and Profcsuiuv Cade, my license is
infant° eandeffect-b (�(Jt ((
LIKE FOR LIKE BEAM REPLACEMENT ONLY
Licm. C s Lic. x
DamConuacWr
ARCHITECTS DECD ATION
I uMas nJ my plans shall W used as public records
Licensed Pnafesdiiind
OWNER -BUILDER DECLARATION
I hereby alarm the, I On accept from the Contractors License Law far the
following mason. (Section iso 1.5. Business and Profe@ions Calc: My city or county
which ¢quires a Permit to construct, alma improve, demolish. or repair any structure
$16000
! prior W its issuance. also mquims the applicant for such permit to file a signed summer,
that be is licerLxd o the of the Contractor's Lice= Law (Chapter 9
Sq. Ft. Floor Area
Valuation
pursuant provisions
(commending with Section 7000) or Division 3 of the Business and Professions Coda) or
that he is exempt themfmm and the haste for the alleged nemption. Any violation of
r u u
Occupancy Type
Section 7031.5 by any appliesn, for a Permit subjects the applicant in a civil penalty of
not more than five hundred dollars (5300).
❑ 1, u owner of Jte property, or my aaployw with wags as Jath sok a ampevsdm,
will do the .,it. and Ne rwmum is Imtintended oraRertd parole (Sec. 70as, Business
Required Inspections
and Pmfeuslana Cade: The Commissaries Liana Law does oat apply in in owner of
property who l f dmon, hwork orNrmogh his
romploes.proiddthC=himpcmmUmnatinM crunched for saltIf.howevv,
Ne Wilding or impmwmann u sold within one rw or
for the °road
improve
builder will have Jte Wrden of proving Out be did IWC build w improve far purpose of
sale.).
cor,racting with licensed contractors
co 1. 43 owner of Ute progeny, .B .mess
U.
(Sec. 70x4, apd The Conrracwh IF
construct Nc add
/
esnjea
weer of
cense law does not apply W an owner of progeny who Wilde or improves Wemon, and
property who Wilds
ds or
who for such projects with a cantncros(s) licensed pursuant W tW Conuutors
. Lace
Linc mLaw.
a escmps under Sec ,06 PCfar this rtawn
O�
Date
WORKER'S COMPENSATION DECLARATION
1 hcmby affirm under penalty or perjury nom of the following decimations:
art am will cadnum a Cer6fiax ofCoven,mself-insure for wintersCompm-
1017'71
, v provided for by Section 37M of the Labor Code• for the pesfmmance of the
for which Of, permit is issued.
ave and will mainum Workers Compensation Ivuanm, u required by Scedon
ofNcLabor Code. lerNe performance of Ne work for which this permit is issued.
m mudio Surma carrier mW Policy number ve:
Lmf�
'D��t!—O
II//11 Polity N.A60 LO] T
CE ICATE OF E) MON FROM WORKERS'
COMPENSATION INSURANCE
(Thu smite need not uncompleted from permit is forone hunNed dollars (5101f)
or less.)
1 arufy the, in the performantt of the, work Inc which this permit its issued. I shall not
emplia; m, pcmen in my reanrcrm as W beam. subject W the Workers' Ciampcwtion
Lava pf Califibrau Dem
Applicant
NOTICE TO APPLICANT: If. arm, making this Cenificam of Exemption you should
became subject to one workers COmpenudon provisions of Ibe Labor Code, you most
forthwith comply with such brown.. or this permit shall x loaned revoked.
I
CONSTRUCTION LENDING AGENCY
1 hereby affirm Out Nese is a em surtmonn lending agency far the performance of
the work for which this permit Is issued (Sce. 3097, Civ. C.)
Lenders Namc
Lenders Address
I anify Nat I have read this application and state Na the above information is
.renes. l time to comply with all city and county ordinaues and sum laws xlating to
building construction, and hereby authorize mp eunusives of Nis city to enter upon the
above menduned property (or inspcetion purposes,
(We) agree to save, inacmni fy and keep harmless the City of Cupertino against
Liabilities. judgments. toss and expenses which may in my way scene, again, aid City
In eom iders" Of the gtmdng of Nu permi
APPLICANT A D L COMPLY WITH ALL NON -POINT
Issued by: DateSOURCER/EGSignature
UNDERS�TDS
I�
Re -roofs
01serl�p�
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Wil"'cap
Nc appliant or (mum building ecupmt store or haMlc hvaNpus material
e0ncd bOa Cupertino Municipal Codc. ChapWr 9.13, and Ne HeaIN mJ Sa(e,y
Section 13532(a)?
Yes
All roofs shall be inspected prior to any roofing material being installed.
Will the applicros Orrt. occupant ose.yuipment or devices which
If a roof is installed without first obtaining an inspection, I agree to remove
emit hurardous air conuminmts as defined by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑ Yu
Ihave ousm55U5,23333men3un Yd.95or,
theh,&c..
25M5,smyuireme5534.IrChapmrbduddeCalifon
ria Heal"&Safety COde,S 1uChapu
&SZaI building
does no, currently have a mnmL that i, is my responsibility W notify the o cup¢ of Jat
rcyuirtmcnu?,nKn� tpriorWissusevot�Cerircateafo an<y.I
S ignature of Applica--r- Date
e\it I n
roof coverings All f verin s to be Class "B" or better
owner or soma md� Da