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CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
RCONTT, $g0k'jNFORNI�TIO _
au"InAqV140MESTEAD RD BLDG 21 A-
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WEST BUILDERS, INC.
PERMIT NO.
07120189
SNAUME:
PE IS51JEDATE
VILLA SERRA APT CA LTD PARTN
1608 4TH ST STE 120
09/26/2008
PHONE:
SANITARY NO. CONTROLNO.
(510) 525-9378
A0.CHTTECT/ENGINEFA:
BUILDING PERMIT INFO
BLDG EIECI' PLUMB MECH
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LICENSED CONDIACmWS DECLARATION
lob DOSCiIpilOn
1 me licensed uer provisions; of Chapter 9 (commcing
1 hereby +term Nat nd
Setup Section 70W)Of Division 30f the BusinessanP%ru Cade cry license is
NEW APT BLDG 21 A—B — 1,205 SF
IS full
Cl"m`rc"' Lin 8 -5
8/25/08 SEE #07120212 'FOR SUBS
Date ( (,� ContrmCL
RCHTIECTS DEuar— I
I understand my plans s aR he hand as public records
LicCoad Impersonal
OWNER -BUILDER DECLARATION
1 Wrehy aRrm that 1 am attempt from Ne Conhattofs Uccam Lsw for the
following mason. (Sadao 7031.5, Business and Prefcsdmu Code: Any city or County
which requires a permit in cmuhuct, alter, improve, demolish, or mpmr my structure
prior a its issuance. also requires the applicant farsuch permit a rile a signed auitemem
this he is licensed pursuant a the provisions Of the Commutes UT= lsw(Chapter 9
Sq. Ft. Floor Area
Valuation
SectionI (commencing with Section 700M ofDivision J of the Business and Professions Cade) or
$555555
• Net he is attempt therefrom and the bah for the alleged mo mpdon. Any violation of
32609056Occupancy
!
TyPe
Section 7031.5 by airy applicant for a permit mbjecui the appliu IL to a Civil penalty of
ME mre Nso five hundred dallars(S5WB
.umber
I, v owner of the property, Or my moplayw with wages in their mk compensation.
Required Inspections
will do the work, and the mucous is not smntied oroffcrad for We (Sat. 704, Business
and Profession, Cade TW CostranoYs I.i¢nte Law dos set apply to an Ownv of
propenywho Wilds aimpSow duman. andwho doessucltwork hi pamfordensigh his
awn employees. provided that such improvements are ootin¢Med oroBeed for ads. If,
howew, the Wilding ser improvement k Sold within ane year of completion, the owner -
builder will Itave the burden of proving that W did not bda or improve far purpose of
ak.).
❑ 1. in owner of She property. am exclusively contracting with heaved Convenors a
conatmet the project (See. 7W. Business am Prufecdo s Cade:) The Continues Lr -
cove taw does as apply to an damn of property who Wilds m improves thnsmn, Md.
who nonuaeui for such pmjeeu with a eonmcloKs) licensed pursuant a dm Contractors
Lkeaan law.
thisasaa
meamoptuer See ,BkPCforrt
Iatnd
went Dam
WORKER'S COMPENSATION DECLARATION
1 buldry aPrme under perulty of pmjury one of the following desdaadov:
Ihave andwie eCmi of Consents sdf-Wurt far
37M al the labor Code, for Uta peRorman¢ of the
anon, forSection ppod. of
pvvidhi far
r mi d,
work for which Nu permit is Wtm6
❑ I home and will maintain Workers Compensation Insurance, u reyuiad by Section
37W of the lsWr Code. for the psolmooance of the work for which this permit is Lssned.
My Worker pean Luarax
ucarrier and Policy ro mthicur : may `
Grrier. m' . (_1 iley Na.: /mss -
"&6 `]� y 1
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu farm tend rot W compkmd tide permit is forane hundred Milan (5100)
or lea)
1 artily that in the pmfounaae of the work for which this permit is issued. I shall tat
employ soy pcuon in any mannerm as k become subject in the Work.- Comperuadon
Laws of California. Data
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Eamptiun, you should
become subject s Lha Workers compensation provisions of the Li lar Cod, you mum
' foMwith comply with such Provisions or this permit shall W darted revoked.
i CONSTRUCTIONIFNDINGAGENCY
Wt then lace Comametinn agcney for Eve, pmfermaam of
• TWmwhich
this
' Ne murk for which mu pemtit u issued (Sat. JWT, Civ. CJ
.Ch,
Lenders Name
Lenders Address
1 1 coolly that 1 have rad this appliadon and suite Nat ate above information is
' coraco 1 agree to comply with all city and county omrmseca and suite laws rtladng to
Wilding cmuuuction. and hereby mtharitn reprvattadmes of ddi city or enter upon tic
1 aWve-mantis ny fa inspection purpo¢k
(We) as ave, indemnify and kap harmless the City of Cupntino against
I tiabilltia.jdg U amandexpemes which mayin anywayseenm agaludism Gly
in cavcq the cuminsofthuprnnit.
' AP
Date
RDOUS MATERIALS DISCLOSURE
Will tite applicant or future Wilding aaupantaore orhandle hmudov material
' u deRncd by tie Cupenimo Mun' al Code. Chapter 9.12. and tiro Health and Safety
Code. Send. 25632(.)1
❑ Yon o
All roofs shall be inspected prior to any roofing material being installed.
Will sura (ding
If a roof is installed without first obtaining an inspection, I agree to remove
g P g
tW applicant or aovpanl tic equipmeet or devices which
eCaph air Comamivnts defined by f Bay Area Air Quality Manatcmem
all new materials for inspection.'
ib.,none,
Gy. Nu
I have ca a hvaNnus materisu aquirommus under Chapter 6.95 ofthe Celifor.
ria & ety dc,5ccd-255U5.25533.d25534.1undcuundth.ifsc Wilding
dons
issumt¢ofa Cadfc;m fQapv
Gl yG
Signature of Applicant Date
All roof coverings to be Classor better
owners authncedagcm Dam