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CITY OF CUPERTINO
BUILDING DIVISION PERMTT
CONTRACTOR IN'EORMATION
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BUILDPERMITNO.
F TIB OMESTEAD RD BLDG 65 A—
WEST BUILDERS, INC.
07120193
Wills NAME:
PERMTTISSUEDATE
VILLA SERRA APT A CA LTD
1608 4TH ST STE 120
09/26/2008
PHONLn m oy
SANITARY NO. CONTROL NO.
(510) 525-9378
ARCHIIECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB - MECH
LICENSED CONTRACTOR'S DECLARATION
OCSCiIP
Job Description
1 Wintry aRThu Ton 1 am li¢under der Provide" of Ch•per 9 (commenting
withSection 7OM)ofDividon 3afthe Business and Profeasiom Code, and m licensels
NEW APT BLDG 65 A—H — 4,391 SF
I. aayaneur� �t �L'
8/25/08 SEE #07120212 FOR SUBS
Dam ,/ ComDEC
17 RCNIfECT.DECLARA ON
1 undersand my plans shall W mcd M public records
i
Licensed Norman ... I
OWNER -BUILDER DECLARATION
1 hereby artnm Nal I am esempt from the Comaeara License Law for Ne
following reason. (Section 70313, BudMss and Pmressions Code: Any sly or county
which requires a Permit to cor"uuar. alter improve, demolish, Or repair MY mucmm
'
prlwb its 4RWIKe. alta mTLd=the applicator for SYeh Permit m rile a Signed MOMMnl
W is licensed in tho or the Conmclwu Liee•se law (Chapter 9
Sq. Ft. Floor Area
Valuation
that p secant provisions
(commencing with StionTIM) of Division 3 or die Buinrss and Professions Code) or
M
$555555
1 • that M is rump, therefrom and the basis for the alleged ermnption. My violation of
Section 7031.5 by any applicator for a permit subjects the applicant m, civil penalty of
32609056A?YAAjtuber
Occupancy Type
nor mart shun live hundred dollars (15M
❑ I. u owner of Ne psapeny. a my employees WIN wage as Heir role cmmpensation,
Wort. andthe suuctutounotintendede fwssle(S'. Badness
Required Inspections
and Prthe
a.do to an
and Cone: The ecmr, Llan: Law dam to an awncr of
err hims
ertywh W vest M1inwJf or WougW his
property who WM Nercon, and h.doBout
man employees. proAded tha Me intended for ale If.
wcM1impRvemausato retocar
.woiRrtd
however. Ne Wilding or improvement is said within eM year of a for On aso'f
ver.thproNdr improvement
improve
builder will have the burde. of poling IN, k did rot build m W pros rw purpose, of
sale].
0 1, as moll' of t e property, am exclusively consisting with licensed munnos's on
eonsuuct the project (Sec. 7064. Business aed Professions Cade:) The Contractors U.
ecru Law does not apply to an owner of property who Wilds or improv thanon and
who Wnm•'S for Saab projects will, .c sOuncar(S) licensed pormanl in the cmunte ce,
nR
oro tempt Under See . B k P C for this reason
t1
If
Dam
WORMS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury note of the following declaration:
❑ Ihave and will malnuina CersiOmm mf Conummsalfinsurt fm Workers Compem
now. as provided for by Section 37M of has labor Code, for On performeMe of the
work for which Nis permit is land
0 1 have and will maintain Wwkerl OMprmado t InsuMee, as mqulRd by Stele.
37W of the War Cade. for he performance of de work forwhich des permit is issued.
rs oW(rMe:
My Warkrfs omp taxon Insmalla '' and Policy Wa
,t
kR A
Cartier. t/ Policy No.: ` b 11
CE IFICATE OF DIJON FROM WORKERS'
COMPENSATIONINSURANCE
(TM1Y,MIM Ked M(Wcenpl=Kd If Nr permit is forme hundred dollars (SIM)
or leu)
1 terrify Nm in the "I... u the wed for which this permit u issued. l Mail nw
employ any person in any manecrso u to bccwne subject to the Wane^* Cwapensadm
Laws of Califomia Dale
Aypliant
NOTICE TO APPLICANT. If, alter making this Certificate of Excerption. rad should
become,ubjea he the Woh''s Compensation provisions or to. Labe Cade, you most
forthwith comply with such PromWOm or this permit shall W deemed evoked.
CONSTRUCTION LENDING AGENCY
T omby affirm thus dome lora construction lending agency for the perrommmae u
de work for which this permit Is utaed (Sec. 309'7, Civ. C )
Lenders Name
.
lender, Add.
I certify that 1 have read this application and all this Ulc above information u
'
correct. 1 agree N comply with all city and comity oMimw.v and state laws totaling N
building consumerism. and hereby Mahmire O f.utiv orchis city m ens' upon de
Move to Lo d pmpeny for inspeaoon purpmes.
(Wc) rte to ave. indcmrtily std trop n'mless tie Ciry or Cupertino a rot
W
m nts, cowering may In any way accrue agalns,sald City
.
incommith
in consegK o c{nlNn{orf Nu penin
of this nemph.
APPLI A U
..,or Date
1 HAZARDOUS MATERIALS DISCLOSURE
Type of Roof /
Will •ppoanrwfulmocWildingeaup•mswmwhmdlehmsrdoumaWiil
dcRud by the Cupertino Munici al Code. Chapter 9.12 roti the Health Mod $.(cry
cede. $trim ss532(.)7
❑res o
All roofs shall be inspected prior to any roofing material being installed.
Will the. ficant w mon ildin em nr mm m
Ins t w w 'proco, ter Jevlaa which
If a roof is installed without first obtaining an inspection, I agree to remove
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emit havrdnm oir cmumiM is dcfncd by the Bay Ma Air Quality Management
all new materials for inspection.
DiMict7
Nu
❑kh
(wu maadau Rquvemmts underOolaor6.95ofthe Cabins.
nulhaldors
on, raKeer,c"irte
acagm
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Signature of Applicant Date
All roof coverings to be Class '%." or better
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