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GONTRACTnR INFORMATION ;
BUILDING DIVISION PERMIT
BUI 1 RESS:
�l.(8�
PERMIT NO. '
IIOMESTEAD RD
WEST BUILDERS, INC.
08050140
NER'S NAME:
PERMIT ISSUE DATE
VS]J A CALIFORNIA LTD
1608 4TH ST STE 120
08/15/2008
ONEn nn.... t•u'r n
SANITARY NO. CONTROL NO.
(510) 525-9378
ARCHITER/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
Chaps 9
Jab Description
1 homey affirm that 1 am lieeaudd under pmvitiaea of (ammmeing
with Section T01f0)of Dwidon 3offt Basneas and Pmfessioes Cock, and my license ut
TEMPORARY LAUNDRY FACILITY MODULAR STRUCTURES
in full fares and effmL .S
Liao I Lk.d
(HOUSING TEMP LAUNDRY FACILITIES)
HIIECnua DECIA ATION
1 understand my puns shall be used as public mCONs
Licensed Professional
OWNER -BUILDER DECLARATION
I hatch, nor. Not I Mn smcmpl from the Contnnota License Law for tae
following mason. (SCLOon 703 [.5, Business and ProfeNuns Catlin: Any City or County
which requires a pmmil to censrocl alcor. improve, demoita a. m repair any suu sure
prior m its issuance. Man requima the applicam forsuch permit to file a signed statement
dadkislicensed din ContractoriLiceneLaw (Chapter 9
Sq. Ft. Floor Area
Valuation
pursuanttothe provisions of
(eommenang with Section 7000) of Division 3 of the Business and Professions Cudc) or
$5000
that he Is exempt therefrom and the basis for the alleged exemption. Any violation of
32609056!}E Number
Occupancy Type
P Y YP
Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penally of
net come dun five hundred dallaOt (5500).
D 1, as Owner of the property, or my employees with wages as their sale compensation,
will do the .,it. and the.uuclum u not immackd or offered for ask (Sec.] .Busness
Required Inspections
and Pmrecdans Cade The Camm�ot, License law does rot apply m an owner of
propsny who builds Lir improves thermn,and whodassuch wok himself orthrough his
awn employes, provided that such improvements art oat inendd waffemid for sale ff,
however, the building or improvemem is sold within me year of completion. the owner-
Woder, will haw the Wrde , of pmvine dust W did not Wild or improve for purpose or
ask.).
D 1, as mvaer of the property, am escl.i,,I, contracting with licensed antncmrs m
construct the project (Sec. 7044. Busnev and Professions Code:) The Canuacmts Li.
.
cense Law does out apply m an. of pmpoty who Wilds or improves therean, and
who contracts for such projects wit a contractors) licensed puissant m the Contramota
Lk.. law.
D l san exempt under See .BdPCfor this reason
Ma Dam
WORKERS COMPENSATION DECLARATION
I hereby aRmt under penalty of perjury one of the following declanuans:
D I ham and will maintain Certibcete of Caren m self-irtsure rortlic sCompere
sauan, as provided for by Section 3700 of the Labor Code, for the perfomona of the
work for which this parmit u issued.
D I have and will maintain Workter's Compensation Insurance, u required by Senkn
3700 of the labor Code, for the perfarmance ofthe work forwhich this permit i.issued.
'
My Worker's conce'resi ion Bwr`ame'U�'m sand policy number are
_O7`]J
Cartier.5k \T Paliry N..1�Z lxt�
CERTIFICATE OF EXEMP ION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section need not be completed VIM permit is forme hundred dollars ($100)
or lcsv)
I certify Nut in the Performance of the work for which this permit u issued. l shall not
c.•npky anypecum in any mannermw as m becomte.mbjeet m the W ari Compensation
Laws of"ramia. Dam
Applicant
NOTICE TO APPLICANT: If, after making this Cenifnte of EumPuao, you should
become subjat m the Worker', Compensation provisions of the Leber Code, you muss
Comply with such pmvitimts or this permit shall Its deemed coveted.
CONSTRUCTION LENDING AGENCY
1 hereby affirm dust thea i, a construction lending agency for the performance of
the work for which this permit Is amid (Stec. 3097, Civ, C.)
Lader'. Nam,
Lander'. Add.
1 certify that I hive mad this application and sem dues due above information Is
cotmcL I agree to comply with all city and county ordinances and stale laws relating m
building construction, and hereby submarine representative; of this city to enter upon the
above-mentioted properly for im pcnion purposes
(We) agree to Live, indemnify and loop harmless the City of Cupenino against
liabilities, judgm osis. costs and vprnases which may in any w'ay. agaWt said City
in cone picsec of the ung of this permit.
Dem
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
WIII IW cep jcent Or future Wal Code.9.12, handle Renrdoas mamsd
u defined Chapter
Ihs Cupertino Municipal Codc. Chapter 9.13, and the HdN and Safety
Section
. CY.2553zaY!
❑res �pysa
All roofs shall be inspected prior to an roofing material beim
P p Y g g installed.
Will Ibe apple., or fu Wading occupant aro equipment a device. which
If a roof is installed without first obtaining an inspection, I agree to remove
emithic�nns air communistic; as defined by ft Bay Arca Air Quality Management
all new materials for inspection.
DYes &—No
I have rend Ne hzaardous materials mannerisms under Chapter 6.95ofdm hbi.s.
nu Health
All roof coverings to be Class 'V' or better
Owner o anth bte agent Data