07120108 CITY OF CUPERTINO � ?/�`��TL�" �'
BUILDING DIVISION PERT. V CTl.l NFA 0
BUILDING ADDRESS: PERMIT NO.
10870 N STELLING RD, BLDG 52 WEST BUILDERS, INC. 07120108dlkL
. .
5 ME: PERMrr ISSUE DATE
VILLA SERRA APTS A CA LTD 1608 4TH ST STE 120 09/26/2008
PHONBrom11 SANITARY NO. CONTROL NO.
(510) 525-9378
ARCH=IENOINEER: BUILDING PERMR INFO
BLDG ELECT PLUMB MECH
l� 0 t� 0
uao LICENSED CONTRACTOR'S DECLARATION Job Description
wC I hereby affirm that 1 m lianacd under Provimmu of Chapter 9(commrncint
MbZZ with,.,.y0W)ofDivisionJofNCBusmenandProfessionsCom,andmyHumanu NEW APT BLDG, BLDG 52 A—B, 2300SQ
=w in full farce and clime.5395
30Z LlaenmC a Lk.• 8/25/08 SEE #07120212 FOR SUBS.
ns-q Date ContractorfL
7W ARCHRECPSDECL. A7f10N
1 undcwnJ my plw slWl he urA u public raortls
ids
'G Licensed Profesionel
OWNER-BUILDER DECLARATION
1 hereby si7irm
that 1 am exempt from the Contractors License Law far the.
i p o following rommn.(Section 7831.5,Business and Profesia.Cade:Any city or county
_ which most.a Iw,mit w co.pucs alter,hmpmw,derwim,m ropmir any avuctmc
_I< priarm in ism.mc.anorepimtheapplicant forsuch permit wfileasigned aawmem
xx that beis licensed p.1thsdo,provisions ofdwCoflombrsLicenseLaw(Chapter 9 Sq.Ft.Floor Area Valuation
yFg (eommnwing with section 7000)of Division 3 of Use Business and Professions Colt)or $555555
`< that ha it exempt thersfrmn and de boar for fie aliquot esempdon.Any violation of
Smolom 7031.5 by any applicant for a Permit subjects the applicant to a civil Penalty of hundred dollars 3 2 6 0 9 0 5 6 ane T Number Occupancy e
not mom than Ove r 5500). P y yP
0 11 u manor of the Property,m my employees with wage an their sok compensation,
will do the wart and the strtmtme is act Warded or offered far sale(Sas.7(66.Bumnm
and Probed.. e Ter cadCaramna's License law den nal apply in s owner ar Required Inspections
property who builds m imputes dwaeon.aha whodaeszucb wmk himsrJlorthrovgh
his
own emPloyess,pmWded that such impmtesents m not in', reofferedfornle.1f.
however,the building or ins moement is std within arc year of completion.the owner.
builder will haw the boNmt of proving Nat ha did rot build m improve fm puryose of
isle.).
1.as owner of the prop nl,am exctusiwll'contracting with IianseA Cenmacwn to
contract the Project(Sec 7044.Business and Preload..CmdeJ The Occusumrs U.
cc.e Law dean nm apply wan owner of Property wino builds or anemones Bureau.and
who Co..far such projects with a comrssm(s)littnsed pursuant in the ConOactors
Lke.e Law.
esemptundo Se, .B4,PCfordtlaaston
Iam: n
Data
WORKER'S COMPENSATION DECLARATION
1 batch,affirm under penalty of perjuY one of the following dwimum¢
ri immaMwiimiinwo,ces mofco.entwslr-imm(mwarkers Compere
stian.as provided for by Section 3700 of the labor Code.far the performance,of the
wort for which this Permit is based.
I have and will maintain Workers C.mpe.ation I.urman.as mounted by Section
37W of the Lbnr Cade,fm the pRarmance ofthe work forwhich this Permit a Wood. '
My Wo Cpenuti0Bas .adl .rtPocnave
Grtier. PolicyOMIWO `�� e 11
CERTIFlCATEO E%EMPfION FlERS'
COMPENSATON INSURANCE '
(Tris xNent need rot he complewe If 0m Permit is Corona hundred doBm($100)
or less)
1 ciatify that 1.the perfam arse of the work fm which this cand,in issued,l shall mot
cmplg an,,..in any rower.u in b¢mme subject w t e Worker'Cooputsal.
laws of California.Dam
Applicant
NOl7CE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject in the Workers Compe.dtion pmtiaioon,of the labor Cade,you must
O forthwith comply with such provisions m this Permit mail M deemed revoked.
CONSrRUCTON LENDING AGENCY
[-+� I many allure thatft.ar a comuucts.lending agency fm the perrmmarceof
lY the week far which this Permit is issued(Sec.3097.Civ.C.)
0 Lenders Name
z Inters Addreas
U Q I certify that 1 haw round this application and soon that the above information is
[,. C..L I agree w comply with sit city and county orchestras,and mute Ian miming w ,
.p building conmuction.and hamby authorise rcpmsentedca of Nu city in anter now the
[i7
aborm-recourgrad properly for inspection purpawL
(w gree he aK indemnify and keep harmless the City of Cupertino against S4��
t..'i Cn liabeCAJ;
en andexpenw which may hes any wayacnuc agarol std City
U z in cranting of this PeMIL
^' APSTANDS AND WILL COMPLY WI ALL ON-POINT Issued by: DateSONS.SigRe-roofs
an b pawZARDOUS MATERIALS DISCLOSURE Type of Roof G
IrWill the Ildiantm in—WillingaavPantam,orhandlc lumard.us numaid
Hoed by the Cupnino Munici Code,Chapter 9.13,and the Health mod Safety
k ❑Yes a semen 155324)?155324)? -All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtainingan inspection,I agree to remove
Will the all
est or fu�wtag aeuPa.,caw equipment or denim which P g
em0 hecardn.air cantmimnts defined by the Bay Amo Air Quality Management all new materials for inspection.
D V ct?
❑Yes No
I haw WNaha>.ar mawriabmquimmenuunecr .Gapwr6.9SoHha Glifor.
mar Health h5 0 ode.Seen.M585,25533 and 25534.1 understand and if the building
don trot a rte ly ha a brans that it is my mPossibility to notify clRRBinpppannt of Om
mquim ts m m !c Ip riminiss.nccafeCeniflac caper( Signature of Applicant Date
L f/!!
owner or civ estID2M All roof coverings to be Class'%W'or better