07120140 CITY OF CUPERTINO BUILDING mvlsloN PERMIT CONTRACTOR I1�IFUILMAII�ON
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PERMIT NO.
BuII.QItIcQjtFEN STELLING RD BLDG 33 WEST BUILDERS, INC. 07120140
l'S AMIEJ: PERMIT ISSUE DATE
VILLA SERRA APTS A CA LTD 1608 4TH ST STE 120 09/26/2008
PHONE:' (510) 525-9378 SANITARY NO. CONTROL NO.
ARCHTTECTiENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
fop LICENSED CONTRACTORS DECLARATION Job Description
1 bcby afr1m wt 1 am licence under pro mumas of Charms 9(wmmrxing
n with Sxdon7m10)ofDlvfaion 3ofw BuSxas Prof mean yliccnx is NEW APT BLDG, BLDG 33A—B, 1607 SQ
in full luxe and effecs �ar �
-pi Lieenmcin Lw.g 8/25/08 SEE #07120212 FOR SUBS
I„ DawContrsnnr
' CHf1EC O.DECI.sRAnoN
< 1 undmsund my plans shW he used as public recortla
-u. Licensed Rorcssionl
m3 OWNER-BUILDER DECLARATION
E 1 hereby aRrm that 1 am exempt fmrn w Conumtoh license Law for the
02 fallowing no mm(Scotian 7W 1.5,Business and Pmfesvona Code:Any city or caumy
S$ which mquirce a permit to cons rm4 alwr.improve,demolish,or repair any sanctum
-i< prior to its issuance.also malum,;the applinnl for such permit to filo a signed mate.1
"E�e don k u licensed pumant m w provision of do,comr«mra Ucces,Law(chape,9 Sq.Ft.Floor Area $555555 Valuation
s: (commencing with Section 7000)of Division 3 or the Busircss and Prolesum.Code)or
$ Nat w u dxmpt therefrom and the basu for the dl.gcd me mption.Any violation of
Section 7031.5 by any applicant for a permit subjects w applicant he a civil penalty OfNumber Occupancy Type
out more than mofive hundred dollars(SM 32609056
❑I.u ows¢r of dr propnsY,a mY voplayen with vagn u Use"v role compenxJon,
void Pr le work,amd w she Con ra not s Liumd,Law de
faaawpply to 44,eudx,s
and Raresdons code:7153 Conumta',Licctm law son not apply m an own"or _ Required Inspections
prnpemy who w i1N a i mpm.themon,and who don such wok himself or dmugh hu
awn .thebipmHdedMauchimprnwmwtsinwtintarOr orllremd the IL
bawd..wbuildingu imprnwmmtg midwithin arc Wild
ofimroe for the of
wildtt will haw w bore.of proWng wt k did not wild or improve far puryore of
saw.).
0 1.as owm of the property am aelusivcly canumting with licensed centrmsas b
wnsmwt the p eject(Sec.'I014.auxin rind Professions Cade:)Tic Contrmmts U.
C.Law does not apply in me owner of pmpemy,who builds or impm..sena.and
vow contracts for such projects with o contracter(s)Homed pursuant to w Contractors
License Law.
I umcxmptunder See .Bk PCrwdmsmasoa
wnv
Data
WORKER'S COMPENSATION DECLARATION
I lumby a(rim under penalty of perjury ore of w following dedaratimte
❑Thaw and w0l munwn aCutiOexw of CAnsentwxlf-insurtforWo,ker'sCompen-
a ion,as provided for by Section 3M of ton labor Code,for the porruth o of the
work for which this remit is issued.
❑I haw send will mainuin Warkefs Cc mpensuion lu mance,as required by Section
3700 aw labor Code,for w Poformsetce of the vat for which this permit in issued. '
My w.2e Can ensaman Inco cenitt and Poliry numb are:
Cartier'�erkO Poliry OM O Q00�_
CEATIFlCCOMPE COMPENSATION
NFROM WORKERS'
COMPENSATION INSURANCE
(3Tu sec0on need rot w Complcwd lithe permit u faux hundred dollars(SIM)
or less)
1 certify wI in the performance Or the work for which this Permit u issued.l shall set
employ any person in my mower an u at become subject or the WorkuY Compexadm
laws of California.Date
Applicant
NOTICE TO APPLICANT:IL afar making this cemirmem or Exemption,you should
hemea:subject to the Worters Compce ettion prnviaions or w Lahr Code,you most
.J z forthwith comply with such provisions or this permit shall he dcemed revoked.
CONSTRUCTION LENDING AGENCY
tom+ 309
I bereb .M.that Wirt u a comsaucuen lendu a
c Y f FxY far w perfwma m of
a w work for which this remit u lured(See '1,Civ.CI
W F Until Name
=)z Tender's Add.
U OI eeAfy,door I haw mad this application and sow that the show Information 6
F
U. comas l agmsAo comply with sit city and county Colossuses s relati
s and soon haws w
.C) Wilding On on,and hereby mosoriw rtparexnoti.of this City to wwr upon Ne
LS) awvcme tti pmpeny for inspection pu,poms
L3, (We) g to saw.indemnify and keep harmless the City of Cupertino against
vy TA !IWIti ,j n.....0 and callouses which may In my way moue against said City
UZ in eo granting of thin permit.
APPLI ? ERSTANDS AND WILL COMPLY W 711 ALL NON-POINT Issued by: Date _21yE.1
SOUR R 0 ONS.
Re-roofs i
slgnam or 1PN and .n=U D'w Type of Roof
ARDOUS MATERIALS DISCLOSURE T
WiIIy apCupertino Muni Municipal
Cgoceupant seortor handle eahlb smawrial
s dcRxd by w Cupertino Municipal Cade.Chapter 9.13,and don Health ani Safety
'cede. 0y.35533(a)? All roofs shall be inspected nor to an roofing material bei;
❑rex No P P Y g g installed.
Will w applicant or more wilding ottvpant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
.mit hamrdme.si,c..=I.anu u fined by the Bay Ams Air Quality Management all new materials for inspection.
District?
❑Yn Nu
I have hmandous mawiau tmptiremeno under Chapter 6.95.f done Califon.
nice Health I .Seeman 35535.25533 and 255x.I aMawnd itself ft wilding
doca not cu norm.oat It u my top ami Eity m nodrY ..P4.1 ton
m mucnacn n' h tee me issuance ofa Catiha
Signature of Applicant Date
owner ora a Dam I I All roof coverings to be Class'W'or better