07120132BUILDING DIVISION PEPMUT
BUILDING ADDRESS:
-
rexrwrr NU.
10870 N STELLING RD, BLDG 53
WEST BUILDERS, INC.
07120132
OW 'S NAME:
P1IIUar ISSUE DATE
VILLA SERRA APTS A CA LTD
1608 4TH ST STE 120
09/26/2008
PHON&T D n -MT
SANITARY NO. CONTROL NO.
(510) 525-9378
ARCHITECTIENGiNEEE :
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTORS DECLARATION
I crebhy afrtrm that I am licensed under provisions of Chapter 9 (commencing
with Sation 7000) of Division 3 of tho Business �and Profession Code, and my license is
in full force and effect.
LicenseCIEssL ic. N
Date Contractor
ARCHITECTS DECLARATION
I understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION .
1hereby alarm that 1 am exempt from the Contractor's License Law for the
following reason. (Section 70313, Business and Profession Code Any city or county
which requires a permit to onnstruM alter. improve, demolish. or repair any mucrure
prior to its issuance atm requires the applicant for such permit to file a signed sutcmcnt
that be is licensed pursuant to the provision of the Contractor's Ilts:nsc Law (Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Profession Code) or
that he is exempt therefsaa and the baric for the alleged exemption. Airy violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not mom than five hundred dollars (2300).
❑ L as owner of the property, or my employees with wages as their sok compensation,
will do the work, and the structure is not intended or offered for sale (Sec 70M, Business
and Profession Code: The Contractors License Lew does not apply to an owner of
property who builds or improves thereon, and who does such wok himself o through bis
own anployees, provided that such improvements are not intended or offered for sale ir.
however. the building or improvement Is sold within one yea of completion. the owner -
builder will have the burden of proving that he did not build or Improve for purpose of
sale.).
❑ L as owner of the property, am exclusively contracting with licensed contractors to
construct the project (See. 7044. Business and Profession Coda) The Coubwors Li -
cone Lew does not apply to an owner of property who builds or Improves thereon. and,
who contracts for such projects with a contractor(s) licensed pursuant to the Contractors
License Lew.
❑ .I am exempt order Sex B de P C for this reason
Owner Due
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations
❑ I have and will maintain a Certificate of Consent to self --Insure for Workers Compeer•
salon, as provided for by Section 3700 of the fibs Code, for the performance of the
work for which this permit is Issued.
❑ I love and will malmaih Wolters Compensation insurance. a rtquhtd by Section
3700 of the Lobo Code, for the performance of the work for which this permit Is issued.
My Walker's m antio/q�h surface carricr and Policy number are. j
Carrier. w� Policy No.:11-loo(} — `
CER77FICATE O CEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This section need eta be completed U the permit is fo ono hundred dollars (SI0(l)
or lens)
I certify that in the performance of the work for which this permit Is Issued I shall Out
employ any person in any maaner so as to become subject to the Workers' Compensation
Lawn of California. Due
Appiiwm
NOTICE TO APPLICANT If, alter malting this Certificate of Exemption, you should
become subject to the Wokcrs Compensation provision of the I.Abor Code, you must
forthwith comply with rich provisions or this p mnit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hcmaffirm a m that there Is a construction lending agency for performance of
the work
for which this permit Is issued (Soc. 3097. Civ. C.)
Lender's Nemo
Lenders Address
I cvtify that I have mad this application and sura that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating to
building 'on, and hereby authorize mprmenwives of this city to eovr upon the
peopet y for inspection purpn—
to ave, indemnify and keep harmless the City of Cupertino against
lkablfities, J M costs and expenses which may to any way accrue against said City
in Venting of this permit
AP IC U STANDS AND WILL COMPLY W ALL N (-POINT
S()"
o
Dab
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant o future building oavpanL pore o handle hazardous Outlaw
as defined by tit Cupertion M Code. Chapter 9. I2, and the Health and Safety
Code. Scolon 25532(x)7
❑ Ya No
Will the applicant or future building occupant use equipment o devises which
emit hazardous air conumi ants u reed by the Bay Area Aur Quality Management
Distric;0
❑ Yes o
1 the bardo s mewdals mqubcmcnts underChapbr 6.95 of the Califo-
niaHol k YCode. Secdons 25505, 25533 wW 25534. l urdcrpand thatif the building
doelon have a umarn, that it is my responsibility to y the t of the
req prior b Issuance of a Cerili f Oc
tcb
even« gent UY Date
Job Description
NEW APT BLDG, BLDG 53 A, 2364SQ
8/25/08 SEE #07120212'FOR SUBS.
Sq. Ft. Floor Area . Valuation
$555555
32609056AF
. �N
Required Inspections
Issued by:
Re -roofs
Type of Roof
Type
Date '0_' Ji
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
all new materials for inspection.
Signature of Applicant Date
All roof coverings to be Class''' or better