0712013373 C
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CITY OF CUPERTINO
BUILDING DIVISION PERNUT
BUIL(il�c STELLING RD BLDG 40 A- I WEST BUILDERS, INC.
rMUS NAME.
VS II A CALIFORNIA LIMITED
I Manby alarm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code. and my license Is
in full force and effect2 ^
Lica sc [1e. r
Date Contractor
ARCHrTECiS D ON
Tundm%�2aamf plan shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractors Lleeac Law for the
following mason. (Section 70313. Business and Professions Code. Any city or county
which requires a permit to construct. aller. improve, demoBsh, or repair any suuctum
prior to in iw� also requires the applicant for such permit to file a signed statement
that he is licensed pursuant to the provisions of the Contractors License Law (Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that be Is mtempt therefrom and the basis for the alleged arampdon Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundmd dollar (SM
❑ L as owner of the property. or my employees with wages as their sale compemalon,
will do the work. and the structure: 4 not intended or offered for sale (Sec. 7044. Business
and Profasions Coda: The Contractors License Law does rot appy to an comer of
property who builds or improves thereon, and who does such work hir—If or through his
we employees, provided dw such imp a emenu are not intended or offered for sales If.
however. the building or improvemem is sold within one year of completion. llm 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 Professions Code:) The Contractors U -
cense Law does oat appy to an owner of property who bull's or Improves thereon. and.
who contracts for such projects with a contractor(s) licensed powam to the Comawws
L iceaee (ace.
❑ 1 am exempt oder Sec. B k P C for this reason
Owner Dare _
WORKER'S COMPENSATION DECLARATION
I hereby affirm oder penalty of perjury one of the following decimations
❑ 1 have and will maintain a CertiBam of Consom to self -insure for Wotkes Conpm-
raion, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
❑ 1 have and will maintain Workers Compensation Insutamx as required by Scotion
3700 of the Labor oo
pC}edge% number am*
for the performance of the work for which this permit is tat- rA
My
1 U �J �vPollcy and Non.: 4 A flloo
CERTIRCATE OF EXEMPTION FROM WORKERS'
COMPIMATION INSURANCE
(This section and not be completed V the permit is for one hundred dollars ($100)
or las)
1 certify that in the performance of the work for which this permit is issued I shall not
employ any person in any manner so as to became subject to the Workers' Compensation
Laws of California, Date
Applicant
NOTICE TO APPLICANT: if, alter making this Certificate of Exemption. you should
become subject to the Workers Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shell be deemed revoked.
CONSTRUCTION I wDWG AGENCY
1 be ahy affirm that them Is a construction lading agency for the performance of
the work for which this permit is issued (Sec. 3097. Civ. C)
Lender's Name
Larders Address
I certify that 1 have read this application and sure that the above information is
comcl 1 agree m comply wild all dty and aunty mWnanas ad state bma retWng to
building construction and hereby authorize reprmeaulives of this city meats upon the
above-mentioned property for ,'T^:on purposes.
(We) agme to am
harmlcs� the
Cupertino
ych�uwm
liabilities. judgments. cum and espenawhich may to any way accrue aCity
in consequence of the granting of this permit
IWLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
HA2 ARD_WS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
as de0rted by the Cupertino Municipal Code. Chapter 9.17, and the Health and Safety
Coda. Season 25532(U?
❑Yea ti
o
Will the applk&nL or fu building occupant use equipment or devices which
snit hanrdos air contaminants as defined by the Bay Area Air Quality Management
District?
❑ Yes /IQ No
I bre read the hit zandous nratcrisis mquirmnat s underChapaw&95 of the Califor-
nia Flealth & tctyCodNSection 2550.5.25533 and 73534.1 understand taaif the building
data dy havel.y�ly
a Cern ca of Omp cy
Owner or autharind agent Date "
1608 4TH ST STE 120
REMODEL -NEW DECK RAILS,
Ft. Floor Area
Issued by:
Re -roofs
Type of Roof
PERMIT NO.
07120133
PElWT ISSUE DATE
07/14/2008
SANITARY NO. CONTROL NO.
BUILDING PERMIT INFO
BLDG ELECT PLUMB M .CH
Description
Required Inspections
Date
Type
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 'n" or better
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10870 N STELLING RD BLDG 40 A -H
CONTRACTOR: WEST BUILDERS, INC.
PERMIT NO: 09080066
OWNER'S NAME: VILLA SERRA APTS A CA LTD PARTN
1608 4TH ST STE 120
DATE ISSUED: 08/19/2009
OWNER'S PHONE:
BERKELEY, CA 94710
PHONE NO: (
❑ LICENSED CONTRACTOR'S DECLARATIONr
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L
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.it
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MECH RESIDENTIAL COMMERCIAL
Contractor Date
1 hereby affirm that 1 am licensed under the provisions of Chapter 9
JOB DESCRIPTION: REVIS ION- UTILITY CLOSET
(commencing with Section 7000) of Division 3 of the Business & Professions
ORIGINAL: 07120133
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
Sq. Ft Floor Area:
Valuation: $2500
I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APN Number: 32609056.40
Occupancy Type:
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating
PERMIT EXPIRES IF WORK IS NOT STARTED
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
180 DAYS FROM LAST CALLED INSPECTION.
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
Issued by: Date:
9.18.
Signature _ Date
/11110,
jr
RE -ROOFS:
❑ OWNER -BUILDER DECLARATION
All roots 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
I hereby affirm that 1 am exempt from the Contractor's License Law for one of
inspection.
the following two reasons:
I, as owner of the property, or my employees with wages as their sole compensation,
Signature of Applicant: Date:
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
1, as owner of the property, am exclusively contracting with licensed contractors to
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER '
constrict the project (Sec.704.4, Business & Professions Code).
1 hereby affirm under penalty of perjury one of the following three
HAZARDOUS MATERIALS DISCLOSURE
declarations:
I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain a Certificate of Consent to self -insure for Worker's
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain
Compensation, as provided for by Section 3700 of the Labor Code, for the
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
performance of the work for which this permit is issued.
Safety Code, Section 25532(a) should I store or handle hazardous material.
1 have and will maintain Worker's Compensation Insurance, as provided for by
Additionally, should 1 use equipment or devices which emit hazardous air
Section 3700 of the Labor Code, for the performance of the work for which this
contaminants as defined by the Bay Area Air Quality Management District 1 Hill
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
permit is issued
Health & Safety Code, Sections 25505, 25533, and 25534.
1 certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to the Worker's
Owne or thor' ed agent: 91 ZY,
Compensation laws of California. If, after making this certificate of exemption, l
Date:
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
APPLICANT CERTIFICATION
for which this permit is issued (Sec. 3097, Civ C.)
I certify that I have read this application and state that the above information is
Lender's Name
correct. I agree to comply with all city and county ordinances and state laws relating
to building construction, and Hereby authorize representatives of this city to enter
Lender's Address_
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
ARCHITECT'S DECLARATION
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
I understand my plans shall be used as public records.
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Licensed Professional
Signature __ Datc