071201340 O
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CY OF CUPERTINO D*
BUILDING DIVISION PERNUT
STELLING RD, BLDG 36
ER'S NAME:
VILLA SERRA APTS A CA LTD
ARCHITECTIENGTNEER:
LICENSED CONTRACTOR'S DECLARATION
1 herby affirm that I am licensed under provisions of chapter 9 (eommerncing
with Section 7000) of Division 3 of the Business and Prof Code, and my iicetnc la
in full force and effect Q,,��
L.Icenac Lic.0 ';" "�
Tate Contractor
CHI I ECI S DECLARATION
1 my plans shall be used u public record;
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractors I icenm Law for the
following reason (Section 7031.5. Business and Profmions Code: Any city or county
which requires a permit to construct. slier. Improve. demolish, or repair any ruunum
prior to its issuance, also requites the applicant for such permit to file a signed statement
that he is lianscd pursuant to the provisions of the Contractor's Ihcnsc Law (Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he is exempt therefrom and the basis for the alleged eamption. Any violation of
Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of
nes more than five hundred dollars (5300).
❑ L u owner of the property, or my employees with wages as their sok compensation,
will do the work and the sauctlue is not Intended or offered for ale (Sec. 7044. Business
and Professions Code The Contractors [cleanse Law docs not apply to an owner of
property who builds or improves thereon, and who does such work himm-1f or through his
own employees, provided that such improvements are not intetndM or offered for ale. If.
however, the building or improvement is sold within one year of eaopletion, the owner -
builder win have the burden of proving that be did rot build or improve for purpose of
ale.).
❑ L u owner of the property. am exclusively contracting with nteased contractors to
construct the project (Sec. 7044. Business and Profeaimu Code;) The Cmtnetars Li-
cense Law 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
Cheese w.
La
❑ 1 am exempt under Sec . B 3 P C for this reason
Owner Date
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and win maintain a Cenillcam of Consent to self -insure for Workers Compen-
sation, u provided for by Section 3700 of the Labor Cork, for the performance of the
work for which this permit is Loved
❑ 1 have and will maintain W~s Compensation lasorsnce, u required by Section
3700 of the Labor Code, for the prrformance of the wale for which this permit is issued
My Workers nation Insurance
eccarrier and Polity
Policy No.: 1 �i
CEAI7FICATE OF EXEMPTION FROM WORKFR4'
COMPENSA77ON INSIJRANCE
Crisis section need rot be completed If the permit is foronc hundred dollars ($10(y)
or less)
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 Worked Compensation
Laws of California. Dae
Appncant
NOTICE TO APPLICANT. If, alter making this Certificate of Exemption, you shouW
become subject to the Worker's Compensation provisions of the Labor Code, you mow
forthwith comply with such provisions or this ptgmit shall be darned revoked
CONSTRUCTION LENDING AGENCY
1 hemby affirm that thee is a construction lending agency for the performs= of
the work for which this permit is issued (Sec. 3097, Civ. C.)
Lenders Name
Lenders Addrms
1 cads that 1 have read Win application and state that the show Information is
Cancel 1 agree to comply with all city and county ordinances and awe laws reading to
building construction. and hereby authorize representatives of this city to enter upon We
above -men property res imtpectien purposes.
(w apex to caw
Indemnify and tttp harmless We Gly of Cupertino against
liabindes, w costa and expenses which may in any way accrue against said City
in
AND WILL COMPLY WITH ALL IJON-POINT
WHAZARDOUS MATERIALS DISCLOSURE
the applicant or future building occupant sore or handle hatardoos maecrial
u defined by the Cupertino M Coda Chapor 9.12 and the HaIW and Safety
Code. Section 25532(x)7
❑ Yes No
Will the applicant or future building occupant use equipment or devices which
emit harardous air comaminu dlcfined by the Bay Area Air Quality Management
District?
❑ Ye(�/
s No
I haw Aadhazanlau maieials nx)ui ernens under Chapter 6.95 of the Califor-
nL Health do t Sedans 25505.25533 and 23534.1 understand that if We building
does
ter
WEST BUILDERS, INC.
1608 4TH ST STE 120
(510) 525-9378
PERMIT NO.
07120134
PERMIT ISSUE DATE
09/26/2008
SANITARY NO. CONTROL NO.
BUILDING PERMrr rNFo
BLDG ELECT PLUMB MECH
Job Description
NEW APT BLDG, BLDG A, 2364 SQ
8/25/08 SEE #07120212 FOR SUBS
Sq. Ft. Floor Area
32609056!
Re -roofs
Type of Roof
$555555
Required Inspections
tod
Type
Date ?G o 4'
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 'A" or better