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07120135CITY OF CUPERTINO BUILDING PERMIT iBUILDING ADDRESS: 10870 N S'rELLING RD BLDG 41 A-H CONTRACTOR: WEST BUILDERS, INC. PERMIT NO: 09080067 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 DECLARATION r r INFO: BLDG r License Class Lic. q R?_c:536 BUILDING PERMIT ELECT PLUMB r r r"" VJ `_ 9 MECH RESIDENTIAL COMMERCIAL Contractor _ Date "Z,4'S I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: REVISION UTILITY CLOSET (commencing with Section 7000) of Division 3 of the Business & Professions ORIGINAL 07120135, 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 Sq. Ft Floor Area: Valuation: $2500 performance of the work for which this permit is issued. 1 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: 32609056.41 Occupancy Type: _APPLICANT CERTIFICATION I certify that I have read this application and state that the aboc 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 ihz above mentioned property for inspection purposes. (Wc) agree to save WITHIN 180.DAYS OF PERMIT ISSUANCE OR r inden:i,iti- and keep harmless the City of Cupertino against liabilities, judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs""mid expenses which n:ay accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and wiil comply with ail non -point source regulations per the Cupertino Municipal Code, Section 1 Issued by: Date: 9.18. ZY'f Signature _ Date RE -ROOFS: ❑ OWNER -BUILDER DECLARATION 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 near materials for I hereby affirm that 1 ant exempt from the Contractor's License Law for one of inspection. the following two reasons: 1. 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) I, as owner of the property, am exclusively contracting with licensed contractors to ALI, ROOF COVERINGS TO BE CLASS "A" OR BETTER construct the project (Sec.7044, Business & Professions Code). I 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 it 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 1llunicipal Code, Chapter 9.12 and the Health & performance of the work for which this permit is issued. Safety Code, Section 25532(a) should 1 store or handle hazardous material, l 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 Day Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12anti the permit is issued. Health & Safety Code, Sections 2505, 25533, and 25534. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in a my manner so as to become subject to the Worker's : Compensation laws of C';tlobrr,ia. It" after snaking this certificate of exemption, 1 -- __ Date: t become Subject to the Worm is Compensation provisions of the Labor Code, I must 10/ forthwith comply with su,:h provisions or this permit shall be d.emed revoked. CONSTRIICI'ION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CEF.TIFICA'TION f6i which this permit is issued (Sec. 3097, Civ C.) I certify that I have read this application and state that the abov;; 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 indemmnify and keep harmless the City of Cupertino against IiaF•ilities,judgments, ARCHYFECT'S DECLARATION costs, and expenses which may accrue against said City in consequence of the grantirg 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. Licenser! Professional Signature __ _ Date _ CITY OF CUPERTINO BUILDING DIVISION PEMM BUTL�Ij(c�gQREs$ PERMIT NO. STELLING RD BLDG 41 A- WEST BUILDERS, INC. 07120135 OW l'SNAME: PERMIT ISSUE DATE VS II A CALIFORNIA LIMITED 1608 4TH ST STE 120 07/14/2008 PHONP31 R T%T SANITARY NO. CONTROL NO. LICENSED CONTRACTOR'S DF.CLARAITON I beroby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Di ' 3 [ic. t of the Business and Professions Codecand my Bca� is n full fora and effect 91 Date Contractor ARCHI'IECPS DECLARATION 1 underaund my plans shall be used as publicrecords I korr d Professional OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractors License Law for the following reason. (Section 7031.5. Business and Professions Code Any city or county which requires a permit to construct. Alta, b'Pro"c_ demolish, or repair any structure prior to its issuance. also requires the applicant for such permit to fik a signet statement Um be is licensed pursuant to the provisions of the ContraCtors I +. muc Lap (Chapter 9 (commencing with Section 7000) of Division 3 of the Bassin r and Prufessimrs Code) or that be is exempt therefrom and the basis for the alleged examption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil pemby of not more than five hundred dollars (SM ❑ L as owner of the property. or my employees with wages as th* sole compmuadon, wifi do the wok. and the structure is not intended or offered for sale (Sec. 7044. Business and Professions Codr- The Contractor's 1leenae Law does not apply to an owner of property who builds or Improves thereon, and who doff such work himself or through hla own employees, provided that such improvements are not intended or offered for sale If. however, the building or hnprovement is sold within one year of compklion. the owner - builder will have the brdea of proving that be did not build or improve for purpose of nk.). ❑ L as owner of the "poly. am atdmively contracting with licensed contractors to construct the project (Sea 7044. Businea and Profrsslorn Codo:) The Contractors LI- cemae Law does not apply to an owner of property who builds or improves Thereon. and. who contracts for such projects with a eontraeten(s) licensed pmsuwt to the Contractors License Law. ❑ 1 am exempt under Sea . B & P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I bereby AMM under penalty of perjury are of the following declandoru ❑ I have and will maintain a Ceri iota of Consent to self -Insure for workers Compen- sation. as provided for by Section 3700 of the Libor code, for the performance of the work for which this permit in Issued. ❑ I have and will maintain Worker's Compensation Insuranm as required by Section 3700 of the: Libor Code. for the performance of the work for which this permit is Issued. My Wo a ompe a(ion Insurance carrier and Policy number Carrie . �` Porky No.. ' CE CATE OF EXEMPTION FROMWORKERS' COMPENSATION INSURANCE (This section reed rot be completed it sire pemnh is forone hunded dollars ($100) or lass) I anify that In the performance of the: work for which this permit is isanad. I "I not employ any person to any mmrcr so as to become subject to the Worked Compensadon Laws of California. Date Applicam NOTICE TO APPLICANT. If. alter maldna this Certificate of Exemption. you should became subject to the Wo rkces Compemsition previsiau of the Libor code, you mug forthwith comply with such provisions or this permit ohm be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby miss that there is a construction lending agency for the performance of the work for which this permit is issued (sec. 3097. Civ. C.) Lenders None I certify that I have read this applies, on and state that the above information Is correct I agree to comply with W city and county ordinances and sure Imrs relating to building construction, and hereby authorize representatives of this city to ems upon the above -mentioned property for inspection purposes (We) agree to save, indemnify and keep harmless the City of Cupenim Against Liabilities. judgments, curs and expenses which may in airy way accrue against said City in consequence of the Ranting of this permit. APPUCANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building oavpamtstom or handle hassrdoos material as defined by the Cupertino Municipal Code. Chapter 9.I2, and the Health and Safety Caob. Section 27532(a)7 ❑Yes '�PNo WTil the applicant or future building mavant puse eguipenem or devices which emit haafrdoua air conuminants as defined by the Bay Area Air Quality Management District? ❑ Yes No I bavc mad she Irartarderts materials mquhwr=u under C3rapterd.95 of the Califor- nia Health & SafeLyCode. Sections 25505.25533 and L"N. I undefined thatif the bwl&g dm�orsrently hq! a