07120137700
F.a
�z
U_O
�a
U�
BUILDING. DIVISION PERNM
STELLING RD BLDG 43
VS II A CALIFORNIA LIMITED
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chaper 9 (commenang
with Section 7000) of DWWn 3 of the Business and Professions Code. and my licerts is
in Awl foss and effect. ^
LJc. t
Date Contractor
ARCNTCECIR DECLARA770N
1 my plans shall be used ss public reeoda
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from ibe Contractors License Law for the
following reason. (Section 70313, Business and Professions Code: Any city or county
which requires a permit tu conatnxct, alter. improve, demdiah4 or repair any structure
prior to is issuance, also requires the applicant for such permit to file a signed Astameot
that he Is licensed pursuant to the provisions of the Contncxoes License Law (Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he is exempt therefrom and the bash for the alleged exemption. Any vk"" of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
out mom than fire hundred dollars ($300)
❑ 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 oRamd for ale (Ser. 7014, Business
and Professions Code The Cmuacturs License Law dos not appy to an owner of
property who builds or impons themon. and who does such work himself or through his
our employees, provided the such improvements are not irde or offered for side. if.
however, the building or improvement is sold within are year of ammpladem, rhe owner -
budder will have the burden of proving that be did not build or improve for purpose of
❑ L as owner of the property: am exclusively contracting with licensed cmumm b
construct the project (Ser. 7044. Business and Professions Code) The Contractors LA -
cense Law does out appy to an owner of property who builds or Improves theme, mud.
who conuxu for such projects with a costractor(s) licensed pnrasm to the Contractors
L CCDM Law.
❑ 1 am exernp under See. . B & P C fa this resson
Owner Due
WORKERS COMPENSATION DECLARATION
1 hereby aQirm under penalty of perjury arc of the following dadaratlaxe
❑ 1 bare gad win malmW n a Ca tficam of Consent toself-imam forWorimrs Compen-
sation, as provided for by Section 3700 M de Labor code. for the performance of the
work for which this permit is imcd
❑ 1 bout and will maintain Workers Compimution luamuance. as required by Satins
3700 of the Labor Code, for the performance of the work for which this permit is Issued
My Worker C p_y ,aa Insurance carrier and Pel number
CartiC \l� Pmlky No.:
CFRTIFICA7E OFF 1PTION FROM I KERS'
COMPENSATION INSURANCE
(This section need not be cempimcd If the permit is formic hundred donus (1100)
or less.)
1 unify the in the performance of the work for which this permit is Issued I shall not
employ any person in any manner so as to becomo subject to the Workers' Compensation
lives Of California. Dam
Appncant
NdncE TO APPLICANT. If, alkr making this Cenifncsm of Exemption. you sbould
became abject to the Workcex Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed rooked.
CONSTRUCTION L ENDINO AGENCY
I hemby &form that dare is a construction lending agency for the performance of
the work for which this permit is issued (See. 3097. Civ. C)
Lenders Nam
Lenders Address
1 certify that 1 have mad this application and ssm that the above information is
correct. l agree to comply with an city and county ordinances and stae laws relating to
building eonanaction, and Icmby authorize representatives of this city to aver upon the
.bovm-merioned property for inspection Purposes
(We) agme to ave, ladcamiry and keep harmless the City of Cupertino aping
liabilities, Judgments. cam and capon w which may in any way scene spdoa said City
in consequence of the panting Of this pen dL
APH.ICANT LIFI RSTANDS AND WILL COMPLY WITH ALL NON -POINT
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or futons budding occupant ane or handle hazardous material
as defined by the Cupertino Municipal Code. Chapter 9.12. and the HeWth and Safety
Code, Section 23332(1)1
C3 yes
WIA the applicant or future building occupant use equipment or devices which
emlt hazardous err contaminant: ss dermad by the Bay Area Air Quality Management
District?
❑ Yes No
1 have rend the hazardous maaials rapbemenis under Chapter 6.95 of the Califor.
ma Hal" SafayCode. Secdons 25545.25533 and 25534.1 mderaad thaif the building
eartenty� that U is my responsibility in notify the occupant of the
Mqu Catdiawt Gc6Psom:
WEST BUILDERS, INC.
1608 4TH ST STE 120
(510) 525-9378
PERMIT NO.
0'712 0137
PffiUvffT ISSUE DATE
07/14/2008
SANITARY NO. CONTROL NO.
BUILDING PERMIT INFO
BLMO ELECT PLUMB
Job Description
REMODEL DECK,STAIR RAILS AND PAINT ADD—WATER
■&W_MW.1
Sq. Ft. Floor Area
32609056.
Issued by:
Re -roofs
Type of Roof
$6976
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' W. or better
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10870 N STELLCNG RD BLDG 43 A -H
CONTRACTOR: WEST BUILDERS, INC.
PERMIT NO: 09080068
OWNER'S NAME: VILLA SERRA APTS A CA LTD PARTN
1608 4T11 ST STE 120
DATE ISSUED: 08/19/2009
OWNER'S PHONE:
BERKELEY, CA 94710
PHONE NO: (
❑ LICENSED CONTRACTOR'S DECLARATION
r
BUILDING PERMIT INFO:
License Class Lic. # �
BLDG ELECT PLUMB
r r r
Contractor 1 Date -Z`F • S
MECH RESIDENTIAL COMMERCIAL
herebj 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
Code and that my license is in full force and effect.
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: 32609056.43
Occupancy Type:
APPLICANT CERTIFICATION
I certify that 1 have read th s application and state that the above information is
correct. 1 agree to comply �%ith 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
RE -ROOFS:
❑ OWNER-BIi1LDER DECLARATION
All roofs shall be inspected prior to any roofing material being installed. Ira 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 foli6wing 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 die 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
ALI, ROOF COVERINGS TO BE CLASS "A" OR BETTER
construct the project (Sec.7644, Business & Professions Code).
I hereby affirm under pen. Ity of perjury one of the following three
HAZARDOUS MATERIAIS DISCLOSURE
declarations:
I have read the hazardous materials requirements under Chapter 6.95 of the
1 have and will maintain a Certificate of Consent to self-insurz 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(x) should I store or handle hazardous material.
I have 4nd will maintain W6rker's Compensation Insurance, as provided for by
Additionally, should I use equipment or devices which emit hazardous air
Section 3700 of the Labor Code, for the performance of the work for which this
S
contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
permit is issued.
Health & Safety Code, Sections 25505, 2593, nnd, 25534.
I 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 uthoriz d agent:
_L} • f
Compensation laws of California. If, after making this certificate of exemption, 1
_ T Date:
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwi'.h 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
A PPLICANC 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. (Vic) agree to save
mdenrnil'y and keep harmless the City of Cupertino against liatilities, judgments,
ARCHITECT'S DECLARATION
costs, and expenses which may accrue against said City in consequence of the
1
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_ __ Date _