07120140BUILDING DIVISION PERNM
STELLING RD BLDG 33
VILLA SERRA APTS A CA LTD
ARCNlfECrfENGINEER:
Vol p LICENSED CONTRACIUR'S DECLARATION
Do 1 hereby affirm that I am Iioetued under provisions of Chapirr 9 (commencing
Z with Section 7000) of Division 3 of the Bueircsa ygProf ode, an my license'
<� y in full force and effect t+�a `t S
C1as� isle. s
Dam G( �� %p Contractor
3 t ��CHr=s DECLARATION %
ee 1 undersand my plans shall be used as public records
U
t u. Licensed Professional
C OWNER -BUILDER DECLARATION
N
I hereby afOrm that 1 un exempt from the Contractors Lleona Law for the
O O following reason. (Section 70313, Business and Professions Code: Any city or county
$ 0! which requires a permit to construct, alter. '.,.prove. demolish. or repair any structure
Z prior to duam file s issnce, also requires the applicant for such permit le a signed statement
In
C that he Is licensed pursuant to the provisions of the Contractor's 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 basis for the alleged exemption Any violation of
Section 70313 by any applicant for a permit subjects the applicant to a civil penalty of
not mere than five hoodred dollars (S500).
❑ L as owner of the property, or my aoployces with wages as their sole compensation,
will do the work and the structure is not intended or offered far sale (Sec 7044. Busincss
and Professions Code The Contractor's Licwe Law docs tet apply to an owner of
property who builds or Improves thereon, and who does inch work him -1f or thmagb hia
awn employees, provided that such improvements are not intended or offered for sale. If.
however. the building or improvement is sold within one yew of completion, the owner -
builder will have the burden of proving that he did not build or Improve for purpose of
ale-).
❑ L as owner of the property, am exclusively contracting with Bcensed contractors to
construct the project (Sec. 7044. Business and Professions Code:) The Contractors LA -
cause Law does not apply to an owner or property who builds or improves thereon, and
who contracts for such projects with a contract r(s) licensed pursuant to the Contractors
License Law.
❑ I am exempt under See B R P C for this mason
Owner Due_
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declantioas:
❑ I have and will maintain a CeNGnm of Consent to self-lasum forWorker's Compen-
sation, as provided for by Section 3700 of the Labor Code. for the perfmnamcc of the
work for which this permit is issued
❑ 1 have and will maintain Workers Comprnsalion Insurance. as requited by Sation
3700 of the Labor Code, for the performance of the work for which this permit is Ironed
My Wodtera Com enaction Ltwranc artier and Policynumher are
Cartier Polley No.� LgOoo!!nA
CERTIFICATE OF CEMPrION FROM WORKERS
COMPENSATION INSURANCE
(This section need not be rnrttplemd U the permit is for one hundred dollars ($100)
OF less.)
1 certify that in the performance of the wok for which this permit L Issued I shall not
employ any person in any mamxr so as to became subject to the Worker' Compensation
Laws of California Dam
Applicata
NGi7CE TO APPLICANT If. after making this Conifncam of Exemption, you should
become subject to the Workers Compensation provisions or the Labor Code, you must
forthwith comply with such provisions or this permit &hall be deemed mvokcd.
CONSTRUCTION LENDING AGENCY
I hereby affirm that them L a construction lending agency for the performance of
the work for which tide permit is issued (Sec. 3097, Ch. C)
Lenders Natrse
Lenders Address
I certify that I have rad this application and sato that the above information L
cortecL 1 agree comply such all cry sad county ordinances and state laws misting m
brBding 'on, and hereby authorize representatives of this city to enter upon the
above -mend property for khsp-ion pwpos<s
(We) m ave, indemnify tad keep harmless the City of Cupertino against
Iiabifl , j unses , coat& and expewhich may N any way accrue against said City
in cotsQ�u gri ring of this permiL
APPLI ERSTANDS AND WILL COMPLY WM ALL,NON-POINT
SigmxurE of�L'plicanr Dam
US MATERIALS DISCLOSURE
Will apt or future b ilding occupant store or handle hazardous mater(
as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety
Code, Section 25532(a)?
C3 Yes 14
Will the applicant or future building occupant use equipment or devices which
cob ha stdons air coauunIna;ssAefi=d by the Bay Area Air Quality Management
District?
❑ Yrs No
1 have harardoas mateiais tequucmenu undermaptr 6.95 of the Caflfor-
niaHcalth Sections 25505.25533 and 25534.1understand that ifthebuilding
does roe taant. that It Is my responsibility to notify_ of the
requihemen ' h ust me of a Cenifica 1 // )
Owner or adhdvad aeon✓ Dam
WEST BUILDERS, INC.
1608 4TH ST STE 120
(
PERMfr NU.
07120140
PERMrr ISSUE DATE
09/26/2008
SANITARY NO. CONTROL NO.
Job Description
NEW APT BLDG, BLDG 33A -B, 1607 SQ
8/25/08 SEE #07120212 FOR SUBS
Area
32609056PP Number
Issued by:
Re -roofs
Type of Roof
BUIIDL40 PERMrr INFO
$555555
Required Inspections
Type
Date Zti
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