07120139 CITY OF CUPERTINOre7=:>
BUILDING DIVISION PERMIT '-COIRACTCTRI,N „,4,RTATI0. N.',�..
BUIL 1 PERMIT NO.
Q� STELLING RD BLDG 45 A— WEST BUILDERS, INC. 07120139
W 's NAME: PERMIT ISSUE DATE
VS II A CALIFORNIA LIMITED 1608 4TH ST STE 120 07/14/2008
PHONFSi R'1`AT SANITARY NO. CONTROL NO,
ARCHMCTfEhrGINEER: BUILDING PERMITINFO
REMODEL DECK, STAIR RAILS & BLDG eO �O O
FAINTups LICENSED CONIRACrOR'S DECLARATION Ib Description
wC
1 hereby alliin that 1 am licensed under provisions esGnP
wu of Chapter 9(commencing
with Section)qM))of Division 7 of the Business and Profession Ca"d my licctsc is
� n in full force and effort
�j Lt., CI Lk.g
DauPW
Contractor
RCHI ICI'S DECLARATION
U I ou ms and my plane mall the used u public mxmrds
6
Licensed Professional
5 OWNER-BUILDER DECLARATION
it.
z o F I berehy.(Sere that 1 1. exempt(an the ficam.mrs License law for the
D O which re vires a(Saint 7031.5.Business and PreImprove.
de nm Cale:Any city or manly
$ which require•permit re cnuw0.slur,imforsu h permit u or repair any m mocn,
Zy
prim.on its ceased c.also require Neapplieantfar C.sumrmr'.Lh. Law(Chap.9
< NommencanW prnuant 70th)of Division
or Ne Co nuacmrsumnulawsCods)9 Sq.Ft. Floor Area Valuation
pso
that M is cngwidtbeaim 70M)ofDivision Sof theopineuand Pt,Any viCodc)m
Nn ore u exempt Nemftom and Ne buts for the vlkgcd eumption Any violation of
Sectie 7031.5 by any applicant for a permit subjects the AWIICMf m a civil penalty of APN Number Occupancy Type
not nae than five hundred dollars 015001
i,u ower of Ne pmpmy,m my eruployeu with wages u Noir sok cmmprwtion.
will do NC w9fk.Nd NC aWLIYR k nal Nlerldld Or Onefed faraak($CC.7Da1,BLLVIWI
and Pmresdon Cotle:The Conuscmrs License law doe ret apply In an coater or Required Inspections
property wW Wildsmimpmves Nnnum.and whodnessuchwork himselforduough his
awn employes,provided Nat such improvements are not intended oroneted fertile.B.
Whoiwldeeer will curs,the of test hedid nuoceWild mofiimproveefortheower-
puryase of
ukJ.
O 1,u awrcr of the property un conclusively contracting with licensed contractors us
cummuces the project(Sec.7014.Bum.ave P ufestion Coda:)The C =Wes Li-
cane law does not apply to an owner of property who Wilds or improves thereon,ted ._
who contracts for such projects with a conlracmgs)licensed pursuant to Ne ConvuWrs
License law.
❑I am eempt underSec. .B&P C fm this realm
Pro,
Data
WORKER'S COMPENSATION DECLARATION
1 thereby of ire under penalty of perjury ore of Ne following decimations
I haw and will maintain•certibeu.f Count to self-intim rte Wmkcrs CompMn
scion.u provided for by Section 37110 or the labor Cade.for the Performance of the
work for which this permit is instead.
Q 1 have and will maintain Workers Compensation Insurance,u required by Section
37W of the labor Code,for the pcRmmana of the Mark for which this Permit is issued. '
My Wa pe htsurana curter and Policy number are:
Cartier Y V
Policy No.:`aSy.I
CERfIFlCA'fE OF EXEMPTION FROM ORKFAS'
COMPENSATION INSURANCE
(This scale need not k completed If tic permit Is fmonc hundred dollen(SIM)
or less)
1 artily,Out in the Performance of Ne work for which this permit is Wood.l"I not
employ any person in any manmr in it b became subject o the Workers''Compensation
Laws of Califomia Dau
Applies
NOTICE TO APPLICANT:If,a0er making this Ccni(iau of Exemption,you should
become subject to the Workers Compauation provisions of the labor Cade,you must
.J z faMwith comply with such Previsiau or this permit shall k deemed mekctl.
z 0 CONSTRUCnON LENDING AGENCY
1 hereby mffrm that them its construction lending a
gcnry for Ne Performance of
D; > work Tor which des permit ts Wood(S .3097,civ.CJ
La
Cl, Q luMcrs Name
a z Lenders Address
V Q 1 certify that 1 have red this applicant..and mate thou Am aWw information u
U.;-` carred 1 agree to cmnply with all city and roety.Nims s W sok laws rtled.g to
0 CSJ^ Wilding construction,and hereby interim representatives of Out city Is enter upon the
almm-mentionW property for inspection purposes
(We)agree to save,in lcmdry and kecP harmless the City of Cupertino agaimt —
Tor limilitice,judgrecnu,cru andupnue which may in anywayaaene agalutsaid CtyS)
t-)z in
��
Re-roofs
Signatum.r AppliamUCon for u
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant m future Wilding occupant stom tube .material
u deRncd by the Cupertino Municipal Code,Chapter 9.13,ted the Health and Safety
Section 25532r.n
❑Ye . All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtainingan inspection,I agree to remove
Will the applicant in future building by occupant B y A cyui it Qu it dcvlar which P g
emit WvaNnus air c.numinants u dcfind by Ne Bay Ana Air Quality Management all new materials for inspection.
District? .
Dyes Nu
1 hew mad the low, materials mquimmms uncksOmpur 6.95ofNeCalifor-
nla IN&Sa(my e,S mn50.5.75533m Z554.1undeaund Noir Nebuilding
d
anthoAll roof coverings to be Class'W'or better
Omsd pre Dau' cog
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10870 N STELLiNG RD BLDG 45 A -H CONTRACTOR: WES"f BUILDERS, INC. PERMIT NO: 09080069
I OWNER'S NAME: VILLA SERRA APTS A CA LTD PARTN 1 1608 4TH ST STE 120 j DATE ISSUED: 08/19/1009 1
OWNER'S PHONE: 1 [BERKELEY, CA 94710 1 PHONE NO: ( 1
❑ LICCNS D CONTRACTOR'S DECLARATION
License Class 41-1, - Lic. # Q
Contractor :i of Date ZY'
1 hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
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.
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.
APPLICANT CERTIFICATION
I certify goat I have read [his application and state that the above information is
correct. I agree to comply with all city and county ordinances acid state laws'relating
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
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 r on -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature Date_®
❑ OWNER.BUILDERDECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
I, as owner of the property, or my employees with wages as their sole compensation,
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
construct the project (Sec.7044, Business & Professions Code).
1 hereby affirm under penalty of perjury one of the following three
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
perfonrrance of the work fur 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.
I certify that in the performance of the work for which this pennit is issued, I shall
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If, after making this certificate of exemption, I
becoma jubject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
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
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
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
9.18.
Signature Date
BUILDING PERMIT INFO: BLDG r- ELECT r PLUMB r
MECH r- RESIDENTIAL ir- COMMERCIAL r
JOB DESCRIPTION: REVISION UTILITY CLOSET
Sq. Ft Floor Area: I Valuation: $2500
AVN Number: 32609056.45 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
I
ssued by:
Date:
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being instalk d. If a roof' is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(x) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District f will.
mointair compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code,,Sections 25505, 25533, and 25534.
agent:
Date: g•�Y f
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professiona