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07120141CY OF CUPERTINO BUILDING DIVISION PERMIT Burl���np81: PERMIT NO. STELLING RD BLDG 47 A- WEST BUILDERS, INC. 07120141 OW 'S NAME: PERMIT ISSUE DATE VS II A CALIFORNIA LIMITED 1608 4TH ST STE 120 07/14/2008 pHo R& rPTTT SANITARY NQ CONTROL NO. ARCH17ECTIENGiNEER i O p LICENSED CONTRACTOR'S DECLARATION r� eros 1 hereby afrum that 1 aro licensed under provisions of Chapter 9 (commencing with Section 7000) of 3 of the Business and Professions Code. and�ty lieeam is O H in full face anti affect 1 i � eC Lie.0 Date Caner EC1. ARCHITECI-S DECLARA ON I undersand my plan shall be used as public nxords g 06 � Liemed Professional 5 q � OWNER-BUILDIiR DECLARA770N gt >1 1 hereby &Warm that 1 am exempt from Ihm Contactors I Icemse Law for the in O following reason. (Section 70313, Business and Professions Cade: Any city or county V which n gW'cs a person to construct, alter, improve, demolish, or spair Bey structure prior to its istusnm also requires the applicant far such permit to file a signed statement < that he is licensed pursuant to the provision of the Contractors Limnsm Law (Chapter 9 S(commencing with Section 7000) of Division 3 of the Bush= and Professions Code) or .. that he is exempt tbeefmm sad the bads for the albged exemption. Any violation of Section 7031.3 by any applicant for a permit subjects the applicant to a civil penalty of nut more than five hundred dollim (S500). ❑ L as owner of the property. or my employees with wages a their sole compensation, win do the work, and the structure is not intended or offered for sale (See. 704. Business and Professions Coda: The Contactors License Law does hal apply to an owner of property who builds or improves thereon. and who does such work himsel or through bis we employes, provided that such improvements ate not intended or offered for sale. If. however. the building or improvement is sold within one year of completica. the owner - builder will have the burden of proving that he did not build or improve for purpose of sate—). ❑ L a owner of the property, am a=lmively conuacting with licensed coottrtoa to construct the project (See. 7044. Business and Professions Code) The Cauramora Li- cense Law does not apply to an owner of property who bands or improves thaem. and, who contracts for such projects with a contactor(a) licensed pursuant to the Contractors License Law. ❑ 1 am exempt under See . B A P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm miler pendty of perjury oma of the following deciatatienc� ❑ 1 have and wilt mainuio ■ ceniamm of Consent o self-ks m forwarkees canpen- mdon, as provided for by Section 3700 of the Labor Code for the perfa nance of the work for which this permit is issued. ❑ 1 have and will maintain Warkres Compmadon losurance. as required by Section 3700 of the Labor Code, for the perfarmanee of the work for which this permit is trued. My W a orop(q,pm, oo inmralco carrier sad Policy number am:: l Policy No S �1 gf�24O� CERTIFICATE OF EKEMPTION FROM WORKERS COMPENSATION INSURANCE (11th section teed not be completed U the permit Is foranc hundred doom: (5100) or less.) I certify that to the performance of the work for which this permit is Issued. l snail not employ any person In any manncr so as to became subject to the Workers' Compensation Lawn of California. Due Appliam NOTICE TO APPLICANT: If, aft making this Certificate of Exemption, you should become subject to the Workers Compensation provisions of the Labor Code, you must 0 O forthwith comply with such provisions or this pcsmit shall be deemed rooked. CONSTRUCTION LENDING AGENCY I hereby affirm that thea is a construction lending agency for the performance of fY, > the work for which this permit Is issued (See. 3097. Ch. C.) �W 0 Lenders Name J z `.osier's Address U O 1 certify that 1 have read this application and sista that the above information is LL, co:mct 1 agree to comply whh all city and county aNimmacs and state lows reWing to 0 p building construction, and hereby a tboriae rep escrus thea of this city o em. upon the W above-mentioned property for Inspection purposeL (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, jodgments, cars and expensaa which may is any way acrnc opiate said City IJ in co nseq, of the ganting of this pMWL A UND ANDS AND WILL COMPLY WITH ALL NON -POINT S� � - 1�1 HAZARDOUS MATERIALS DISCLOSURE Will the applicant or furoate building oavpant sore or handle hamldoas material as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety Code. Section 25332(s)7 [1 Yes No Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management DWrlct7 ❑Yes �No 1 have read the haxadous materials requirements under Chapter 6.93 of the Califor- nia Health a Safety Cade. Sections 25503.25533 wW 25534. I understand"if the building doesUiekeorrently hbn a tenant haat it Lmy responsibility to notify the occupant of sine rcq wh(cb tape o issuance of a ccNficate Baimarsy� BUILDING PERMn'INFO REMODEL DECK, STAIR RAILS & BLDG ELgcr PLUMB PAINT . A£D HOT Wnmrr,n_ --- - �- Job Description Ft. Floor Area Issued by: Re -roofs Type of Roof 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 'V' or better CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: -10870 N STELLfNG RD BLDG 47 A -H I CONTRACTOR: WEST BUILDERS, INC. PERMIT NO: 09080070 OWNER'S NAME: VILLA SERRA APTS A CA LTD PARTN 11608 4TH ST STE 120 j DATE ISSUED: 08/19/2009 1 OWNER'S PHONE: 1 BERKELEY, CA 94710 1 PHONE NO: ( 1 ❑ LICENSED CONTRACTOR'S DECLARATION License Class �. Lic. N Contractor w Date I 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 that I have read this application and state that the above information is correct. I agree to comply with al I 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. p Signature Date ❑ OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for one of the following two reasons: 1, as onner 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) 1, 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 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. 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 Compensation laws of California. If, after making this certificate of exemption, I become subject 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 entu upon the above mentioned property for inspection purposes. (Wc) 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 PLUMB MECH r RESIDENTIAL 1— COMMERCIAL r JOB DESCRIPTION: REVISION UTILITY CLOSET Sq. Ft Floor Area: I Valuation: $2500 APN Number: 32609056.47 1 Occupancy Type: PERMIT EXPIRES IF `'YORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Date: RE -ROOFS: 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 HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should 1 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 IA -ill maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25503, 25533, and 25534. or autho ' d agent: hh .— Date: e7,%- 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 Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professiona