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CITY OF CUMKI-M) � ad filo
BUILDING DIVISION PERNIITT
Bu1L�l�r STELLING RD BLDG 48 A- WEST BUILDERS, INC. "0'7'1"2
OW 'S NAME PE IM ISSUE DATE
VS II A CALIFORNIA LIMITED 1608 4TH ST STE 120 07/14/2008
moRM R'TTT SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEEM BUILDING PERMIT INFO
REMODEL DECK, STAIR RAILS & BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
I heseby affirm that 1 am liamsed under provisions of Chapter 9 (commencing
with secHat 7000).ffthdom 3 of the Busimss and Professions Code. and my license h
in full force and effect
L�tro l.lc.1
r_�,_r�l Contractor
ARCI;ITEC.TS D ON
I utuderstand my plans shall be used u publi record,
Licaued Professional
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Cohuactor's license law for the
following masa (Section 70313. Business and Pmfrsslmu Code: Airy city or county
which requires a permit to construct. alter. improve, demolish. or repair Pry structure
prior to its fasuance. also squires the spplicant for such permit to fib a signed stalcment
that he Is liconscd pursuant to the provisions of the Contractors License Law (Chapter 9
(commencing with Section 7000) of Division 3 of the Business ud Professions Code) or
that be Is mu:mpt therefrom ud the bash for the alleged esamptioa Any Viola" of
Section 70313 by any applicant for a permit mbjeas the applicant to a civil penalty of
sec more than five hundred dollars (±3001.
O L u owner of the property, or my employees with wages u their sob eompemudos.
will do tiro work and the structure is not intended or offered for sale (Sec. 7044, Business
and Profession, Codon The Contracmes License Law does sec apply to an owner of
property who builds or improves tMuon and who doessuch work himself a through hit
own employees, provided that such improvements are not intended or offered for ala 11.
however. the building or improvement is sold within one year of completion, the owner -
builder win have the burden of paving that he did not build or improve for Purpose of
sabJ.
0 L as owner of the property, am exeladvely contracting with licensed contractors to
construct the project (See. 7044. Business and Professions Code) The Coahauara U-
ause Law does nes apply to an owner of property who builds or improves thereon and.
who contracts for such pmjcm with a eonuactur(s) licensed pursuant to the Conscious
License E".
0 [am mmmpt roller Sec B s P C for this rmss
Owner Dau
WORKERS COMPENSATION DECLARATION
I hereby amrrs miler penalty of perjury one of the following declaatlons
0 I have and will maintain a Certificate of Consem to self -lime for Wafxfa Compeo-
adon, as provided for by Section 3700 of the tabor Code, for the performance of the
worts for which this permit is issued.
0 I have and wfu mdruln wbdmes Compensation Insurance, as cogdred by Section
3700 of the tabor Code. for the performance of the work for which this permit Is Issued.
My Worker
WmmPnoN FROM W ORKERS
COMPPNSATIONINSURANCE
(This aection need rot bo complesed if the permit Is fa ane handned doDara (f 100)
or lar)
I certify thm In the performance of the wort for which this permit Is Wood. l shall not
employ cryperson [many manner so u to bccano subjecto due Worlaus' Compensation
Laws of California Dna
Applkmm
NOTICE TO APPLICANT If, alter making this Certificate of Exemption. you should
become sub)= to the Workers Compensation provisions of the Iabor code, you must
forthwith comply with such provisions Of this peenit shall be deemed invoked.
CONSTRUCTION LENDING AOENCY
1 hemby affirm that Woe Is a construction lending agency for the performance of
the work for which thin permit is issued (Sc,. 3097. Civ. C.)
L.endces Name
Lenders Address
I sadly that I have read this applladon and sue that We above hfor adon Is
coneeL I agree to comply with W city and county mdbannces and sue lawn mbdng to
building conumuction. and hereby amhorine spraeruatiw of this city to atm upon the
above-mcatirred property for inspection proposes
(We) agree to are, Indemnify and keep harmless the City of Cupertino against
Iiabilidca, jodgmcots. cera and expo nw which may in any way acerae against said City
in kjEo%;;�
ing of this permit
AP COMPLY WITH ALL NON -POINT
s KKR
( oa
Signature
DISCLOSURE
Will the applicant or fame building oavpant store or handb harardouus masenial
u dented by We Cupertino Municipal Code. Chapter 9.12, ud the Health and Safety
Code. Section 25532(x)7
O Ka � No
Wdn the aWliant or future building oeropatu use equipment or dc+laa which
emit hazardous air contaminants as denncd by do Bay Area Air Quality Management
District?
0 Yrs No
1 have mad due haarleuu materials nequimmeras under Chapter 6.95 of the Califor.
th & Safc ode, SceUens 25505.25533 and 25534. I understand that. ifthe building
I I ( Date
Job Description
Sq. Ft. Floor Area
Required Inspections
Issued by:
Re -roofs
Type of Roof
Date
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 'N' or better
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10870 N STELLRJG RD BLDG 48 A -H
CONTRACTOR: WEST BUILDERS, INC.
PERMIT NO: 09080071
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 ELECT r
INFO:
License Class Lic. k T.�l5
IILIILDING PERMIT BLDG PLUMB
MECH T_ RESIDENTIAL r— COMMERCIAL r
t�
Contractor W 6 Date e _2`f • 07
W
I hereby affirm that 1 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.
1 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
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: 32609056.48
Occupancy Type:
APPLICANT CERTIFICATION
1 certify that 1 have read this application and state that the above information is
correct. 1 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 the above mentioned property for inspection purposes. (We) agree to save
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
indemnify and keep harmiess 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.
e
Signature Dat42-
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 new materials for
I hereby affirm that I am exempt from the Contractor's License Law forone 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
ALL 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 ha:.ardous materials requirements under Chapter 6.95 of the
I have and will maintain a 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 Municipal Code, Chapter 9.12 and the Health &
performance of the work for which this permit is issued.
Safety Code, Section 25532(a) should I store or handle hazardr,us material.
I 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 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, 25533, and 25534.
1 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
O-* er o authori* agent: p
`Z7
Compensation laws of California. If, after making this certificate of exemption, I
Date: CJ
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisiens 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
APPLICANT CERTIFICATION
for which this permit is issued (Sec. 3097, Civ C.)
I certify that 1 have read this application and state that the above information is
Lcnder'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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
ARCHITECT'S DECLARATION
costs, and expenses which may accrue against said City in consequence of the
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