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071201480O Z M aZ UO wtO �a U� rY OF CUPERTINO BUILDING DIVISION PERNUT aul[.!)1�qQ0 N STELLING RD BLDG 55 A-1 WEST BUILDERS, INC. M'S NAME: VS II A CALIFORNIA LIMITED 1608 4TH ST STE 120 ARCHrrECT/ENGINEFR LICENSED CONTRACTOR'S DELLARATIGN I hereby affirm chat 1 we licensed under provisions of Chapter 9 (commencing with Section 7OD0) of ' ' m 3 of tho Business and Professions; Coda and my license is in full force and effect [lcmuETrl.le. i Dalt Conuactmr ARCHITECTS DECLARATION I understand my plans shall be used u public records Licensed Professional OWNER -BUILDER DECLARATION 1 hereby alrrm that 1 am exempt from the Contractors License Law for the following mason. (Section 70313, Business and Profession Code: Any dry or county which requires a permit to construct. alter, improve, dcmolisb, or repair any structum prior to its issuance also mquiress the applicant for such permit to fik a signed statement sial be is licensed pursuant to the provision of the Contractors Licence Law (Chapter 9 (commencing with Section 7000) of Division 3 of We Business and Profession Code) or that be is exempt therefrom and the basis for the alleged exwpdoa Any violation of Seaton 70313 by any applicant for a permit subjects the applicant to a civil Penalty of mm more them five hundred dollars (55M ❑ L as owner of the property. or my employers with wages u their sale compensation. will do We work and the structure is not intended or offered for sale (Sec. 7044, Business and Profession Coda The Caotractn s I imus Law does net apply to an owner of property who bunds orimprovrs thereon, aW who does such work himulf or Wroagh his own gmployom provided that rich Improvements am not intended or offered for ale. 11. however, the building or improvement Is sold within one year of completion, the owner - budder will have the burden of proving that be did not btdW or hnpaove for purpose of ale.). ❑ L u owner of the property, we eiclusivoly contracting with licensed cormseturs to construct the project (Sec 7044, Business and Profession Coda) The Contractor's Li - emu Law does not apply to an owner of property who builds or hmpmm thereon, and, who comuacts for Such projects with a amh-scw*) licesed passant b the Comractoes License Law. ❑ 1 am exempt under Sea B & P C for this reason Owner Dare WORKERS COMPENSA71ON DECLARATION 1 hereby &M m under penalty of perjury ane of the following declarations ❑ 1 have and will maintain a Ctrtincate of Consent to serf-iuum for Workees Compen- sation, u provided for by Section 3700 of the Labor Coda for the performance of the work for which this; permit is issued ❑ 1 have and will imsintain Workers Compensation Imurams, as mquhed by Sectian 3700 of the Labor Coda for the performance of the work for which this permit is issued My Woti��r�s Com on Insurance carrier and polk7 number am: lity Carrkr. ��i PoNo.: a CEKMCATE OF EXEMPTION FROM WORKERS COMPENSATiONINSURANCE (This secdon need not be complecd if the permit is forest: hundred dollars ($torn or lest) 1 certify that in the performance of the work for which this permh is Lsstued, 1 shall not employ arty person in any maws m as to become subject to the Worker' Compensation Laura of Califorais. Date A NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workera Compensation provision of the Labor Coda you must forthwith comply with such provisions or this permit shall be ticenued rewind CONSTRUCTION LENDING AGENCY I hereby affirm that them Is a construction lending agency for the performance of the work for which this permit is issued (See- 3097, Civ. C) l.nudera Name Lenders Address 1 certify that I have read this application and sale Was the above information is rnmrt. l agree to comply with all city and county onlinannces and state laws relating to budding construction, and hereby authorize representatives of this city to enter upon the above-mentioned popery for inspection purposes. (We) agree to ave, indemnify and keep harmless the City of Cupertino against liabilities, judgments. Costs and apenaa which may in any way accrue against aW City in consequence of the granting of this permit A UNQWLSTANDS AND WILL COMPLY WITH ALL NON -POINT S Siv-AnKol'ApplicastlConuactor HAZARDOUS MA DISCLOSURE W1n the applicant or future building occupant son or haeme hazardous material IS defined by tic Cupertino Municipal Code. Chapter 9.13, and the Health tad Safety Code, Scaion 35532(x)7 ❑ Yes No Win the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as dc1 cd by the Bay Ana Air Quality Management Disria7 ❑ Yes Nilo 1 have mad the hazardous materials mWiremeuv under Chapter6.95 of tine Califor- nia Hesith & SafayCode. Sccdans35505.35533 and 25534.1 understand that if tic building not cmmntly that it is my responsibility to notify We oecopse, of the last., c of a 7:2M cone or authorized agent Date PERMIT NO. 07120148 PERMIT ISWE DATE 07/14/2008 SAMTARY NO. CONTROL NO. BUILDING PERMIT INFO REMODEL DECK,STAIR RAILS & 0 PA FP , Job Description Floor Area Issued by: Re -roofs Type of Roof Required Inspections Date Valuation 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 'A" or better CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10870 N STELLING RD BLDG 55 A -H CONTRACTOR: WEST BUILDERS, (NC. PERMIT NO: 09080073 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 BUILDING PERMIT INFO: BLDG ELECT PLUMB r License Class Lie.# /5 F_ r j MECH _ Q Contractor way, Date l7 —2Y ra/p RESIDENTIAL COMMERCIAL I hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION: REVIS ION- 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 Sq. Ft Floor Area: Valuation: $5200 performance of the work for 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. APN Number: 32609056.55 Occupancy Type: 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 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. e(J. 0 Signature DatAr 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 for one 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: wil I do the work, and the structure is not intended or offered tot 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 hazardous 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. I 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 hazardous material. 1 have and will maintain Worker'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 contaminants as defined by the Bay Area Air Quality Management District 1 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 perfonnance 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 r authoriz d . gent: -Z O f Compensation laws of California. If, after making this certificate of exemption, I Date: 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. 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 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. (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 conszquence 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