07120149 CITY OF CUPERTINO �y�s,�r * ',-'A✓.a.;. t" '�"' "
BUILDING DIVISION PERMIT ,CONTRAGTORINFORMA'�7QN
aulLplg0.A9nR N PERMIT NO.
STELLING RD BLDG 56 A- WEST BUILDERS, INC. 07120149
'1W I .SCNAMUE: PERMIT ISSUE DATE
VS 11' A CALIFORNIA LIMITED 1608 4TH ST STE 120 07/14/2008
ONEAP11•NI SANITARY NO. CONTROL NO.
ARCHrIELT/ENGINEER: allruaN0 PERMIT INFO
REMODEL DECK, STAIR RAILS & 'BLDG ELECT PLUMB MECH
0 0 0 0
uoo LICENSED CONTRACTOR'S DECLARATION JobDescription
ZC 1 Mreby affirm Nal 1 am IicmuN under provisions or Chapmr 9(commeMlnif """'"'"'"""
<Cs with Sauon]IXMp of Division Sof NC Budnev aM Profcssiais QCade.aM mylianscu
nesse in full force and cO
j Z Liensn"con—MiCS6 "AS.
Clave Lic.0
s„ Dau C I DELL
A CHTIELTS DECLAR N
1 ominous. mY plus enol W aced as public meow
�,W,u
s C� Licensed Professional
tl OWNER-BUILDER DECLARATION
ai i f I hcraby alfim that I am cacmpt from the Conuamar's Use..law far Ute
p O following moon.(Section](131.5,Bud•..ar and profession Code:Any city or county
which reyuima a permit to cmrstraet.altar,improve,demolish,or raisin my sonmum
palorbiuissua=.als uimtivapplicutforsahNmitbrmieasigned Raument
ppmm< thuheislicensedpursuanttothcprovisionsoftheCommuteriLiameLaw(Chapla9 Sq.Ft. Floor Area Valuation
yF$ (commencing with Section 7000)of Division 3 of the Business and Professions Cods)or
Nu W u exempt Obs efrom and de baso for the alleged eareptiao.My violation of
Section 7031.5 by any applicant fur a permit subjects the applicant to a civil penalty of APN Number Occupancy e
not come than rice hundred doll.(SSOOk P Y TYP
Q I.as owner of die pmpaty,army wploym with vagi as tite'v sakcompensstion,
will do the wmle and theme sure k Out intended amRered krsale(Sec.7014,Business
and Pmfea ions Cocke The Comment es License Law dose:out apply to an trader a Required Inspections
Property who builds a improves thus eon,and who dao such wale him W f or Nmogh his
own employaa,provided that such improvements art not intended arrogated forsale.If.
however,the building or improvement is sold within one Year of completion.the ownv.
Wilder will have the Wales of proving that W did not build or improve for purpose of
sale.).
Q 1,as Owner of the properly am exclusively contracting with liaised conuackrs to
constma the project(sac.Hiss.Business and prefesemu Code:)The conbaemrs U. .
omen law does mot apply to a to of propene who Wilds Or intimmet themom.and
who contracts for such projects with a camas er(a)licensed posses m the Coners:ufs
L am:law.
❑1 oro exempt under Sec ,B&P C rar Nis moon
Das
417 WORKER'S COMPENSATION DECLARATION
1 bareby air=under penalty of perjury oro of the following deelaratlone
I ham and will maintain a Caaurmcateof Covens to mll-insum fa Warler'sCompen-
astian.u provided fa by Section 3700 of g lobo Cade,far IW pmfomana of the
wort fa which this permit is ssad.
0 1 have and will maintain Worbefe CompeNation IM1Nmna,a rationed by Sccran
3700 adde Labe Calc.for the purarce.of Na work fa which Nis permit is issued.' '
My Woolens m ksurma artier and Pull n}umbe/.r art: �7 ^{,�
Carver. Polity No: I�V��l -C"G,-P
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(IXis section deed Out be completed B the petit it fe one hundred W.($I W)
or leu)
1 ani(v that in the performance of the work fa which this petit Is issued.I shall nor
employ anyperwn in any manrterso as Or became subject to the Workms'Compevation
Laws of C.BkmIL Dau
Applicant
NOTICE TO APPLICANT:Ir.afar making this Certificate of Exemption,you should
become subject n the Walker's Compensation provisions of the Labe Code,you comm
.,O forthwith comply with such provitiom a this petit mall W domed hooked.
Z"' CONSTRUCTION LENDINGAGENCY
[-mom Ihereby.11fom used mart is a construction lending agency for thn performance of
G' the were fe which Nis permit is issad(Se.3077,Civ.C.)
MW A Lessees Nam.
z Leader's AM.
U Q 1 aatifY Nm I have rad this application and sate this de,aW W information is
Ly f•' correct.I a,me to comply with all city and county ordinuees and Tule laws misting to
.0 Wilding construction,and hereby authoria rtpmxnuuvs of Nu city to enter upon tis
W +hove-mnnud m propertyand for inspection ion purpowhich may
Ly (We).gra to rev,indemnify and keep hatless the City of Cupertino againss
fn Iia bilitieajoggmau,Spanning expo-a.mdchmrykamY way accrue against said City
V z A
I/—� Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Mil the applicant or future Wilding aauponlsore or handle havrdoes reasons]
as deriad by the Cupertino Municipal Code.Chapter 9.12 and Ne Health and Safety
^ode.Section 211324)7
❑Ypa All roofs shall be inspected prior to any roofing material being installed.
�No
sun thc.pplkant err Tamm Wining aavwnt ode ewipmat err device,sunk. If a roof is installed without first obtaining an inspection,I agree to remove
emll h,vardnpa air conuminaos as defined by the Bay Ana Air Quality Management all new materials for inspection.
District]
❑Ypa AN.
them mad thehadadvasmatarialaraquinseents undcrCNpsr6.95 of the Utter-
nuHahA&Safely Cude,Socuea 25505,25533 and 25534.1 understand destitute bulking
d t.,me.I nam•anent,Nu it is my responsibility to notify de accupmmt of sec
nye
I ,te- All roof coverings to be Class'W'or better
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10870 N STELLING RD BLDG 56 A -H I CONTRACTOR: WEST BUILDERS, CNC. PERMIT NO: 09080074
OWNER'S NAME: VILLA SERRA APTS A CA LTD PARTN 11608 4TH ST STE 120 1 DATE ISSUED: 08/19/2009 1
OWNER'S PHONE: 1 BERKELEY, CA 94710 J PHONE NO: (
❑ LICENSED CONTRACTOR'S DECLARATION
License Class el Lic. N 85 2S1(ZS
Contractor V 131 Date A Zy '�
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 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 P ZY.1
❑ OWNER -BUILDER DECLARATION
1 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)
1, as owner of the property, am exclusively contracting with lic:nsed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
declarations:
I have and will maintain a Certificate of Consent to self -insure Ibr 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.
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.
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
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 informarion 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 r COMMERCIAL r
JOB DESCRIPTION: REVISION: UTILITY CLOSET
Sq. Ft Floor Area: I Valuation: $2500
APN Number: 32609056.56 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 1.80 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 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 I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
Owne r all horized agent: & Z,/. S
Date:
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for fl -,e performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
1 understand my plans shall be used as public records.
Licensed Professional