07120151BUILDING DIVISION PERNUT
Bu1Lplixc�ggjtEss: STEELING RD BLDG Mrr NO.
57 A— WEST BUILDERS, INC. P�07120151
OW 11UStNSA/MEE: 1V PERMIT ISSMDATE
VS II A CALIFORNIA LIMITED 1608 4TH ST STE 120 07/14/2008
PHON¢i1 P q NT SANITARY NO. CONTROL NO.
AR '' BUILDING
REMODEL DECK, STAIR RAILS & BLDG ELECT PLUMB MECH
a O 6 LICENSED CON7RACrOWS DECLARATION
1 hereby affirm that 1 w licensed under provisions of Chapw 9 (commencing
M with Section 700 of Division 3 of the Business aid Profuoona and my kcr m is
''+ w in full fame and QG3�1`<\
MM
° cauractur
3 i AR5—ir— rS D
1 understand my plans sha0 be used as public records
NaN Licensed Professional
a OWNFR-BUILDER DECLARATION
e 1 hereby affirm that 1 am exempt from the Contramor's I kcam Law for the
p O following reason. (Section 7031-3. Business and Professions Code: Any city or county
$ which requires a permit to "n""nW% alter, hmprmve, dcmdisk or repair my ftrochnre
y prior 10 its issuance also requires the applioartl for such permit to file a aimstatement
.i.n onl
< shat he is licensed pursuant to the provisions of the Contractors Uccam Law (Chapter 9
(commencing with Section 7000) of Division 3 or the Business and Professions Code) or
— that he is exempt therefrom and the basis for the allapd exemption. Any vlolaticu or
Section 7031-3 by any applicant for a permit subjcca the applicant to a civil penalty of
nes more than five hundred dollars (S M
L as owner of Itis property, or my employees with wages as their wk compensation,
will do the work and the structure Is not intended or offered for ale (See. 7044. Business
and Professions Code: The Contractors License Law does not apply to an owner of
property who builds or improves thereon. and who doe°such work himself or Ihrongh bis
awn anploycs, provided that such improvcuens at not Intended or offered for aide if.
however. the building or improvement is sold within ane year of wmpletio4 the mrrcr-
buildw will have tis burden of proving shat he did not build or improve for pmpom of
ala).
❑ L as owner of the property. w exclusively contracting with licensed contractors to
costrtser the pmJw (See. 7044. Business and Profession Cod() The Contractors Li.
censo Law does mor apply to an owner of property who builds or Improves thereon. and .
who contracts for such pnojecs with a contractor(s) licensed pursuant to the Contractors
[.;¢ansa Law.
Q 1 am exempt under Sec . B 3 P C for this maws
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following dedantianc
Q 1 bam and will maintain a Certificate of Consent to serif-hnsum for Warkers Compen-
sation, as provided for by Section 3700 of the Labor Code. for the performance of the
work for wtich this permit is issued.
❑ I have and will maintain Workers Compensation Imwrance, as required by Seetim
3700 of the Labor Code, for the pmforr eanm of the work for wki tk this permit is Issued.
MY Work s p ince carrier and Policy �lJ '
Cam Policy No
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(ndt sectiam meed not be completed u the permit Is for one hurthmd "ans ($I00)
or lea)
Job Description
Sq. Ft. Floor Area
Required Inspections
I certify that in the performance of the work for which this permit is seed l shall not
employ any person in any manner w as to became abject to the Wafers• Compensation
Luis of California. Due
Applicant
NOTICE TO APPUCANT: If. alter making this Certificate of Exemption. you should
became subject to the Water's Compensation provision of the labor Code, you must
Oforthwith comply with such provisions or this permit shall be doemmd revoked.
CONSTRUCTION LENDWO AOENCv
rte. 1 hereby affirm that dam is t construction lending agency for the performance of
p; > the wort for which this panic is issued (Ser. 3097. Civ. C)
W Qund
Laers Nano
�+ Z Landers Address
U O 1 certify that I have read this application and sure nkat the above Information is
iy rte",' carted I agree to comply with all city and county ordinances and sate Ian relating to
O ' ` building commuctiov, and hereby.taboda repraarWives of th i city torata upon the
v above-mrntio ned property for inspection pmpmea
14 (Wer) a&- to ave, bnderatify and beep harmless the City of Cupertino against
a
w) Iiabhltk>. Jmdgmema coos and expenses which nay in any way acax against said sly
U 7 in severe of Ne Xpenting of this pormit.
r7 A UND_021,rnDS AND WILL COMPLY WITH ALL NON -POINT Issued by:
HAZARDOUS MATERIAfs DISCLOSURE l
WN the applicant or future building occupant stare or ban& hazardous material
as dcfbwd by the Cupertino Municipal Code. Chapter 9. 12, and the Health and Safety
Code. Section 25532(a)7
Q vers
WII the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as de0ned by the Bay Area Air Quality Management
District?
Q Yes ;�'No
Its mad sire hatstdous materials requirements under Chapter S95 of the Csiifor.
niAWLh&Safc'YCAcic,S=&m2M.25533wbd23534.IwA=KUW the ifLbe h Wftg
a errant. that h s ccthe
my nnponsibility to notify do occupant of
req w mel priortoisstamco of a Df
Owner l7 Dna
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 inspectibn, I agree to remove
all new materials for inspection.
Signature of Applicant Date
All roof coverings to be Class 'W' or better
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10870 N STELLiNG RD BLDG 57 A -H
CONTRACTOR: WEST BUILDERS, INC.
PERMIT NO: 09080075
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 DCECLARATION
r I— r
BUILDING INFO:
License Class L. Lic. # a Z53/ S
PERMIT BLDG ELECT PLUMB
[_RESIDENTIAL I—
Contractor f1 / Date tq- ?-,I. S
MECH COMMERCIALr
I hereby affirm that I 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:
1 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: 32609056.57
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.
b
Signature DateC�'�Y
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
1 hereby affirm that 1 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:
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).
1 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: 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 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.
I certify that in the performance of the work for which this permit is issued, l shall
not employ any person in any manner so as to become subject to the Worker's
Owner 8 Z'/f
Compensation laws of California. If, after making this certificate of exemption,)
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
1 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 I 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 consequence of the
granting of this permit. Additionally, the applicant understands and will comply
l 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
Signaturc Date