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CITY OF CUPERTINO
BUILDING DIVISION PERNIIT
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STELLING RD BLDG 58 A—
WEST BUILDERS, INC.
07120153
OW 'S NAME.
PERMIT ISSUE DATE
VS II A CALIFORNIA LIMITED
1608 4TH ST STE 120
07/14/2008
pi{ON6A R TTT
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER
REMODEL DECK, STAIR RAILS & BLDG BE[ECt PLUMB MEca
PAINT, a 0 a 0
LICENSED COKIitACI1DR'S DECLARATION
Job Description
I hereby affirm that I an licensed under provisions of Chapter 9 (eommmelas
- -' ^^^
with Section 7000) of 0 3 of the 13udrrss Prof Code. and my license is
in lWl fora and cif
Lie. t
Contractor
ARCHITECTS D
1 urhdctstand my plans shark be used sa public record,
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that 1 on exempt from the Contractor's Licata Law for tie
fallowing reason. (Section 70313, Business and Professions Code: Any city or county
which requires a permit m cdaqumM. Alas. improve, demall:h, car mpaif any stncCtmm
prior to its iauancs, also requires the applicant for such permit to file a signed statement
that be is licensed pursuant to the provisions of un Contractors License Lev (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 7000) of Division 3 of to Busirm and Professions Code) or
that he is exempt tbemfrom and the basis for the alleged exemption. Any violation of
Section 70313 by any applicant for a permit subject the applicant to a civil penalty of
APN Number
Occupancy 'Type
not mac tiara Ree bo dmd dollar, (SSOOy.
0 L as owner of the popraty, or my employees with wages as their sole compensation,
will do the wort, and the structure is not intended or offered for rale (See. 7044, Badness
Required Inspections
and Pmfeadons Code: The Com moors License Law does out apply to an owner of
poputy who builds or impnmes themon. and who does such work himself or through his
awn enplay es, provided that such improvement are not marded aroffeted for sale. )f.
however. the building or Improvement is sold within one year of completion. the owner -
builder will have the I o I of proving that he did not build or improve for purpose of
sale.)_
0 L as owner of do property. am eldudvely contracting with licensed contractors to
construct to pmjeci (See. 7044. Business and Professions Code:) The Contractors Li-
cense Law dons mot apply to an owner of property who bonds or improv, Unman. and ,
who conaacts for such projects with a conuacteM licensed pursuant to the Contractors
Lkeefm Law,
0 1 am exempt under See. B k P C for this moron
Owner Due
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury ane of the following Qedantlont
0 I bave sod wiB main W n ■ C=Ufimtm of Conaenl to self-imme for WakcesCanpar-
radon. as provided for by Section 3700 of she Labor Code. for the performance of the
work for which this permit is issued
0 1 have sad will maintain Workers Compensation Insurance, as required by Section
3700 of the Labor Code, for the performance of the work for which this permit is Issued.
My Wo s pew . nInsurance carrier and Policy number am ^�6
, l
Policy No
CERTMCATE OF EXEMPTION FROM WORKELT
COMPENSATION INSURANCE
(furs section need rot be compknd Uthe permit Is foram: bandied dollars (3100)
or Irss.)
I mndry that in the performance of the work for which this permit is issued. I dull not
employ any person to any manner eco as to become subject to the Workers' Compenoton
'
Laws of California. Dae
Appllca :
NOTICE TO APPLICANT. If, alley mating this Cenimmia of Exemption. you should
became subject to the Workers Compensatian provisions of to Isbor Code, you must
forthwith comply with such provisions or this permit WWI be deemed revoked.
CONSTRUCTION LENDING AGENCY
I Mosby affirm that them is a construction lending agency for the performance or
to work for which this Permit is issued (See. 3097. Civ. C.)
Lendari Nm
Larders Address
I certify that I have read this s"ficedon and state that the above information is
correct I agree to comply with all city and county ordinances and state laws muting to
building comsunction. and hereby autharimm representatives of this city to enter upon the
above -man toned property for inspection purposes.
(we) agree to rave, ladamrdfy and keep harmless the City ar Cupertino against
liabintic& judgments, costs sad expmaes which may in anyway acme agaiutl sdelcoq
as
rune the grading of this parmlL
NT AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
( (J�
Re -roofs
Type of Roof
Signature or Appliant/Contrector
HAZARDOUS MATERIALS DISCLOSURE
Will to applicant or future building occupant store or handle hazardous marcid
as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety
Code. Section , x5532(')7 L N.
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
Will to applicant or future building occupant use equipment or devices which
emit humdous sir contaminant as Wined by the Bay Am Air QhWlly Managemeat
all new materials for inspection.
District?
❑Yeaa
1 have read the muviAls hegnhirerncents ender Chapter &" of the CaGfar-
th h Safes Sections 25505.25533 and 23334.1 understand dm if the bolding
nal &K 1-1quint. that it is my responsibility to notify the occupan of the
rcqu Lprior missuance ofa ^�
Signature of Applicant Date
All roof coverings to be Class res' or better
owner Dae
or sumarivrd a t
.
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10870 N STELLING RD BLDG 58 A -H
CONTRACTOR: WEST BUILDERS, INC.
PERMIT NO: 09080077
OWNER'S NAME: VILLA SERRA APTS A CA LTD PARTN
1608 4TH ST STE 120
DATE ISSUED: 08/19/2009
OWNER'S PRONE:
BERKELEY, CA 94710
PHONE NO: (
❑ LICENSED CONTRACTOR'S DECLARATION
r T-
0-25395BUILDING
PERMIT INFO: BLDG ELECT PLUMB
License Class- Class Lic. q
r—r—
'- 4
8 ' I
MECH RESIDENTIAL COMMERCIALr
Contractor W Date --z-r
1 hereby affirm that I am licensed under the provisions of Chapter 9
JOB DESCRIPTION:REVISION: UTILITY CLOSETS
(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.
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: 32609056.58
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.
Signature Date G Z y S
JV
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 I am exempt from the Contractor's License Law for one of
inspection.
the following two reasons:
I, 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:
1 have read the hazardous materials requirements under Chapter 6.95 of the
1 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.
I 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 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.
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'sr
uthor' ed agent:
~-
Compensation laws of California. If, after making this certificate of exemption, I
Date$ -e
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
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