07120190rY OF CUPERTINO
BUILDING DIVISION PERMIT
800 HOMESTEAD RD BLDG 15 A-1 WEST BUILDERS, INC.
AC'S NAME:
VILLA SERRA APT A CA LTD
ARCHRECUENGIIM :
LICENSED CONTRACTOR'S DECLARATION
I hereby dthat I me licensed under provisions of Chapter 9 (c
rum oremancing
with Section 7000) of Division 3 of the Business and Professions Code, and my license is
in full face and effect 0a'S 3
nse Clan Lk.
Licef
Dam Carttractor
CHITECI'S DECLARATION-
I uncicrisand my plans shall be used ss public records
I iconsed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from ibe Conuacto's License Law for the
following reckon. (Section 70313, Business and Professions Code: Any city or county
which nCIuhes a permit to Construct, deer. Improve, dmnallsh, or repair any wtmmre
prior to its issuance, also requires tiac applicant for such permit to ftk a signed statement
that be is licensed pursuant to the provisions of tiac Contracterr s License Law (Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that be It exempt therefrom and the basis for the alleged exemption. Any violation of
Section 70313 by airy applicant for a permit subjects the applicant m a civil penalty of
rot nae than flare humdmd Clutton (S%0).
❑ 1, as owner of the property, or my employees with wages as their sob ecmpenuUon,
will do the work and the structure is not imtdc a offered forsale (Sec.7044, Business
and Professions Code: The Contractor's License Law does not apply to an owner of
property who builds or improves thernon, and who does such wort himself or through his
owe employees. provided that such improvements are not imanded or offered for site. if,
however, the building or improvement is sold within one year of completion. Ibe owner.
builder will have the burden of proving that be did not build or irppavc for purpose of
sale.).
❑ L as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044. Business and Professions Code:) The Cmuuacsoes U
erese Law does as apply to an owner of property who builds or improves thereat. and,
who contracts for such projects with a eon ractorw licensed pursuant to the contraactoes
License Law.
❑ 1 am exempt under Sea B & P C for this won
Owner Dam
WORKER'S COMPENSATION DECLARATION
I hereby afflne under penalty of perjury am of the fallowing declarations
❑ I have and will maintain a CctiBam of Consent to self-insm fa Worfoces Compenr
satin n, as provided for by Secdan 3700 of the Labor Code, for the performance of the
wart for which this permit is issued
❑ I have and will maintain Worker's Compensation Ins u ince, as required by Season
3700 of the Labor Code, for the perfarnamx of the work for which this permit is Issued
My Wake com easatio ruunnce artier and Policy number a=
Carrier. policy No: 1%4
% `0" s
CERTERCAT'E OF mvIPTION FROM WORKERS
COMPENSATION INSURANCE
(This section need ret be completed if the permit is foram hundred dollars 4f 100)
or tat)
I certify that in dm performance of the work for which this permit is issued l shall not
employ any person In any manner so as In become subject to the Wad==' Conpetsatlon
Laws of California. Dam
Applkm
NOTICE TO APPLICANT. If. alter making this Certificate of Exemption, you sbould
become subject to the Workces Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be dccmed revoked.
CONSTRUCTION LENDING AGENCY
I hereby dDrm that there is a construction lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ. C)
Lcedefs Norm
Latdds Address
I certify that I have read this application and sum that the above information Ts
correct I to comply with all city and county ordinances and stab laws relating to
!tles.
ng , and hereby authorize representatives of this city m enter upon the
abed property for inspection pmpo—
mtprm save, indemnify and keep harmless the City of Cupertino against
s. coats and expenses which may In any way accrue aga(Nl Said City
in
Due
US MATERIALS DISCLOSURE
Wi the applicant or future building occupant store or handle hazardous material
as dented by the Cupertino M Code, Chapter 9.12. tad the Health and Safety
Code. Section 25532(a)7
❑Yea No
WIO the applianl a future ding Occupant use eguipmeol a devic s which
cull hazardous alr canuminans defined by the Bay Area Air Quality Management
Disuict7
My- Yes No
t-th
mudo s mamrials mquiremens under Chapter 6.95 of the Califor-
nia Sections 25305.25533 and ]5534. I urtdestand that i<the building
issuance of a
OwL Dam
1608 4TH ST STE 120
(510) 525-9378
PERMIT NO.
07120190
PERMIT ISSUE DATE
09/26/2008
SANITARY NO. CONTROL NO.
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Job Description
NEW APT BLDG 15 A -B - 1,205 SF
8/25/08 SEE #07120212 -FOR SUBS
Sq. Ft. Floor Area
32609056
Issued by:
Re -roofs
Type of Roof
$555555
Required Inspections
Type
Date F, 'LQ' %
/—
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 %" or better