07120113BUILDING DIVISION PERNIIT
munGV7uU riOMESTEAD RD BLDG 1 A—
WEST BUILDERS, INC.
07120113
OW 'S NAME:
FERMrf ISSUE DATE
VILLA SERRA APTS A CA LTD
1608 4TH ST STE 120
09/26/2008
PHO
(510) 525-9378
SANITARY NO. CONTROL NO.
ARCH]I EC /ENGINEEIL
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
3 C Zp LICENSED CONTRACIMS DECLARATION
u 1 hereby alarm that I w linemcd under provisions of Chapter 9 (commencing
wish Section 7000) of Diviaioa 3 of the Business and Professions Codep, and license Is
n � y In full force and effect. �' l
D co [ leense Lic. A
3 Dam `� Contractor0601
ARCHriEC['S DECLARATION
m 1 understand my pWta shall be used as public records
U
! ram. Licensed Professional
0 OWNER -BUILDER DECLARATION
I hereby alirin that I am exempt from the Contractors License Law for utter
O O following reason, (Section IM 13, B ugliness and Professions Code: Any city "con
$ Pi which requires a permit to construct. alter, improve, demolish, or repair any sesame
_ I prior to its issuance, also requites the applicant for such permit to file a signed statement
that he is licensed pursuant to the provisions of the Contractors License Law (Chapter 9
F- (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
.. that he is exempt therefrom and the basis for the alleged exemption. Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars (S500).
.J O
1- M
Paz
UO
❑ L 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. 70". Business
and Professions Code: The Contractors Lkxuse Law does not apply to an owner of
property who buik)a or improves thereon, and who does such work himself or through his
own employees, provided that such improvements are not intended or offered for sale If.
however, the building or improvement Is sold within one year of completion. the owner -
budder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑ L as owner of the property, am exclusively contracting with licensed contractm to
cousrnct the project (Sec 7044. Business and Professions Code:) The Comnictda Li.
cense Law does not apply to an owner of property who builds or improves thereon. and
who contracts for such projects with a contractor(s) licensed pursuant to the contractors
Lk eme Law.
❑ 1 am exempt under Sec B & P C for this mum
Owner Dam
WORKERS COMPF-NSA71ON DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations
❑ 1 have and will maintain a Certifiaue of Consent m self -insure far Workers Compen-
sation, as provided for by Section 3700 of the I - Code, for the performance of the
work for which this permit is Issued.
❑ 1 have and will maintain Workers Compensation Insurance, as mquired by Section
3700 of the Libor Code, for the performance of the work for which this permit is issued.
My Worker Compensation Insurance artier and Policy number arc
Carrier A tiCAZ Policy No.; 1 te`rJ001411
CER77FICATE OF CI7NP7TON FROM WORKERS'
COMPFNSA710N INSURANCE
OU section need nor be completed if the permit is forono hundred doom ($I00)
Or lea)
1 certify that In pdVrmancc of the wo for which this permit Is isrrA 1 snail not
emplay any two o I !ybject m the WorCa lmrs' mpensstion
Laws of Cal D e �JJ
Applicant
NOTICE TO Ap cW: If, alter making this Certificate of Exemption, you should
become subject orkcra Compensition provisions of the Labor Code, you 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
The work for which this permit is issued (Sere. 3097, CH. C.)
Lenders Name
Lenders Address
1 outify that I have read this application and sum that the above Information is
correct 1 agree to comply with all city and county ordinances and sum laws relating to
building onion. and hemby authorize representatives of this city to enter upon the
above -mentioned property for inspection purposes.
) ag— to save. Indemnify and keep harmless the City of Cupertino agahw
fA
ments. Coss and expenses which may In any way scone against said City
of the granting of this permit.
L 0 .NDS AND WILL COMPLY WR'H NON -POINT
770 au oj IantlComraaor Data
HAZARDOUS MATERIALS DISCLOSURE
Win the applicant or future budding occupant store or handle haardous material
as defied by the Cupertino Municipal Code, Chapter 9.I2, and the Health and Safety
Code, Section 25532(a)? /
❑ Yea 94.
Will the applicant or future building occupant use equipment or devices which
emit hazardous air coruminanu as defined by the Bay Area Air Quality Management
District?
❑ Yea WK0
14ave cite bazardeus materials requirements under Chapter 6.95 of the Csifor.
rdaHcaith& Sections 25505.25533and25534.1understandthat ifthe building
does no tiY hs a reran, that it is my responsibility to notify are occupant of the
req is in met prior to issuance of a Caiif cm off O�v�arcy/n�
Job Description
NEW APT BUILDING 1 A—D, 3,2191
8/25/08 SEE #07120212 FOR SUBS.
Sq. Ft. Floor Area $ 5 5 5 5 5 5 Valuation
32609029
Required Inspections
Issued by:
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 inspection, I agree to remove
all new materials for inspection.
Signature of Applicant Date
. All roof coverings to be Class 'A' or better
Ow— — uuh7rbzd &sent Date