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07120124CITY OF CUPERTINO BUILDING DIVISION PERNIIT .. e BU1Lf�1�c DRF kMESTEAD RD BLDG 11 # d 17 WEST BUILDERS, INC.0712 PERMIT NO. 0124 OW •S AM�EE. PERMIT ISSUE DATE VILLA SERRA APTS A CA LTD 1608 4TH ST STE 120 09/26/2008 FHOp&-T D n MT SANITARY NO. CONTROL NO. (510) 525-9378 ARCHfrECr/ENGiNEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION licensed Chapter 9 Job DeSCri lion P I hereby affirm that I am under provisions of (commencing with Section 7000) of Division 3 of the Business and and my • is NEW APT BUILDING 11 # A — B , 1,574 SF in full faan force d effect License ►�-� 8/25/08 SEE #07120212 'FOR SUBS Date Contractor ARCHITECTS DECLARATION i understand my plans dull be used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractors License Law for the following reason. (Section 70313. Business and Profession Code: Any city or county which requires a permit, to construct. alter, improve, demolish• or repair my structure prior to its issuance• also requires the applicant for such permit to file a signed statement that be is licensed purmant to the provisions of the Contrutors License Law (Chapter 9 Sq. Ft. Floor Area Valuation (commencing with Section N)00) of Division 3 of the Business and Professions Code) or $ 5 5 5 5 5 5 that M is exempt iherefsoa and the basis for the alleged exaoptlon. Any violation of ,7� 3 2 �i' Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not mom dunfive hundred dollars (team). 60 902 9 ❑ L u owner of the property. or my employees with wages as their sole compensation, Required lied Inspections nS et win do the work and the structure is not intended or offered for sale (Sec. 70". Business and Profession Cod—_ The Comrseors License Law does roapply to an owner of q P property who builds or improves thereon, and who does such work himself orthrough bia mint employees, provided that such improvements are not intended or offered for sak if. however, the building or improvement is sold within one year of completion, the owner - builder will have the harden of proving that he did not bmld or hnpnm for purpose of sale.). ❑ L as owner of the property. am exdusiwly Contracting with licensed contractors to construct the pro)= (Sec. 7044. Business and Professions Code:) The Comaacwrs Ll- cause few dos not apply to an owner of property who builds or improves thereon, and . who contracts for such projects with a contractor(s) licensed Mum to the Contractors License Law. ❑ 1 am exempt under Sea . B h P C for This mamm Owner Data WORKERS COMPENSATION DECLARATION i hereby afrum order penalty of perjury am of the following declarations: ❑ I have and will maintain a CotiBate of Consent to self -insure forWorkers Compen- modem as pmAded 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 Warker's Comptmaulon Insurance, as required by Section 37M of the Labor Code, for the performance of the work for which this permit is issued. My Wo ore dons innmance curie and Polley number ere: Carrier "ei Polley No.:'I 190 W4'1 CER M OF EX PITON FROM WORKERS COMPENSATION INSURANCE OThis section need not be completed it the permit is for am; hundred dollars ($10fi) or Ins.) 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 abject to the Waked Compensation ' Laws of California. Date Applicant NOTICE TO APPLICANT. If. after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this p=it shall be deemed revoked CONSTRUCnON LENDING AGENCY I hereby affirm that dare is a construction lending agency for the performance of thework for which this permit is issued (Sea 3097, Civ. C.) - Lender's Name Ictders Address i certify that I have meld this application and sum that the shove Information is correct. I agree to comply with all city and county ordinances and state laws relating to building 'on. and hereby authoin representatives of this city to ester upon the above -men - Property for inspection purposes CW W cow, indemnify and keep harmless the City of Cupertino against osts and expenses which may In any way ac a e 4*mst said Cityin Iiabi*1ECRS7 coanting of this permit. ATANDS AND WILL COMPLY WiTH ALL NON -POINT Issued by: DateSOUONS. 26' Re -roofs ®f Type of Roof Signature ppl• muactor Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant atom or handle hazardous material as defined by the Cupertino Municipal Code. Chapter 9.12. and the Health and Safety c°''e 0Yes 2ss3ua)7 Nm All roofs shall be inspected prior to any roofing material being installed. future 01ding devices If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or occupant use equipment or which emit hazardous air conumil defred by the Bay Area Air Quality Management all new materials for inspection. District? ❑ Yes No I mad tie hazardan materlab requuiremew under Chapter S95 of the Califor- nia Health Code, Sections 25505, 25533 wW 25S34. I understand tbn if the building does t ve a taunt• that It is my responsibility m notify the occupant of the req h tnr be met priorto issuanee ofa emir r Signature of Applicant Date All roof coverings to be Class''' or better owner axcnt Date .