07120107BUILDING DIVISION PERMIT
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BUILDING ADDRESS:
10870 N STELLING RD, BLDG #50 1 WEST BUILDERS, INC.
VILLA SERRA APTS A CA LTD 11608 4TH ST STE 120
PHORET DMAT
(510) 525-9378
ARCHITECrlENG1NEER:
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under pmvisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business dprofsss* Code, a d my license is
in full force and effccL
License 1 s Lie. #
Date r Contrar
ARCHITECTS DECLARATI N
1 understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for,the
following reason. (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit to construct, alter, improve, demolish, or repair any structure
prior to its issuance, also requires the applicant for such permit to file a signed statement
that he is licensed pursuant to the previsions of the Contractor's License Law (Chapter 9
(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 1031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars ($500).
❑ f, 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. 7044, Business
and Professions Code: The Contractor's License Law does not apply to an owner of
property who builds 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 -
builder will have the burden of proving that he did not build or improve for purpose of
sale.). [11, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044. Business and Professions Code:) The Contractor's Li.
tense Law does not apply to an owner of property who builds or improves thereon, and.
who contracts for such projects with a conwctor(s) licensed pursuant to the Contractors
License Law.
❑ 1 am exempt under Sea B & P C for this reason
Owner Date
WORKER'S COMPENSA71ON DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a Certificate of Consent to self -insure for Worker's Compen-
sation, as provided 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 Worker's Compensation Insurance, as required by Section
3700 of the Labor Code, for the performance of the work for which this permit is issued.
My Worker' CO pensauo r�nsuranc camor and Policy number am:
Card er. Polity No.:�L�� G��
C RTIFICATEOF CEMPTIONFROM WORKERS'
COMPENSATION INSURANCE
(Thu section need not be completed if the permit is forono hundred dollars ($100)
or less)
I certify that In the performance of the work for which this permit is issued, t shall not
employ any person in any manner so as to become subject to the Workers' COmpensadon
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If, after making this Certificate or Exemption, you should
become subject to the Workcrs Compensation 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 them is a construction lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ. C.)
Lenders Name
Lender's Address
I certify that I have read this application and state that the above information is
comet 1 agree to comply with all city and county ordinances and state laws relating to
building can traction, and hereby authorize representatives of this city to enter upon the
above -men ' \droperty for inspection purposes(Wesave, indemnify and keep harmless the City of Cupertino against
liabil' 'es,j costs and expenses which may in anyway accrue againstsaidCity
inco qu granting of this permit.
APP A RSTANDS AND WILL COMPLY WITH *LL NONJPOINT
4C�a ARDOUS MATERIALS DISCLOSURE
Will the applicant or future building Occupant store or handle hazardous material
as defined by the Cupertino Munici 1 Code, Chapter 9.12, and the Health and Safely
Code, Section 25532(a)?
❑Yes O
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as fined by the Bay Area Air Quality Management
District?
❑Yes o
I&1�vclv.�,dou,mamrialsrequiremcnundcrChapLcr6.95oftheCalifor-
niaHcaltns25505,25533and25534.1undcrstartdthetiCthchuilding
does nott. that Il u my responsihility to motif the accup t O(thc
requiremprior to issuance of a Ccrific f cupanci�,�Owner obate'
PERMIT NO.
07120107
PERMIT ISSUE DATE
09/26/2008
SANITARY NO. CONTROL NO.
Job Description
NEW APT BLDG,BLDG 50 A—B,2300SQ
8/25/08 SEE #07120212 FOR SUBS
Sq. Ft. Floor
32609056.
Issued by:
Re -roofs
Type of Roof
BUILDING PERMrrlNFO
$555555
Required Inspections
Date f
'1 '
Type
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