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07120125CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10870 N STELLING RD BLDG 37 A-L I CONTRACTOR: WEST BUILDERS, 1NC. PERMIT NO: 09080063 OWNER'S NAME: VILLA SERRA APTS A CA LTD PAR7N 11608 4TH ST STE 120 1 DATE ISSUED: 08/19/2009 1 OWNER'S PHONE: 6509313457 ❑ LICENSED CONTRACTOR'S DECLARATION License Class, _t C. Lic. # !i" Contractor R g Date 1 hereby affirm that I am licensed under the provisions of Chapter 9 (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. I 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. 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 to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, 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 9.18. Signature Date ®7,(y ' ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: I, 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 & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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. I 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. 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's Compensation laws of California. If, after making this certificate of exemption, I 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. 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 to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, 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 9,18. BERKELEY, CA 94710 PHONE. NO: (510) 525-9378 BUILDING PERMIT INFO: BLDG ELECT r PLUMB r, MECH r RESIDENTIAL r COMMERCIAL r JOB DESCRIPTION:REVISION UTILITY CLOSET ORIGINAL: 07120125 Sq. Ft Floor Area: I Valuation: $2500 APN Number: 32609056.37 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION, Issued by: Date: RE -ROOFS: 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 HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owner or nthor' ed agent: Date: 'ZY' CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (See. 3097, Civ C.) Lender's Name Lender's Ad ARCHITECT'S DECLARATION 1 understand my plans shall be used as public records. Licensed Professional Signature Date EY OF CUPEKfINO BUILDING DIVISION PERMIT BUILf6O 6Q5R N STELLING RD BLDG 37 A-1 WEST BUILDERS, INC. 49k'S NAME: VS II A CALIFORNIA LIMITED 1608 4TH ST STE 12.0 ARCHI IECT/ENGINEER: p p LICENSED CONTRACTOR'S DECLARATION ur I hereby affirm that I am licensed under provisions or Chapter 9 (commencing Z with Section 7000) of Division 3 of the Business and Professions Code, and my license is a y in full force and effect 9S v� .Z. Li cen CI Lm• 5 n F Dam Contractor ARCHITECTS traL — A ION 6 I understand my plans shall be used as public records 4 U u. F. Licensed Professional y y OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License Law for the pO 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 G that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 F. $ (commencing with Section 7000) of Division 3 of the Business and Professions Code) or y 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 (5500). 0 1, 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 Contractors License Law dos 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.). ❑ 1, 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- 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 License Law, I am exempt under Sea B & P C for this mason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a Certificate of Consent to self-insum for Workers Compen- sation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 0 I have and will maintain Workoes Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued, My Worke);Cgmpen_r Insurance carticr and Paltry num _ f .,W�/�n�� >\ Cartier C�Lt6�_l�n Jru> Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) or less.) I carry that in the performance of the work for which this permit is issued, I shall not employ any person in any mannerso as to become subject to Uro Workers' Compensailon 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 Codc, you must 0 O forthwith comply with such provisions or this pearl shall be deemed revoked. CONSTRUCTION LENDING AGENCY [~i C/1 I hereby allirm that there is a construction lending agency for the performance or 7 the work for which this permit is issued (Sec. 3097, Civ. C.) W A Lender's Name L.endees Address V Q I certify that I have toad this application and state that the above information is LL H correct. 1 agree to comply with all city and county ordinances and state laws misting to 0 U building construction, and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against t•• rA liabilities,judgments, costs and expenses which may in any way accrue against said City U in consequence of the granting of this permit APP ANT UNDEW ANDS AND WILL COMPLY WITH ALL NON -POINT So EGU 0 Sign App icanU ntraclor ate HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Code, Section 25532(a)? 0 Yes o Will the applicant or utu building occupant use equipment or devices which emit hazardous air contamina is as defined by the Bay Area Air Quality Management District? ❑Yes No 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Code, Sections 25505, 25533 and 25534.1 understand that if the building docs roriqrrontly 2ha tcnan4 that itis my responsibility to notify rho occupant of the mquire n whicmet prior to issuance of a Certificate ofOccupan y. Owner or authorized aac Date REMODEL -NEW DECK RAILS,STAIR Ft. Issued by: Re -roofs Type of Roof PERMCI- NU. 07120125 Pi.Rivfl'1' LSSUE DATE 07/11/2008 SANITARY NO. CONTROL NO. BUILDING PERMITINFO Job Description Required Inspections Valuation Occupancy 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's" or better