07120126BUILDING DIVISION PERMIT
STELLING RD, BLDG 46
VILLA SERRA APTS A CA LTD
ARCHITECT/ENGINEER:
u 0 p LICENSED CONTRACTOR'S DECLARATION
o ud U I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
X„, with Section 7000) of Division 3 of the Business and Professions Code, any license is
p H in lull force and effecnse ass t ✓ J�� ,
Z LiceLIc. N
Data Contractor
ARCHITECTS DECLARATIO
11 1 understand my plans shall be used as public records
W rn Licensed Professional
n 01 OWNER -BUILDER DECLARATION
V 1 hereby affirm that 1 am exempt from the Contractor's License Law for the
q o following reason. (Section 7031.5, Business and Professions Code: Any city or county
t m ii which requires a permit to construct, alter, improve, demolish, or repair any structure
u " prior to its issuance, also requires the applicant for such permit to file a signed statement
Ex G that he is licensed pursuant to the previsions of the Contracturs License Law (Chapter 9
X F (commencing with Sccdon 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).
[11. 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 contractor(s) licensed pursuant to the Contractor's
License Law.
❑ I am exempt under Sea B & P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penally 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.
❑ 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 Worke Com easatio `nsuranc carrier and Policy number am:
Cartier. -IG Policy No.:�%
CERTIFICATE OF CEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is foronc hundred dollars ($100)
or less.)
I certify that in the performance of the work for which this permit is issued, 1 shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California. Data
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
,J O forthwith comply with such provisions or this permit shall be deemed revoked.
t CONSTRUCTION LENDING AGENCY
►�- I hereby affirm that there is a construction lending agency for the performance of
> the work for which this permit is issued (Sec. 3097, Civ. C.)
W A Lenders Name
04 lz Lenders Address
U Q 1 certify that 1 have read this application and state that the above information is
Lt t F CerreeL I agree to comply with all city and county ordinances and state laws relating to
0 C> building co welter, and hereby authorira representatives of this city to enter upon the
U above -me . ncd property for inspection purposes.
ato save, indemnify and keep harmless the City of Cupertino against
� liabilities, ugree mcnts, casts and expenses which may in any way accrue against said City
() in c seq G f the granting of this permit.
All IC DERSTANDS AND WILL COMPLY WI ALL ON -POINT
SO C JU
TIONS.
Signalurc VokViic4contraclor Data
AZARDOUS MATERIALS DISCLOSURE
Q-�Ppiilr ppiicanl or future building occupantstoro or bandle hazardous material
as defined by the Cupertino Muni c' al Code, Chapter 9.12, and the Health and Safely
Code, Section 25532(a)?
❑Yes e
Will the applicant or future b ilding occupant use equipment or devices which
emit hazardous air contaminants defined by the Bay Area Air Quality Management
DistrJLhS
the hazardous materials requirements under Chapter6.95 ofthe Califor-
niaH ode, Sections25505,25533and25534.1understandthatifthc building
does va a tmtam, that it is my responsibility to nod the occup t of the
requih ust be met priorto issuance ofa CertillQ7�
Owner o ihoriyodagenL Date
WEST BUILDERS, INC.
1608 4TH ST STE•120
(510) 525-9378
NEW APT BLDG, BLDG 46
8/25/08 SEE #07120212
PERMIT NO.
07120126
PERMIT ISSUE DATE
09/26/2008
SANITARY NO.
CONTROL NO.
BUILDING PERMIT INFO
BLDG ELECr
PLUMB
0 0
0
Job Description
A—H, 3219SQ
'FOR SUBS
Sq. Ft. Floor Area I $ 5 5 5 5 5 5 Valuation
32609056.,
Required Inspections
Issued by:
Re -roofs
Type of Roof
Occupancy
Date rr—���d
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