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07120127BUILDING DIVISION PERMIT STELLING RD, BLDG 38 VS II A CALIFORNIA LIMITED ARCHITEC (ENGINEER: u p p LICENSED CONTRACTOR'S DECLARATION v I hereby affirm that I am licensed under provisions of Chapter 9 (commencing c w with ;i��u 'Business and Professions Code, and my license Is lie y in ful j Licen Llc. N F p Date Contractor CTS DECLAMATION ON r I understand my plans shall be used as public records �yU Cy Licensed Professional y S OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License Law for the qO following reason. (Section 7031.5. Business and Professions Code: Any city Of 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 xthat he is licensed pursuant to the previsions of the Contractor's License Law (Chapter 9 t $ (commencing with Section 7000) of Division 3 of the Business and Professions Code) or L .. 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 ($5W). ❑ 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 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 forsala 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.), ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Ir- cense Law does not apply to an owner of property who builds or improves thereon, and, who contracts for such projects with a conimclor(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 penalty of perjury one of the following declarations: ❑ I have and will maintain a Certificate of Consent to self -insure for WorkeesCompen- sation, as provided for by Section 3700 of the Labor Code, for the performancc of the work for which this permit is issued. ❑ I have and will maintain Workers 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's Goo ensati Irurance carrier and Polity, number am: Cartier. Polity No.: CERTIFICATE 0 EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) or loss.) I certify that In the performance of the work for which this permit is issued, I shall not employ any person in any manncrso as to become subject to the Workers' Compensation Laws of California Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the workers Compensation provisions of the Labor Code, you must O forthwith comply with such provisions or this permit shall be deemed revoked. Z+ 0-4 CONSTRUCTION LENDING AGENCY C/2 I hereby affirm that there is a construclian lending agency for the performance of the work for which this permit Is issued (See. 3097, Civ. C.) 64 A Lenders Name z Lenders Address U 0 I certify that 1 have read this application and state that the above information is V. H correct 1 agree to comply with all city and county ordinances and state laws relating to 0 U building concoction, and hereby authorize representatives of this city to enter upon the OW above -mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against Hrn liabilities, judgments, costs and expenses which may in any way accrue against said City U 7 in consequence of the granting of this permit. r7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT SO GU TTON e. Signature orApplicant/Cilnuactor 0 k Mite 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)?����rrr C] Yes No Will the applicant art future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District? ❑ Yes No I have read the hazardous materials requirements under Chapter 6.95 of the Califor. nd alth&Safety ctions25505,25533and25534.1undcrstandthatifthebuilding d t curtenlly have �b. 4 that h is my responsibility to notify the occupant or the rcyuire whit misriot to issuance or a Certificate of cupancy. orauth nzed agent ate WEST BUILDERS, INC. 1608 4TH ST STE 120 REMODEL -NEW DECK RAILS, STATR-sTI's, & PAINT. ___ _— T—r lob Ft. Issued by: Re -roofs Type of Roof PERMIT NO. 07120127 PERMIT ISSUE DATE 07/14/2008 SANITARY NO. CONTROL NO. BUILDING PERMrTINFO Required Inspections Date 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 CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 10870 N STELLING RD BLDG 38 A-H I CONTRACTOR: WEST BUILDERS, INC. PERMIT NO: 09080064 I OWNER'S NAME: VILLA SERRA APTS A CA LTD PARTN 11608 4TH ST STE 120 1 DATE ISSUED: 08/19/2009 1 OWNER'S PHONE: 6509313457 1 BERKE,LEY, CA 94710 ! PHONE NO: (510) 525-9378 1 ❑ LICENSED CONTRACTOR'S DECLARATION License Class 6- Lie. # Contractor W g i Date 9 •Zy -9 I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Sectiou 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 1 certify that I have read this application and state that the above information is correct. 1 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. 11 Signature EYE _ Date ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 & 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. (1Ve) 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. BUILDING, PERMIT INFO: BLDG r ELECT r PLUMB I- MECH r- RESIDENTIAL F COMMERCIAL 1- JOB DESCRIPTION: REVISION UTILITY CLOSET Sq. Ft Floor Area: I Valuation: $2500 APN Number: 32609056.38 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: Ali 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 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, 1 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 I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. outho;ieagent: IL::: peDate: 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 (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Profession Signature Date