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09060119CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20800 HOMESTEAD RD BLDG 28 A CONTRACTOR: WEST BUILDERS, INC. PERMIT NO: 09060119 OWNER'S NAME: VILLA SERRA APT A CA LTD PARTN 1608 4TH ST STE 120 DATE ISSUED: 04/15/2010 OR'NER'S PHONE: 6509313457 BERKELEY, CA 94710 PHONE NO: (510) 525-9378 JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIALS ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lic. # 0—S DEFERRED SUBMITTAL: TRUSS CALCS-ORIG #07120196 Contractor vL%"; �� \�©=date [ . lv VILLA SERRA APT HOMES,NEW APTS& RNOVTN,(1)COPY I hereby affirm that I am licensed under the provisions of Chapter 9 ORIGL BLDG TYPE#8A TRUSS LAYOUT(2) COPIES REVS'D (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. Sq. Ft Floor Area: Valuation: $10000 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 APN Number: 32609056.28A Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DA PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter JOF upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS FR ST CALLED INSPECTION. 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 Issued by: Date: with all non -point source regula i pe�the Cupertino Municipal Code, Section 9.18, 7� ((� RE -ROOFS: Signa� lure — — 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. ❑ OR'NE Tyl DER DECLARATION I hereby affirm thatl exempt from the Contractor's License Law for one of Signature of Applicant: Date: the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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) 1, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as deemed by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505, 25533, and 25534, Section 3700 of the Labor Code, for the performance of the work for which this ll Owner or authorized agen;� �=3� ire Date: �-1 ts ._ 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. Il after making this certificate of exemption, I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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, ARCHITECT'S DECLARATION costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. the applicant understands and will comply granting thi7r5 -vmnth all non-pper the Cupertino Municipal Code, Section Licensed Professional �18. 24 Signatu{e Date