07120145 CITY OF CUPERTINO T��Y�ITkk,,�g�T
BUILDING DIVISION PGlUI'ul
PERMIT NO.
Bu1Lgl�cl�LE STELLING RD BLDG 54 A– WEST BUILDERS, INC. 07120145
NtJ'S NAME: PERMIT LOVE DATE
VS II A CALIFORNIA LIMITED 1608 4TH ST STE 120 07/14/2008
PHONEY\P'TINT SANITARY NO. CONTROL NO.
ARCHITECTMISGINEER: BUILDING PERMIT INFO
REMODEL DECK, STAIR RAILS & '.BLDG ELECT PLUMB MECH
upp
LICENSED CONTBACOR'SDECLARATION bDescrivon
4 U F 1 hereby NNu i
irse I me lived under pmu ofvisimCleapmJoDescription
r 9(commencing '-"'""'"'
ZZ`� wits Section 70(10)of0ivishm fondue Business and Pnfessiom Cade,W my license is
n?h in full force and eff
u�x LkenLk.g
Contractor
m wEE
` W ARCHITECTS DFLLARA ON
CC 77 I unMrvand my Plans"I be urA u public rteoNs
2yU
g u,H Licemud Pro fcasianil
SN3 OWNER-BUILDER DECLARATION
E I hereby anom Nat I am exempt from the Conbacfors License Law for the
C❑O following mason.(Section 7011.5,Business and Profession Code:Any city or county
$Pi which mqu me;a permit m con trust after,improve,demolish,OF repair any Shocture
Z y prior ne its issuance.also requires the applicant for snch Permit m file a signal summent
C that he is licensed pursuant oThe provisions ofTOO Contrecwr.Lee.U.(0.11.19 Sq.Ft.Floor Area Valuation
�$ (commencing wits Section 7000)of Division l of the Business and Profusion Codc)or
dust an is motorist tMsefrum and the basis for the a1kgul meamptims My Aolmon of
Section 7071.5 by any applicant for a permit subjem the applicant To a civil penalty of APN Number Occupancy Type
tat mom duo It huMred dollen($Salt
L as ewho of the pmpc",carry amployeu watt wage u Ne'v sok eampenortion,
will do the work,and On sti.Llum items inknded or efrered potash,(Sec.7814,Buainms
and Prefrsslou Code The Contracmrs License Law dais but apply m an own«of Required Inspections
pnperty who builds«imrovea Nercon,and wo does such work himself or through his
own employees,provided Nat such improvements are net!needed oraRered for silty If.
however.
The Wilding or impmmn att OF sold within one year of completion.On owner-
Wilder will have On burden or poring that se did had Mid or improve for purpose of
ask.).
❑1.as rwsc of the property,am exclusively contracting with Hamed Contractos,to
common the reject(Sec.70th.Rosie and Profusion Cotle:)The Com marine.Li-
cone law does not apply or an owner of property who Wilds or improwes thereon,and
who contracts for such projects wits a contractan(s)licensed p rmumt to the Contractors
Lacune law.
❑Immexempunder See .B&PCforthisor,m.
Dam
WORKER'S COMPENSATION DECLARATION
I hereby aEim under pnWty,of perjury one of the following deskradom:
Q 1 have and will maintain•Canilleate er Cement OF self-intim f«Worker's Comp.-
ubon,aspro for by Section 1700 of Ne labor Cade.far the perfannana of Ne
welt for whichh This petit is ivued.
❑1 have and will maintain Workers Compensation Immnran¢,as wired by Section
3700 of the labor Code,for the pcAormance of the work for which This permit is Issued. '
My Wm1su,` C pe ImuMo urrivand Policy orae art:100
�� -
Camkr. `y)U& J Policy No.: 0/
CERTIFICATE OF EXEMPTION FROMWO ERS'
COMPENSATION INSURANCE
Mus sectlm heed ors to.emphemd if the permit is fares hundred doll.($100)
or lass)
1 certify,Toot in the perfommehee of the work for which this Permit u;Wood.l shall not
employ anypenon in any mannerso as N become subject to the Workers Compematian
Laws of California.Due
A,ficant
NOTICE TO APPLICANT:If,after making Out Certiftnm of Exemption,you should
become subject an the Workers Compensation provision of The Labor Code,You must
.,O forthprovision or comply with such provisioor Nis permit shall Ise dommted
ed u .
'Z"5 CONSTRUCTION LENDING AGENCY
E-a vN. 1 hereby affirm dm them is•conuuctim lending.p.,for the performamoa
Cdue work for which this Permit is issmd(Sec.3097,Civ.Q
W 0 Lenders Name
D z undoes Md....
V Q I oemly dun 1 have mad this application and Forte Nn the above infororN.n is
p, torrent.I qme TO comply with all city and county ordinances and soon laws orlating N
.0 building constmeton,aed omby autharive mprommortivet or this city to enter upon Nc
W move-mentiahed Property for iaspeeuon Tompases
(Wt)agree to save,indemnify and keep hamdess the City of Cuperfino against
rn liabilities,judgments.costs aM upecme,which may in any way name against said City
V Z in consequence of tlm granting of this pumniL
A NT UND STANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
s�r p wnocanra To, 1—�m Re-roofs
HAZARDOUS M AIS DISCLOSURE Type of Roof
Will Ne applicant or fugue Wilding occupant nom Or haMk hrnonew material
as dcrmned by the Cupcomo Municipal Code.Chapter 9.12,and due Health and Safety
.Section 25532e,>7 All roofs shall be inspected prior to any roofing material being installed.
❑Yn a
If a roof is installed without first obtainingan inspection,I agree to remove
WIII dm applicant rouce r unto building by ft B me cy AT,Qu or de ora which P g
emit hauNom air contsminants as defihed by Ne Bay Arta Air Quality Mangcment all new materials for inspection.
District?
[D Y. /91P
1 havered CWNrnumm H3)3rquimmmuundcrchaper&95or .Tot Caliror.
tats aWm&Safety ,SeeuchurIM5,25533su17551<.lundermand thatifmhe building
dos urtendy hsKk,.k dor it IS my responsibility or mutiny th,occupant of Ne
te All roof coverings to be Class'JW'or better
I CITY OF CUPERTINO BUILDING PERMIT
I BUILDING ADDRESS: 10870 N STELLING RD BLDG 54 A -H I CONTRACTOR: WEST BUILDERS, INC. PERMIT NO: 09080072
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:
❑ LICENSED CONTRACpDTOR'S DECLARATION U
License Class r_ Lie. # "_3
Contractor k6l
Date 8_21f F
I 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:
1 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. 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.
Signature
Date 'p' 2r• i
❑ 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 (See. 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 Califomia. 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.
Signature Date_
BERKELEY, CA 94710
PHONE NO: (
BUILDING PERMIT INFO: BLDG r ELECT r` PLUMB r
MECH r RESIDENTIAL r COMMERCIAL r
JOB DESCRIPTION:REVISION UTILITY CLOSET
ORIGINAL: 07120145
Sq. Ft Floor Area: I Valuation: $2500
APN Number: 32609056.54 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
1 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 1 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.
agent: —Date-
CONSTRUCTION LENDING ACENCY
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
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional