07120198CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
-CONT! CT,,OR Nk',U 'TATTION
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dh Bu1(nIM tTffsSiOMESTEAD RD BLDG 25 A
WEST BUILDERS, INC.
PERMITNO.
07120198 ,
R'S NAME:
PERMIT ISSUE DATE
VILLA SERRA APT A CA LTD
1608 4TH ST STE 120
09/26/2008
SANITARY NO. CONTROL NO.
(510) 525-9378
ARCHr1ECfIENGINEER;
BUILDING PERMD' INFO
BLDG ELECT PLUMB - MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
lob Description
P
1 hemby sunme Nal I am licenvd under provisions of Chapter 9 (commencing
with Secliort7") of Divides 3ofdm Bednar and Professions Code,, mylmense is
NEW APT BLDG 25 A - 2,364 SF
Li:.!<"��i`.yy°..nd`rr"` Lk.g s
8/25/08 SEE #07120212 FOR SUBS
Dammr_ ..Con
1EC
�y;A R�CNftECI'S DECLARATI N
1 understand my plans shall h used a public mcmda
Licensed Pmfcod ..I
OWNER-BUILDER
mDECLARATION
I hrobY (firm that 1 uempt from the ConLicense taw for me
1 1. airmr. aM Professions Code: Any city m scurvy
knowing mason. . ons Co
eauto
construct,
which mgulnns • permit to cnnswet a@r. improv. demullah, or repair any structure
t,
'
! prior to is issuance.dw requires the applicant forsuch permit us file a signed statement
he u licensed In me me Conuasm's License Law(LTapmor9
Sq. Ft. Floor Area
Valuation
IMI purstanl proHdwsaf
$555555
(commenting with Section 70DO) of Division 3 of rise Business and Profcmions Codc) or
that he is exempt muei' om and the bout for me alkgcd eumpuom Any Holation of
3 2 6 0 9 0 5 6 AFNpjiumber
Occupancy Type
Section 7031.5 bypermit ruby cts me applicant m ° civil penalty of
�dredapplicants,
mn me. for ($5004
1, u ownor of Jm prvpmy, a mY wpltyeca aW vngn u the'v sok compewdon,
do Budans
sense:
Required Inspections
lesions The CumunotkmndWe Lawus am
aro Professions Ctde: The Conuacton. License Law dorm not apply m rt ,war of
red dos mm apply
_
W andwho saessuchworkhimselfathrough his
whobuiW,trimproves
himpr
own em Wlsochimpmwmensamne earoedoroRued for sale. If,
twoemr,
mers,proHEW
hmice, Ne building or is sols within one year orI m the
animprowmont
cases for case of
hildor H0 haw Ih burden of gaHnG IMI h did rot MdW a Imposes for purpose of
no.).
Ej 1, u owner of the property son conclusively contacting with Bcemued contractors to
consuoet the project (Sex. 7044. Business and Professions Code:) The Ccomcwrs U.
.
cense law dorm not apply in an owner of property who builds or improvns th eon, and
who contscts fmoch projecs with, commeux(s) licensed Pursuant m the Contacmla
me IJW.
emeumptunder See .BAPCform
dlisawn
In
rr Due
WORKER'S COMPENSATION DECLARATION
1 hereby air= under penally of perjury one of the folkwing declarstions;
.
❑ IhsmandwllmunWna CutiOamofComnuomlf-insumfor Wt esComan-
vtion, as pmvised for by Section 3100 of the labor Code. for the performance of me
wort for which this permit is issued.
l lions= and will maintain Werlmre Compensation Inammee, as Rgt red by Section
3100ofine Lahr Code. for the pcmformaae of the wort for whim mu permit is issued
.
My world, Cam cvautn sumnce curia mud Policy n��mybbc��aaam�s.�
limier. '� Poliry
CERTIFlC ROMW
EIONINSPRAN WORKERS
O PEN
COMPENSATION INSURANCE
(Thi, section heed Inst hcomplemd If the permit is Ionto hundred dollu° ($100)
or leas)
I certify in., in me performance of me work for which thin permit is issued. l shall on,
employ any person in any manrmrso as m became subject m lh Workrn' Cncep tuadden
Laws of California. Dam
Applicant
NOTICE TO APPLICANT: IL after mating this Certificate of Exemption. you should
become subject in Ih WmIkcYs Compensation pmvidona of the labor Code you mus
foMwilh comply with such provuinns Or this Permit shall h doomed revoked.
I
CONSTRUCTION LENDING AGENCY
I hmby alarm that them is a construction lending apeay for the performance of
the work for which this permit u usred (Sec. 3091, Civ. C.)
Lender's Name
Lessner Address
-
1 cenify that 1 haw mad this application and sum dust the abtw infam then is
corm I aOca on comply with all city and county ordinances and sum laws relating m
buildings pion, modhmby cuthodse reprosenutiws ofmis city m color upon the
ahtm-m " ad PmpcnY for insaction purposes.
gme re aaw, indemnify and trop harmless Ih City of Cupertino agdml
liabilities fsaodoxpeoses which may in any way acctuc agdml said City
ins nseg e ranting of this pmmlt.
STANDS AND WILL COMPLY WI ALL ON-POINT
R.,
1
Issued by:DateINS,
^ b
ll / �/ `iJA/
saV
Re-roofs
Signuu A UConllacror Das
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applicant orfuuue wilding oauPmt mom m Mndk hrnrdow malorid
fined by dm Cupeniw M ipal Code. Chapter 9.13,
asW con Health and Safety
. Serono 35533(.)?
❑Ye, Nt
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or fuw (ding occupant use equipment or JeHus which
If a roof is installed without first obtaining an inspection, agree to remove iection, I
P
C.IL lloV dnw all cnnuminarl defined by the Bay Ama Air Quality Mans,cmcm
all new materials for inspection. -
❑sacs Nu
cul the Musdums malorialaroquimmensunderCMPlorG93ortheGliror-
m.Hijpty Code.Sccuus25505,25533and25534.1oo omndmmifthe Wilding
docsntt7�) Msec s mnane mar It u my maWrmibilitY m aury dm occupant nr me
omh
rcqul mLLmhotelRormismimccofaC=IIIr= oroc 1 .
Signa[ureofApplicantDate
All roof coverings to be Class '%¢" or better
]sent D,m'
CITY OF
CUPEVIN0
CITY OF CUPERTINO
NEW SINGLE/MULTI FAMILY DWELLING
PERMIT APPLICATION FORM
d, 2�0 / �, �
APN #
32t* — cook— O 5 (P
Date:
k() 'Z001
Building Address:
X01%0 l��orn� 31c�c� LS/4--fi
orAt� �c� A
Mailing Address (if different from building address):
00 <>C,VAl N No,e;o11ez_ Skr4w\-, S" \k e. Ck 94403
Owner's Name:
V i � w rr�. �/��� Iw��}�• o, �+
one #
(pbo 'I 31-345'1
Contractor:
hone #: 5 �4 gL�j -At3la
j
WC -Jr & �\%C�t/5
Fax #: 510 525-04566
Contractor License #: 82.53' CJ
Cupertino Business License #:
Contact:11
Phone #: 1P so ci 31 —
1A%%c�GIeI
Fax #: 1060 at 3k — 3*61
Alternate Contact:
Phone #: V&b , 3, .. 34 6F�
% HbS&
Fax #: & 60 d"I 3 - 36b&i
Single -Story ❑ Two -Story Y Three -Story ❑ Basement ❑ Hillside. El
Multi -family Y Apartment V Condo ❑ Townhouse ❑
Sq.Ft. Living Area (Including Basement & Attached Garage:
Sq. Ft. Garage (Detached Only):
91131014
Valuation:
55ss
Job Description: `'AcftN r4A ^z\cM% •}�,�, �, �{, �
L%P 0— +VV�0.\ 4 111* \A A\4M . I A4fe, %00R *.A 0. a ID.,.& ak.-
1e.ss�r ol�lrl�. �1�oM,oN►�,c +- te.-kJV foo -,AA ems ro rnn� 1
Type of Construction (Usage Class):
Occupancy Type:
1 FR, llFR ❑ 11, 111,V -IHR ❑ 11, 111, lV V -N
e`
Project Size: Standard ❑ Large E] Major
Green Building: Must attach completed Green Building Checklist to the plans
Green Building Points Achieved:
For help, contact Build it Green at www.bu ilditgreen.ora
Ott
.41
CITY OF CUPERTINO
NEW SINGLElMULTI FANIILA DWELLING
FEE SCHEDULE
Quantity
Fee ID
Fee Description
Fee.Group
Permit Type
1RIINSP
Apt. Bldg inspection fee
B
1R1APT
1 R1 PLNCK
Apt Bldg plan check. fee
. B
1RIREINSP
Apt Bldg repeat unit
Inspection fee
B
1RIAPTR
1RIREPLNCK
Apt Bldg repeat unit plan
check fee
B
1R3INSP
Dwellings Inspection
B
IR3SFDW
1R3PLNCK
Dwellings Plan Check
B
1R3REPINSP
Dwellings Repeat
Inspection
B
1R3SFDR.
1R3REPPLNC
Dwellings Repeat Plan
Check
B
1R3HINSP
Dwellings Hillside
Inspection
B
1R3BILL
1R3HPLNCK
Dwellings Hillside Plan
B
-
1R3HREINSP
Dwellings Hillside
Repeat Inspection
B
1R311REPLNC
Dwelling Hillside Repeat
Plan Check
B
1R3ALTINSP
Dwellings Alternate
Materials
13
1R3SFDALT
1R3ALTPLNCK
Dwellings Alternate
Materials
B
1GARDTW<=1K
Detached Garage Wood
B.
1GARDTM<=1K
Detached Garage
Masonry
B
1BCONSTAXR
Constax—ResifMobile
B
1BMITIGA.TR
Residential Housing
Mitigation Fee-chrg only
if lot is vacant or it is a
subdivision -see lannin
PL
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CITY OF CUPERTINO
NEW SINGLE/WILTI FAMILY DVVELLING
FEE SCHEDULE
Quantity
Fee ID
Fee Description
Fee Group
Permit Type
1BSEISMICR
Seismic Residential
B
` J
1PLLONGRNGR
Long Range
PL
Planning/Residential
1BPWSVCS
Main Water Service
P
1BSWIM
Swimming Pool
B
1PCESS
For Ea.Ces*pool
P
1PATMOBF
For Atmospheric Type
P
Vacuum Breaker -
backflow not included in
item 1 (1-5).(5+) .
1PPRSEWG
Ea. Private Sewage
P
N
Disposal System
1PRSEWER
For ea building sewer,
P
/
sanitary sewer, & ea trailer
ark sewer
1BPSPRINK
For ea. Lawn Sprinkler Sys-''.
P
on any one mtr, incl.
backflow protect device
-.
1BUSLIC
Business License
B
3 of 3 .