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CITY OF CUPERTINO
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BUILDING DIVISIONz
PERMIT
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BUI 1 SING D sS:
GOff HOMESTEAD RD BLDG 19 A—
WEST BUILDERS, INC.
FEItMrr NO.
07120195
OW 'S NAME:
I MUM ISRM DATE
VILLA SERRA APT A CA LTD
1608 4TH ST STE 120
09/26/2008
PHONBa o rRTT
SANITARY NO. CONTROL NO.
(510) 525-9378
ARCHiIECr/ENGiNEM
BUILDING PERMrr INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
P
I hereby alarm that I am licensed under provisions of Chapter 9 (commencing
with section 7000) ofDivision 3 of the Business aj4 Profradom Code. and my lleenc is
NEW APT BLDG 19 A — H — 4,391 S F
in full to= and dEwL
MIC Lrc..
8/25/08 SEE #07120212 'FOR SUBS.
Date Contractor
ARCHrTECCS DECLARATION
I understand my plans shall be used as public meorda
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractors License Law for the
following Mason. (Section 70313, Business and Professions Coda Any city or county
which requires a permit to construct, alter, improve, demolish, or repair any structure
prior to is issuance, also requires the applicant for such permit to file a signed statement
this be is licensed purmani to the provisions of the contractors Liceuua Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 7000) of Division 3 of the Business and Profersiou code) err
$555555
that be is exempt tbem1rom tad be basis for the alleged exemption. Any vlolathoa of
3 2 6 !` PAWumber
Oecu ane Type
y Type
Section 7031.3 by any applicant for a permit subjects the applicant to a civil penalty ofp
ml more than five hundred dollars (s500).
6 0 9 0 5
❑ L as owner of the property, or my employees with wages as their sole compensation,
Required Inspections
will do the work, and the structure is not intended or offered for sale (Ser. 7044. Business
and Professions Code: The Contactors License Law does not apply to an owner of
property who builds or improves thereon, and who does such work himself orthroogh bier
we emplayees, provided that such improvements we not Intended or offered for sale. V,
however, the building or improvement is sold within ase yew of completion. the owner -
builder will have the htuden of proving that he did am build or improve for purpose of
sale.).
❑ 1. as owner of the property, am exclusively contracting with licensed contractors to
consumer the.projea (Sec 7044. Business and Profeavons Code) The Coatractoes Li.
come Law does not apply to an owner or property who bulkier or improves themon. and .
who contracts for such projects with a conuactor(s) licensed pursuant to the Contractors
L icenso Law.
❑ 1 are exempt under See. B d: P C for this reason
Owner Due
WORKERS COMPENSATION DECLARATION
I hereby aa'um under penally of perjury one of the following declarations:
❑ I have and will maintain a CcUBate or Consent to self -insure for Worl ens Conpen-
sabot, as provided for by Section 3700 of the Labor Code. for the performance of the
work for which this permit issued.
❑ I have tad will maintain Workers Compensation Insurance, as required by Section
3700 or the Labor Code. for We pmiarmu cc of the work for which this permit is issued.
MY W oro ematia rsaz carrier and Policy number are:
Carrier Policy No.:
CERTIFICATE OF Cl]viPrION FROM WORKERS'
COMPENSATION INSURANCE
(This section meed not be completed U the permit is foram hundred dollars (SIOq
or less.)
I certify that in the performance of the war for which this permit Is issued. I shall not
employ any person in any rosea r so as to become subject to the Worbes' Compensation
Laws of California. Date
ApplicuLL
NOTICE TO APPLICANT: If. after making Wim Certificate or Exemption, you should
become subject to the Workers Compcmation provisions of the Labor Code, you mum
forthwith comply with such provisions or this peamit shall be deemed revoked.
CONsmucnON LENDING AGENCY
I hereby affirm that them is a comaruction lending agency for the perform&= of
the work for which this permit is Issued (Sec. 3097, Civ. C.)
Lenders Nemo
Lenders Address
I certify that I have mad this appliadon and sum that the above Information Is
errmcl 1 agree to empty with all city tad county ordinances and sure laws misting to
building construction, tad hereby authorim represenatives of this city to enter upon the
above- pro;- y far Inspection puq—
/07
(Wel lzme to ave. Indemnify and keep harmless the City of Cupertino against
liabilities, j ,%costa and expema which may in any way aceuue against said City
in corueq gram ing of this permit.
AP STANDS AND WILL COMPLY WITH ALL GN -POINT
/
Issued by: Date c- ri
SO NS.
Re -roofs �Z
Type Of Roof
O
Signature o US MAT ER1ALs DlscLosulta Date
W it Iho tar fume building occupant atom er handle hazardous material
as dented by the CupertinoMurdgfpal Code. Chapter 9.12, and the Health and Safety
Code. section 25532(.)7/No
All roofs shall be inspected prior to any roofing material being installed.
❑ Yea
•
devices
If a roof is installed without first obtaining an inspection, I agree to remove
WBI the applicant dor mime bj a;ng occupant use equipment dor which
emit haxardoua air conuunl find by the Bay Ara Air Quality Ma agmmat
all new materials for inspection.
District?
❑ o
1 hammd~✓material-mWkcmcnuunderampmr&95oftheCsiifer-
nia Ha1W k et Saban 25505.25533 and 23534. I wJmmand timif thc building
docs no ti a tnmant, War It is my responsibility to co ' y the pout or the
req n be met prior to issuance of a Coif f
ere
O
All roof coversn to be Chas!'" or better
Owner ora gent I f
-all
QTY of
CUPEkTINO
CITY OF CUPERTINO
NEW SINGLE/MULTI FAMILY DWELLING
PERMIT APPLICATION FORM
APN #
.32 -to- oil _ o s (� ,19 A 1+
Date:
Building Address:
buo 11 -� Q 11 '1 /� tJ,
OrAtb-FG� G'�� p G lat A"
Mailing Address (if different from building address):
S.^v, �Aakeo, M 944o3
Owner's Name: �dwPhone
V i 1 w r�•� v �n}3 l i��}�. 01 4*4, mft
#
Contractor:
hone #:
WC—Jr 9v%%CtCW4,
Fax #: 610 'SZ -0555
Contractor License #: 82.534%45
Cupertino Business License #:
Contact:I_
Phone #: (A so �'� 1 •
11
�A%% c- `ate -A lDwAx.
Fax #:
Alternate Contact:
Phone #: Vtb A 31 r, 34
irk HUS&
Fax #: 1p&0 01 3\ — 361*01
Single -Story ❑ Two -Story Y Three -Story ❑ Basement ❑ Hillside ❑
Multi -family Y Apartment [� Condo ❑ Townhouse ❑
Sq.Ft. Living Area (Including Basement & Attached Garage:
Sq. Ft. Garage (Detached Only):
443FA1 4
Valuation:
S
Job Description:d`� ,�`,� •}�, ��,�
LAW
►e� s�� oto �. a1�l�v�,+�►+•� i�n�.-�tt�r �'O� �,'�-v�e�s re.�,nn� 1
Type of Construction (Usage Class):
Occupancy Type:
1 FR, 11FR ❑ 11, 111,V -IHR ❑ 11, 111, 1V V -N
al 4 *k
Project Size: Standard ❑ Large❑ Major 61
Green Building: Must attach completed Green Building Checklist to the plans
Green Building Points Achieved:
For help, contact Build it Green at www.bui[ditareen.orQ
R%
CITY OF CUPERTINO
NEW SINGLE/MULTI FAMILY DWELLING
FEE SCHEDULE
Quantity
Fee ID
Fee Description
Fee Group
Permit Type
1RIINSP
Apt. Bldg inspection fee
B
1R1APT
1RIPLNCK
Apt Bldg plan check. fee
. B
1R1R.EINSP
Apt Bldg repeat unit .
B
1RIAPTR
Inspection fee
1R1R.EPLNCK
Apt Bldg repeat unit plan
B
q3l(
check fee
1R3INSP
Dwellings Inspection
B
1R3SFD.W
1R3PLNCK
Dwellings Plan Check
B
1R3R.EPINSP
Dwellings Repeat
B
1R3SFDR.
Inspection
1R3REPPLNC
Dwellings Repeat Plan
B
Check
1R3HINSP
Dwellings Hillside
B
1R3H]LL
Inspection
IR3HPLNCK
Dwellings Hillside Plan
B
_Check_ — _
1R3HREINSP
Dwellings Hillside
B
Re eat Inspection
1R3HREPLNC
Dwelling Hillside Repeat
B
Plan Check
1R3ALTINSP
Dwellings Alternate
B
1R3SFDALT
Materials
1R3ALTPLNCK
Dwellings Alternate
B
Materials
1GARDTW<=1K
Detached Garage Wood
B
1GARDTM<=1K
Detached Garage
B
Masonry
f
1BCONSTAXR
Constax—Resi/Mobile
B
1BMITIGATR
Residential Housing
PL
Mitigation Fee-chrg only
if lot is vacant or it is a
subdivision -see lannin
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T
• CITY OF CUPERTINO
NEW SINGLE/MULTI FAMILY DWELLING
FEE SCHEDULE
Quantity
Fee.ID
Fee Description
Fee Group
Permit Type
1BSEISMICR
Seismic Residential
B
1PLLONGRNGR
Long Range
PL
Planniug/Residmfial
1BPWSVCS
Main Water Service
P
1BSVJIM
Swimming Pool
B
1PCESS
For Ea.Cesgpool
P
1PATMOBF
For Atmospheric Type
P
Vacuum Breaker -
backflow not included in
item 1 (1-5).(5+) .
1PPRSEWG
Ea. Private Sewage
P
W
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 .