07120196CY OF CUPERTINO
BUILDING DIVISION PERMIT
BUILfT69613SHOMESTEAD RD BLDG 27 A
OWNER'S NAME.
VILLA SERRA APT A CA LTD
UCENSED CONTRACTORS DECLARATION
I hereby affirm that I am licensed under provisions of Claper 9 (commencing
with Section 7000) of Division 3 of the Business and Profeints Code, Wd my license is
in full face and effect. S /?psi EJB
License a Llc. s
Date Contractor 1 J►1
ARCHIIF.M DECLARA ON
I undersand my place shall be used as public records
Licensed ihofosmonal
OWNER -BUILDER DECLARATION
1hereby affirm that 1 am exempt from the Contactors License Law for the
following rumn. (Section 7031.3, Business and Professions Code: Any city or county
which requites construct. fi
PC,.,, m construct. tmprovedcmai(ah re
or repair any strcrru
prior to its issuance. also requires the applicant for such permit m fik a signed statement
that he is (kens d purawnt to the provision of the Contractors License Law (Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that be Is exempt therefrom and the basis for the alleged exemption. Any violation of
Section 7031.5 by acy applicant for a permit subjects the applicant to a civil penalty of
rot mere than five hundred dollars (555(m
❑ L as owner of the property, or my employees with wages as their sob compensation,
will do the wort. and the structure Is not intended or offered for sale (Sec. 7014. Business
and Profession Code. The Contractors Lice= Law does not apply to an owner of
property who builds orimproves tbarom and who doessuch wort himself orthrough his
own empbyocs, provided that such Improvements arc not intended or offered for sale. If.
however, the building or improvement is sold within one year of compktioo. the owner -
builder will have tin burden of proving that he did nm build or improve for purpose of
❑ L as owner of the pmputr am exchadvely contracting with flamed conaaaons to
construct the project (Sec. 7044. Business and Professions Code:) The Contra:tora Li.
cease: Law does not apply to an owner of property who bands or improves thereon. and .
who compacta for such projects with a con ractor(s) licensed porauam to the Comraetera
L c=w Law.
❑ I am exempt under See . B k P C for this reason
Owner Due
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury ane of the following decimations:
❑ 1 have and will maintain a certificate of Consent to seif-Inawe for Wasters Compen•
sWan, as prwidcd for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issue&
❑ I have and will maintain Workers Compensation Insurance, as required by Section
3700 of the Lobar Code, for the performance of the work for which this permit is issued.
My ww ee m asatio trance rtier aced Policy nnuamlbne:
erer a
Cartier. Porky No: ` `_ Q� � I
CERTIFICATE OF P77ON FROM WORKERS'
COMPENSATION INSURANCE
(This sealant need not be completed if the permit is for one hundred dollars (f 100)
Or les,.)
I certily that in the performance of the work for which this permit Is Issued. I shall net
employ any person in any maucr so as to bane subject to the Workers' Campematian
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If. Atter making this Ccmlfiwte of Exemption, you should
become subject to the Workees Compensation provisions of the Labor Code, you mars
forthwith comply with such provisions or this pesnit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that dere is a construction lading agency for the performance of
the work for which this permit Is Issued (Sec. 3097. Civ. C)
Landers Namc
Lenders Address
I certify that I haw read this appliwim and sum that the &hove iaformatico Is
co., 1 &pee to comply with all city and county ordinances and state Iaws relating to
building comwnction, and hereby authorize representatives of this city to ever upon the
above'acted property for Inspection paq—
agree to saw. Indemnify and keep harmless the City of Cupertino against
liabilid cops and exp— which may In Any way accrue against saki City
in the gantlng of This Permit.
A STANDS AND WILL COMPLYALL ON -POINT
SO ONS.
(: v
SigmilirelfA
MLWACORtraclor Due
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or hulk hnudoos material
as defined by the Cnnptxtino M Code. Chapter 9.12. and the Health and Safety
Cade, Section 25532(47
❑ No
Will the applicant Or future building occupant use equipment
co
equipment or devices which
emit huardan w
air maminan by the Bay AAir Quality Managemt
Dlsnict7
❑Yes No
I bow cite harandoua materials requiremetas under Chapter 6.95 of the Califor.
ntisHealth A a Sacions25505.25533And 25534.IunderstandsituUdcbuildintg
does nn. ha a wtua. that It is my responsibility m notify the oaatpant of the
require nn. m be met prior to issuancc of a Catiljcye Oc
rlwry,r n sr l Gam) Date
WEST BUILDERS, INC.
1608 4TH ST STE 120
(510) 525-9378
PERMIT NO.
07120196
PERMIT ISSUE DATE
09/26/2008
SANITARY NO. CONTROL NO.
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Job Description
NEW APT BLDG 27 A — 2,364 SF
8/25/08 SEE #07120212'FOR SUBS.
$555555
32609056:
Required Inspections
74197
'.�
Re -roofs
Type of Roof
Type
Date f ="�' U
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 ';q" or better
ITY OF
CUPEkT1N0
CITY OF CUPERTINO
NEW SINGLE/MULTI FAMILY DWELLING
PERMIT APPLICATION FORM
APN #
Date:
Building Address:
� oaoo �1 orr�e��c•� c� �Lnrn� � T3l �.Z1 A" � �
Mailing Address (if different from building address):
I11t00 SOVAIn N0q,; 14_ 5�,.��-c roo 5•�� 1� �, �A, c14403
Owner's Name: a �1� '
V i 1 w �•�. �/'C��13 lwiru
Phone #
Contractor:
hone #:
Fax #: Sll� gZ {J �OrJSJ'
Contractor License #: $Z53� CJ
Cupertino Business License #:
Contact:
Phone #: (P so 31
4,16inate-A
Fax #: 1060 q 3, .. 2✓b�j1
Alternate Contact:
Phone #: V60 AS I �
Tin Huss
Fax #: 10 60 3 i - 361*01
Single -Story ❑ Two -Story W Three -Story ❑ Basement ❑ Hillside ❑
Multi -family Z Apartment d Condo ❑ Townhouse ❑
Sq.Ft. Living Area (Including Basement & Attached Garage:
Sq. Ft. Garage (Detached Only):
4>115(044—
>113fihValuation:
Valuation:
s SS.S-
Job Descriipttiion: AaAk1 �--
of- rq t& &J%AfW,-M*e
Type of Construction (Usage Class):
Occupancy Type:
1 FR, 11FR ❑ 11, 111,V -IHR ❑ 11, 111, lV V -N [
9-1
Project Size: Standard ❑ Large❑ Major
Green Building: Must attach completed Green Building Checklist to the plans
Green Building Points Achieved:
For help, contact Build it Green at www-builditareen.ora
of
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
1RIREINSP
Apt Bldg repeat unit .
B
1RIAPTR
2-3G
Inspection fee
1RIREPLNCK
Apt Bldg repeat unit plan
B
check fee
1R3INSP
Dwellings Inspection
B
1R3SFD.W
1R3PLNCK
Dwellings Plan Check
B
1R3REPINSP
Dwellings Repeat
B
1R3SFDR.
Inspection
1R3REPPLNC
Dwellings Repeat Plan
B
Check
1R3HINSP
Dwellings Hillside
B
1R3BILL
Inspection
1R3HPLNCK
Dwellings Hillside Plan
B
—
1R3HREINSP
Dwellings Hillside
B
Repeat Inspection
lR3HREPLNC
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
1BCONSTAXR
Constax—Resi/Mobile
B
1BMITIGATR
Residential Housing
PL
Mitigation Fee-chrg only
if lot is vacant or it is a
subdivision -see planning
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CITY OF CUPERTINO
NEW SINGLE/MULTI FAMILY DWELLING
FEE SCHEDULE
Quantity
Fee.ID
Fee Description
Fee Group
Permit Type
1BSEISMICR
Seismic Residential
B
'2 bl
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
Disposal System
/
1PRSEWER
For ea building sewer,
P
sanitary sewer, & ea trailer
park sewer
1BPSPR ,4K
For ea. Lawn Sprinkler Sys'
P
on any one mtr, incl.
backflow protect device
1BUSLIC
Business License
B
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