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07120197loo iU 9 J4 CITY OF CUPERTINO BUILDING DIVISION PERAM Bu1LD,(N�,�gp� HOMESTEAD RD BLDG 28 A I WEST BUILDERS, INC. OWNER'S NAME: VILLA SERRA APT A CA LTD 1608 4TH ST STE 120 ARCHI EC )ENGINEER: I hereby affinm that 1 am liocnaed under provisions of Chapw 9 (commencing with Section 70110) of Divldon 3 of the Business and Professions Codd, and my licence is in full force and effect. LiceDalc!7 Cl Contractor Due CHriECI'S DECLARATION— I understand my plata stall be used as public records Licensed Professional OWNER-BUMDI7t DECLARATION 1 hereby affirm that I am exempt from the Contractors IXonse Law for the following reason. (Section 703 M. Business and Professions Code: Any city or county which requires a permit to co eruct. alter. improve, demolish. or repair any structure prior to its inuanez. also requires the applicant for such permit to file a signed statement that be is licensed pursuant to the provisions of the Contrectoes License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Profession, Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not mac than five hundred dollars (5500). ❑ I, as owner of the property, or my employees with wages as their sok compenatlon, will do the work. and the structure Is not Intended or offered forsalo (Sec 7044. Business and Professions Code The Coousictors License Law does not apply to an owner of property who builds or improves thereon, and who does such wort himself or through ilia own employem provided dud such improvements ase not intended or offered for sale. IL. however, the building or i mprovermenl Is sold within one yew of completim the owner - builder will have tis burden of proving that he did not build or bnprom for purpose of sale.). ❑ I, as owner of the property. am exclusively contracting with licensed cmtrattors to construct the project (Sec. 7044. Business and Professions Gee:) The CooUanoes U amse Law does not apply to an owner of property who builds or improves thereon. and who contracts for such projects with a contractor(s) Hewed pursuant to the Contactors L.ieense Law. ❑ I am exempt under Sec. B & P C for this mason Owner Due WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations ❑ 1 have and will maintain a Cctifcare of Consent to self -Insure for Workers Compen. ation. as provided for by Section 3700 of the Labor Code. for the performance of the work for which this permit is issued. ❑ 1 have and will maintain Workers Compensation Instance, a required by Section 3700 of the Labor Code, for the porfmmance of the work for which this permit is issued. My Worker's Caner ado, L nate carrier and Policynumber O Carter Polley No CERTIFICATE OF IJ PrION FROM WORKERS COMPENSATION INSURANCE (This section need not bre completed U the permit is forono hundred dollm ($101) Or Iesa) 1 cerufy that in the performance of the work for which this permit is issued I shall not employ any person in any mauler so a to become subject to the Workers' Compensation Laws of California. Due Applicant NOTICE TO APPLICANT. Ir. alter mating this Cerd iate of Exemption. you should became subject to the workers Compensation provisions of the Labor code, you must forthwith comply with such provisions or this peanit shall be deemed mvokcd. CONSTRUCTION LENDING AGENCY I bemby affirm that there is a construction lending agency for the perfarmance of the work for which this permit is issued (Sec. 3097. Civ. C.) Lenders Nature Landers Address 1 certify that I have red this application and sate that the ,hove information is coned I agree to comply with all city and county nrt9.unces and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above-mptionctl property for inspection p° i ) agree to ave, indemnify and keep harmless the City of Cupertino against IfajL4NT$NDERSTANDS mena, toss and expenses which may In dry way accrue against said City inf the granting of this pCrMIL A AND WILL COMPLY WITH ALL N POISONS.2 V Si A tractor bate HAZARDOUS MATERIALS DISCLOSURE Will the applicant or fumuc building occupant sure or handle haardom material as dented by theGryatino M pal Code. Chapter 9.12. and the Health and Safety Code.Scelic 25532(U7 ❑ Yes rg No Will the AWICI nt or 11 to building occupant use equipment or devices wNch emit iazardoua air contaminants ned by the Bay Area Air Quality Management DWrict7 ❑ No I thehazardousmaterials requbemrltuwderChaptr6.95oftbeCalifor- Znia Code Sd�lons 25505.25533 ad 23534.1 m&ntmW thatif the buNing does t vo a wris m. that it Is my responsibility m notify the occupant of the ust be met prior m Lssoancc of a certiOcS(p b (.i Owner or orv2d agent Dare (510) 525-9378 PERMIT NO. 07120197 PERMrr ISRM DATE 09/26/2008 SANITARY NO. CONTROL NO. BUILDING PERMIT INFO BLDG ELECT PLUMB Job Description NEW APT BLDG 28 A — 2,364 SF 8/25/08 SEE #07120212 FOR SUBS. Sq. Ft. Floor Area $555555 Valuation 32609056 Required Inspections Issued by: Re -roofs Type of Roof Date /� -7 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 %" or better .�E CI OF CUPEkT1NO CITY OF CUPERTINO NEW SINGLE/MULTI FAMILY DWELLING PERMIT APPLICATION FORM APN # 32�• - a1- o 54F Date: Deor mev to, 2 oo-i , Building Address: oaoo O W►C'd.,►� B144 z8 h VA Mailing Address (if different from building address): Igloo 5�,.�-}fin No��oti�. S%r-emA-1 StkNk:e. 160 , Sow, 4r,�, M 94403 Owner's Name:L v i 1 w rr•�. V'C � IMM + of Phone # : (p5� 31-351 Contractor: hone #: 516 U1G_'Jr �v� ta/�j Fax #: 51C' '52.5-066.6 Contractor License #: 82.53 15 Cupertino Business License #: Contact: Phone #: (P SO C% 3 t 11 ���alr►l DtiwdTc. Fax #: 1060 q Sk " ✓'1o�J, Alternate Contact: Phone #: V16b AS I .. 1.&4� TVPA Hib%bo Fax #: to 60 d13 \ — 361001 Single -Story ❑ Two -Story Three -Story ❑ Basement ❑ Hillside. ❑ Multi -family [� Apartment d Condo ❑ Townhouse ❑ Sq.Ft. Living Area (Including Basement & Attached Garage: Sq. Ft. Garage (Detached Only): X13(vs} 4, Valuation: Ss� S-S-.S— Job Description: `�.T1� r�fW VW%^4 %tAAMP, • 7IA40fG 46.. vvc� te•� s►� ��� �. �1�vbwN►�.t +VVe. kty' Yoa%AA) ems ro.:,nn� 1 Type of Construction (Usage Class): Occupancy Type: 1 FR, 11FR ❑ 11, 111,V -IHR ❑ 11, 111, lV V -N �1 iit AF�rr Project Size: Standard ❑ Large❑ Major J Green Building: Must attach completed Green Building Checklist to the plans Green Building Points Achieved: For help, contact Build it Green at www.buiiditgreen.org o1 • CITY OF CUPERTINO NEW SINGLE/MULTI FAMILY DWELLING FEE SCHEDULE Quantity Fee ID Fee Description Fee.Group Permit Type IRI INSP Apt. Bldg inspection fee B 1R1APT 1R1 PLNCK Apt Bldg plan check. fee . B 2-'3 6 `� 1RIREINSP Apt Bldg repeat unit Inspection fee B 1RIAPTR Z3� 1 R 1 REPLNCK Apt Bldg repeat unit plan check fee B 1R3INSP Dwellings Inspection B 1R3SFDW 1R3PLNCK Dwellings Plan Check B 1R3REPINSP Dwellings Repeat Inspection B 1R3SFDR. 1R3REPPLNC Dwellisigs Repeat Plan Check B I -INSP Dwellings Hillside Inspection B 1R3B LL 1R3HPLNCK . Dwellings Hillside Plan Check..._ B - 1R3HREINSP' Dwellings Hillside Repeat Inspection B 1R3I3REPLNC Dwelling Hillside Repeat Plan Check B 1R3ALTINSP- Dwellings Alternate Materials B 1R3SFDA.LT 1R3ALTPLNCK Dwellings Alternate Materials B 1GARDTW<=1K Detached Garage Wood B. 1GARDTM<=1K Detached Garage Masonry B 1 1BCONSTAXR Constax—Resi/Mobile B 1BMITIGATR Residential Housing Mitigation Fee-chrg only if lot is vacant or it is a subdivision -see lanning PL 2 of 3 CITY OF CUPER I NO NEW SINGLE/MLTLTI FAMILY DWELLING FEE SCHEDULE Quantity Fee.ID Fee Description Fee Group Permit Type 1BSEISMICR Seismic Residential B 1PLLONGRNGR Long Range PL 2(3 G H Planning/Residential 1BPWSVCS Main Water Service P 1BSWIM Swimming Pool B 1PCESS For Ea.Cesapool P 1PATMOBF For Atmospheric Type P Vacuum Breaker - backflow not included in item 1 (1-5).(5+) . �r 1PPRSEWG Ea. Private Sewage P f 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 .