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BUILDING DIVISION PERMIT
Bu1LfFERM1717 No.
2l�,lZgpJ�ESSliOMESTEAD RD BLDG 9 A—H WEST BUILDERS, INC. 07120200
OWNER'S N�jA�M(EJ: PERMIT ISSUR DATE
VILLA SERRA APT A CA LTD 1608 4TH ST STE 120 09/26/2008
pHONn T D nrAt SANITARY NO. CONTROL NO.
(510) 525-9378
ARCHrrECrIENGINEEK:
LICENSED COKfRAC10R'S DECLARATION
I hereby affirm that I we licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business an4_lolossions Code, and my He== is
in full face and effect t$ eC
t.leemso ass lJc. R
hate Contractor
ARCHITECTS DECLARATION
I understand my plans shall be used as public records
Licensed Professional
OWNER-BUnMER DECLARATION
I hereby afrinn that I sm exempt from the Contractor's License Law for the
following reason. (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit to conswct, alter. Improve, demolish, or repair any stntemuo
prior to its issuance, abso requires the Applicant for such permit to file a signed statement
that be is licensed pursuant to the provisions of the Contractors Looe law (Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions 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 mere than five hundred dollars (Ssoo).
❑ 1, as owner of the property. or my employees with wages as their sale compensation,
win do the work ad the strttetme is not intended oroffered for sale (See. 7044, Business
and Professions Code The Contractor's License taw does out apply to an owner of
property who buildsor unprmves thereon, and who doessuch wort himself or through his
owe onployees, provided that such Improvements am not intended or offered for sale n.
however. the building or Improvement is sold within one year of completion, the owner -
builder will have the burden of proving that he did not build or improve for purpose of
❑ L as owner of the popaty. am exclusively contracting with acensed cernractors to
mnammct the pmj= (Ser. 7044. Business and Professions Code.) The Contractor's Lf-
ccnse Law does mol apply to an owner of Property who builds or Improves thereon, mid.
who contracts for such projects with a camracmr(f) licensed pursuant to the Contractor
IJcense Law.
❑ I am exempt under See. , B h P C for this reason
Owner Dae
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of pajmy one of the following declarations
❑ t have and will maintain a Certificate of Consent to self -Insure for Worker's Compen-
sation. as provided for by Section 3700 of the Labor Code, for the performance of the
work for which tide permit is issued.
❑ I have and will maintain Worker's Compensation Insurance, as required by Scaian
3700 of the Labor Code, for the perform&= of the work for which this permit is isaued
My Warkefa Coro rraation arta carrier and PolkXjr are:
Carter !" G policy No.: 1'
CERTIFICATE OF E7 PTTON FROM WORKELT
COMPENSATION INSURANCE
(1 his section need nor be completed if the permit is fa oro hundred dollars ($I00)
or lest)
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 Worked Compensation
Laws of California Dam
Applicant
NC TI iO APPLICANT: If, after making this Certificate of Fsempdm you should
become Subject to the Worker's Compensation provisions of the Labor Code, you moa
forthwith amply with such provisions or this peanit shall be deemed revoked
CONSTRUCTION tFNDm AGENCY
I hereby affirm that there is a construction lending agency for the performance of
the work for which this permit is issued (Sec 3097. Civ. C)
Lender's Name
LAndces Address
I cxstify that I have read this application and stat that the shove information is
conecL I agree to amply with all city and county ordinances and sate Laws relating to
building construction, aced hereby authorize representatives of this city to eamr upon the
above-memioned property for impeelion purposes.
(We) agree lo save, indemnify and keep harmless the City of Cuperd m against
liabiRdea, judgments, costs and expenaa whfc4 may in any way aarne against said City
in of the gnmimg of this PermiL
1C _ UND
rP ERSTANDS AND WILL COMPLY Vi(1TH ALL NON -POINT
I HAZARDOUS MATERIALS DISCLOSURE
Will the appllant orfuurro buildfmg occu(ant store orhandle haandoa mamrial
as dented by the Cupertino M Code, Chapter 9.12. and the Health and Safety
Code. Section 25532(a)7
❑ Yes t7N.
Will the applicant or future ding occupant taro equipment a devices which
emit hazardous air contandr uua recd by the Bay Area Air Quality Management
District?
❑ Yes No
I the hazardous materials requirements under Chapter 6.95 of the Califor-
nia th Code, Saxfem 23505, 25533 and 25534. I understand thstif the building
doest vn a irnartt. that It is my responsibility lo naffy the t of the
req w met prior to isarance of a ccrtA-41c of
2e?
BUILDING PERMrr1NFO
BLDG ELECT PLUME MECH
Job Description
NEW APT BLDG 9 A—H 3,154 SF
8/25/08 SEE #07120212'FOR SUBS.
Sq. Ft. Floor Area $555555 Valuation
32609056gNNumber
Required Inspections
Issued by:
Re -roofs
Type of Roof
Type
Date `f - 'L (_' s
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'r/i " or better
CITY OF
CUPEVINO
CITY OF CUPERTINO
NEW SINGLE/MULTI FAMILY DWELLING
PERMIT APPLICATION FORM
1,0 ,7001,P
APN #Date:
9
�eccr� c/ 10 2 00-1
Building Address:
i oftO
CT 7
Mailing Address (if different from building address):
MOO Hole -6k1, 'S - S,„ k:c 160, <,,,, CA <94403
Owner's Name:
V 11 w I
Phone #
D(v'So '13► -3+}5'1
Contractor:
hone #: 5 16
Wz_-" ' �jv� G/'S
Fax #: 511C
Contractor License #:
Cupertino Business License #: T�
Phone #: (ASO ch31
Contact:__
11
�IJNO.GI DWAX. Fax #: ipbo q 31 " 3 OBJ,
Alternate Contact:
Phone #: (*16b AS ` .. r,
SVPA Hblao Of
Fax #: & 6U 1013 36bot
Single -Story ❑ Two -Story Y Three -Story ❑ Basement ❑ Hillside ❑
Multi -family [� Apartment [/ Condo ❑ Townhouse ❑
Sq.Ft. Living Area (Including Basement & Attached Garage:
Sq. Ft. Garage (Detached Only):
Valuation:
Job Description: $Aa %z 1�`^ .� ; �, ���
____iice
11-p^- +*ViO 1 4 11v y� %NA ��^� i • A-sf %,OR .0-AZ0 6,—P to- vvrr
%p,.4 s%^& older. I C.X%AoWz%A%v6 I +VV6,p-*JVP 4 -00 -AA I V% 1
Type of Construction (Usage Class):
Occupancy Type:
1 FR, l lFR ❑ 11, 111,V -IHR ❑ 11, 111, 1 V V -N
POW
Project Size: Standard ❑ Large❑ Major h[J
Green Building: Must attach completed Green Building Checklist to the plans
in
Green Building Points Achieved:
p
For hel , contact Build it Green at www.builditareen.ora
Ott
FA
CITY OF CUPERTINO
NEW SINGLEMULTI FAMILY DWELLING
FEE SCHEDULE
Quantity
Fee ID
Fee Description
Fee.Gronp
Permit Type
1R1INSP
Apt. Bldg inspection fee
B
1R1APT
1RIPLNCK
Apt Bldg plan check.fee
. B
13 I r y
1RIREINSP
Apt Bldg repeat unit .
Inspection fee
B
1RIAPTR
3
1RIREPLNCK
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
Dwellings Repeat Play.
Check
B
1R3H1NSP
Dwellings Hillside
Inspection
B
1R3H]LL
1R3HPLNCK
Dwellings Hillside Plan
Check.----
B
1R3HREINSF
Dwellings Hillside
Repeat Inspection
B
1R3HREPLNC
Dwelling Hillside Repeat
Plan Check
B
1R3ALTINSP,
Dwellings Alternate
Materials
B
1R3SFDALT
1R3ALTPLNCK
Dwellings Alternate
Materials
B
1 GARDTW<=1K
Detached Garage Wood
B
1GARDTM<=1K
Detached Garage
Masonry
B
J
1BCONSTAXR
Constax—Resi/Mobile
B
1 BMITIGA.TR
Residential Housing
Mitigation Fee-chrg only
if lot is vacant or it is a
subdivision -see lanning
PL
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el
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
Planning/Residential
1
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
ark sewer
1BPSPR1iVK
For ea. Lawn Sprinkler Sys-','.
P
on any one mtr, incl.
backflow protect device
1BUSLIC
Business License
B
3 of 3 .