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07120201306 g�z 3� O� y�5 ZGO �$Pi _Ze >'tF0 e�y�S ❑ O y �z UO BUILDING DIVISION PERMIT BUI NG ADDRESS. `�oo HOMESTEAD RD BLDG 23 A- WEST BUILDERS, INC. PERMIT NO. 07120201 OW 'S NAME: PI RMTr ISSUE DATE VILLA SERRA APT A CA LTD 1608 4TH ST STE 120 09/26/2008 PHOMA ori'mi SANUARY NO. CONTROL NO. (510) 52579378 ARCFDTECUENGINEER: BUIDINO PERMrriNFO BLDG aver PLUMB MECH 1 hereby affirm that 1 w licensed under provisions of Chapter 9 (commencing with Section 700(r) of Division 3 of dee Business *4 Professions Co bpd my license is in full fats and elfecL [T•/4a] tJex ass — s Contractor ARCHrMCT'S DECLARATION I u ndcrstand my pians shall be used as public records Licensed Professional OWNER-BUMDER DECLARATION 1 hereby affirm that i am exempt from the Contraetars license Law for the following ressod (Section 70713, Business and Professions Code: Any City or county which requires a permit to construct, alta, improve, demolish. or repair any stnctum prior to its issuance, also requires the applicant for such permit to file a signed statement chat he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 700(r) 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 70313 by any applicant for a permit subjects the applicant to a civil penalty of net mac than five hundred dollars (11500). ❑ l as owner of the property. or my employers with wags as their sole compensation. will do the work, and the stactum is not Intended or offered for sale (Sec 7044. Business and Professions Code Tia Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself orthrough his own employees, provided that such Improvements are not Ino-nded or offered for sale If, however. the building or improvement is sold within one year of completion. the owner. bulkier will have the burden of proving that he did not build or improve for purpose of sale.). ❑ L as owner of the property. am exclusively contracting with Second contractors to construct the project (See. 7044. Busincts and Profusions Code:) The Coommes I.J. cense Law does mot apply to an owner of prapeny who builds or improves thereon. and. who contracts for such projects with a coniramor(s) licensed pursuant to the Contactors LJeemsm Law. ❑ I am exempt under Sec B h P C for this reason Owner Dao WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a Certificate of Consent to self -Insure for Workers Corrpen. sation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ i have and will maintain Workers Compensation Insurance, as mgrdmd by Section 3700 of the Labor Code, for the performance of the work for which this permit is Issued My Worker's Cam etsario uraeece reser and Policy number are: cartler Policy No.., LI'DCco-4 l FIGTE OF LI7NPTION FROM WORKERS' COMPENSATION INSURANCE (nds section need not be completed if the permit is for one hundred doBan (S 100) or less) 1 cenify that in the performance of the work for which this permit is issued 1 Shan not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT'. If, after making this Certificate of Exemption, you should become subject to the Workers Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this pernil shall be deemed revoked CONSLRUCITON LENDING AGENCY I hereby affirm that thea is a construction lending agency for the performance of the work for which this permit is issued (Sec. 7097, Civ. C.) Lenders Neuse Larders Address i certify that I have read this application and state that the above infamadon is correct. I agree to comply with all city and county ordinances and sate laws misting to building construction. and hemby aut "bz representatives of this city to Cote upon the above- Oiled property for inspection purposes CICFRgST..l ademnify and beep harmless the City of Cupertino agdmn liabnd expenses which may In any way accrue against said City In cng of this permit. APNDS AND WILL COMP Y WrrH lL NON -POINT so O g S(gractar Dora HAZARDOUS MATERIALS DISCLOSURE W18 the applicant or future building occupant stem or handle htardo s material u del6ad by the Cupertino M 1 Code, Chapter 9.12, and the Health and Safety Code, Section 25532(a)7 ❑ Yes No Will the applhxnt a future building occupant use equipment a d,I= which emit hazardous air contannt.L�defmcd by the Bay Area Air Quality Management DLwict7 ❑ No 1 Nthczardous maarialarequirements under Chapter 6.95 ofthe Califor. ria dtSeeders25505.25533and25534.1undersandthatifthe building dap t c tenant, that It is my responsibility o notify ire occupant of tree req ' be met prior to kmance of a of Owner or k6eivedlient Date Job Description NEW APT BLDG 23- 3,154 SF 8/25/08 SEE #07120212*FOR SUBS. Sq. Ft. Floor Area $555555 Valuation 32609056: Required Inspections Issued by: Re -roofs Type of Roof Occupancy Date r zG ' All roofs shall be inspected prior to any roofing material being installed. . If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant Date All roof coverings to be Class *#1 or better k tv CIN OF CUPEI�l CITY OF CUPERTINO NEW SINGLE/MULTI FAMILY DWELLING PERMIT APPLICATION FORM APN # 32t• — o� _ o s�,���� Date: 2 00'I Building Address: Mailing Address (if different from building address): 140too S��„-�1n No��o�1� S ar-e S�.`�-er roo 1 S•►� I.� eo, M 94403 Owner's Name: 1- o. G�-1� r► �.. V i tl^ se Jnr•,. �/T h�3 l i � .` Phone # Contractor: hone #: 5 1a gL5 ••�i�j1$ t wz_,�- av�i C+�/5 Fax #: SIC' '52-S-0665 Contractor License #: 82.530115 Cupertino Business License #: Contact: Phone #: (Aso q 3 l II__ 11 Nl CJ�`a�l DWAX.Fax #: Alternate Contact: Phone #: SA6F� TIMA H -b%& Fax #: IO 60 361 01 Single -Story ❑ Two -Story Three -Story ❑ Basement ❑ Hillside E] Multi -family [,� Apartment [� Condo ❑ Townhouse ❑ Sq.Ft. Living Area (Including Basement & Attached Garage: Sq. Ft. Garage (Detached Only): 3116 Valuation: 555. 5555 Job Description: k\C-PA 4 rwA^ZlCAkl� wP -- +VV -0,\ 4 111* 66.,E �v*4s • iPA-0wt %0 ` ..a•4.0 b'G vvry " led s%W%6410a I CA\ oA oN►..c +- te..hJv ro0--AA V1%v�e�s Type of Construction (Usage Class): Occupancy Type: 1 FR, 11FR ❑ 11, 111,V -IHR ❑ 11, 111, lV V -N 9-1 OWA 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.buiiditareen.ora 01 • CITY OF CUPERTINO NEW SINGLE/M[TLTI 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 Inspection fee 1RIREPLNCK Apt Bldg repeat unit plan B check fee lR3INSP Dwellings Inspection B 1R3SFDW 1R3PLNCK Dwellings Plan Check B 1R3REPINSP Dwellings Repeat B 1R3SFDR. Inspection 1R3REPPLNC Dwellings Repeat Plan B Check 1R3HINSP Dwellings Hillside B 1R3HILL Inspection MFI:PLNCK Dwellings Hillside Plan B Check__ 1R3HREINSF Dwellings Hillside B Repeat Inspection 1R3HREPLNC Dwellieg Hillside Repeat B Plan Check 1R3ALTINSP- Dwellings Alternate 13 1R3SFDA.LT 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 lanni.n 2of3 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 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+) N r 1PPRSEWG Ea. Private Sewage. P Disposal System 1PRSEWER For ea building sewer, P sanitary sewer, & ea trailer ` park sewer 1BPSPRINK For ea_ Lawn Sprinkler Sys ' P on any one mtr, incl. backflow protect device 1BUSLIC Business License B 3 of 3 .