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07120202BUILDING DIVISION PERAUT BUILDING ADDRESS: PERMIT NO. 20800 HOMESTEAD RD BLDG 67 A- WEST BUILDERS, INC. 07120202 OW 'S NAME. PERMRLSSUBDATE VILLA SERRA APT A CA LTD 1608 4TH ST STE 120 09/26/2008 PHONRA D rrT%T SANITARY NO. CONTROL NO. (510) 525-9378 ARCHiTECIYENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH ' I hereby afllrm that I me liamed under provisions of chapter 9 (commencing with Section 70D0) of Divislon 3 of the BusLnczand Profession Code, and my license Is in full farce and effect. Ucm m C a Lk• 6 Date contract" ARCHrIECTS DECLARATION I understnd my plana shall be used as public records Licensed Professional OWNER-BUMDER DECLARATION 1 hereby affirm that 1 am exempt from die Contractors Licertsc Lew for the following mason (Section 7031.5, Business and Prorcaaiom Code: Any city or county which requires a permit to consum4 situ, improve, dcmoitsh, or repair any structure prior to its issuanw. also requires the applicant for such permit to file a signed statement that he Is licensed pursuant to the provisions of the Contactors Ucenm 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 rot more than five hundred dollar (SS00). ❑ L as owner of the property. or my employ= with wages as their sob compensation, will do the work and the structure Is not intended or offered for ask (See. 7044. Business and Professions Code The Contactors License Law does not apply to an owner of property who builds or improves thereon. and who dors such wort bimaelf or through his cow employees, provided that such improvements are not Intended oroffcmd for sate If, however, the building or impmvcmem is sold within one year of completion, the owner - builder w1B have the burden of proving that he did not build or improve for purpose of sale.). ❑ L as owner of the property. am =elusively contracting with licensed contractors to construct the project (Sec 7044. Business and Professions Code,) The C ontraemes U- ccax Law does rot apply to in owner of property who builds or improves thereon, and. who contracts for such projects with a contractor(a) licensed pursuant to the contractors [.k=ris Law. ❑ 1 am exempt under Sec , B ale P C for this reason Owner Late WORICIRR'S COMPENSATION DECLARATION 1 hereby affirm ander penalty of perjury one of the following ❑ 1 hs+c and will maintain a Certificate of Consent to self -Insure for Workers Compen- sation, as provided for by Section 3700 of the Iabor Code. for the performance of the work for which this permit is is=& ❑ 1 have and will maintain Workers Compnmaation lesurance, as required by Saxton 3700 of the Labor Code, for the performance of the work for which this permit is Issued. My We Co enaatioq4nnw&m ' and Policy nnumber ere: Cam s _'(20 Policy No.: -1 lv , CERTIRCATE OF IDC P ION FROM WORKERS COMPENSATION INSURANCE (ibis section need.not be completed u the permit is fa ono hundned dollm (5100) or las) I certily dont in the performance of the work for which this permit Is issued, l shall not employ any person in any manner so as to beerrne subject to the Work crs' Compwatkm Laws of California. Dov 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 mug forthwith comply with such provisions or this pernit aball be deemed revoked. CONSTRUCTION LENDING AOENCY 1 hereby &Mrm that dee is a construction lending agency for the performance of the work for which this permit is Issued (See. 3097, Civ. C) [.enders Name [.enders Address I certify that I have rad this application and sur that the above Information Is coJb comply with sit City and county ardinarcea and sate laves muting to bon, and hereby wthariae tepnevemtauves of itis City to ceter upon the ablagA ANDS AND vV1L L COMPtY WITH AL4 NON -POINT SignturatrX00licartXontsmaor G V Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future bujtdine occupant more or handle haardous material as dented by the Cupatiuro M�wk' 1 Code, Chapter 9.13, and the Health and Safety Code. Scction25532(a)T ❑ Yes Will the applicant or ' run ding mcc rpant use equipment or devices which emit hazardous air coup tests recd by the Bay Area Air Quality Management Disuict7 ❑ Yes No 1 hazardous materials requirements under Chapter 6.93 of the Califor- uiaHWth S=6=255o3.25533au12Ss34.1 thgifWe Tding dao not tenant. dot it h my reaporoibllity to naify occu of the mqu' rat to issuance of a Ccrti(iGagfgf Owner or auth a Date Job Description NEW APT BLDG #67 A -H, 3,219 SF 8/25/08 SEE #07120212'FOR SUBS. Sq. Ft. Floor Area $555555 Valuation 32609056' Required Inspections Issued by: Re -roofs Type of Roof Type Date r, (Z CL -9, 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's' or better r.117 CITY OF CUPER,T1NO CITY OF CUPERTINO NEW SINGLE/MULTI FAMILY DWELLING PERMIT APPLICATION FORM 17'71Y V ,�? APN # .32. to 1P7 Dater Gtwl to � 2 00'1 Building Address: {{ i osbo "OhAC�s�+w O1 �� `a J v-1 Mailing Address (if different from building address): I1colo0 ,O A1n No��o11,� -e S �.�.\�-e. goo , 5.,^ Irl �, CA. X14403 Owner's Name: ,x C••.\i=vio V i 1 w ��.. �/ h 1;,Aaa A Phone # :X50 mist —3451 Contractor: hone #: 516 6Lej _40,318 tt U`1c-,k �v�\ 1�ci/ S Fax #: S%Q 5 Z 5 —055,5 Contractor License #: Cupertino Business License #: Contact: Phone #: (0 so Ci lklc,II__ `dte.A D1Kbkx.- Fax #: jo50 Gi'" -22661 Alternate Contact: Phone #: V&b AS I .. 1,�A6f� Tin Hush, Fax #: (O 9)Q di 3 - 3 61001 Single -Story ❑ Two -Story Three -Story ❑ Basement ❑ Hillside ❑ Multi -family [[ Apartment [� Condo ❑ Townhouse ❑ Sq.Ft. Living Area (Including Basement & Attached Garage: Sq. Ft. Garage (Detached Only): 3)2I'i 4 Valuation: SS5 53S Job Description: ��,•��, �.�,� ,he .` +VV�0"\ 11(o VW`ry ,.tAbb. . TA-S*C, %-OR ..a �o 6P. a - h� leos,v,%otos. &JVJA *A%v6 +\1-Ve.,.JV foa-AA T%N-VW..s r+o.rM* 1 Type of Construction (Usage Class): Occupancy Type: 1 FR, 11FR ❑ 11, 111,V -IHR ❑ 11, 111, 1V V -N �"� 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.orc,, 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 3 Z( `/ 1RIREINSP Apt Bldg repeat unit Inspection fee B 1RIAPTR 5-24q 1RIREPLNCK Apt Bldg repeat unit plan check fee B 1R3INSP Dwellings Inspection B 1R3SFD.W 1R3PLNCK Dwellings Plan Check B 1R3REPINSP Dwellings Repeat Inspection B 1R3SFDR. 1R3REPPLNC Dwellings Repeat Plan Check B 1R3HINSP Dwellings Hillside Inspection B 1R3HILL _ IR3HPLNCK Dwellings Hillside Plan Check.. . B 1R3HREINSP' Dwellings Hillside Repeat Inspection B LR3HREPI NC _ Dwelling Hillside Repeat Plan Check B 1R3ALTINSP Dwellings Alternate Materials B 1R3SFDALT 1R3ALTPLNCK Dwellings Alternate Materials B 1GARDTW<=1K Detached Garage Wood B 1GARDTM<=1K Detached Garage Masonry B 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 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 -3 Z 1 i 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 1PPRSEWG Ea. Private Sewage P 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 .