07120203FY OF CUPERTINO
BUILDING DIVISION PERMIT
BUILDING ADDRESS: retcmt t Ru.
20800 HOMESTEAD RD BLDG 14 A- WEST BUILDERS, INC. 07120203
OW 'S NAME: PERMIT ISSUE DATE
VILLA SERRA APT A CA LTD 1608 4TH ST STE 120 09/26/2008
PHON&A 'D rrMT SANrfARY NO. CONTROL NO.
ARCHTIEC IENGiNEEI
LICENSED CONTRACLUR'S DECLARATION
1 hereby affirm that I am licensed under provisions of Chapter 9 (commenting
With Section 7000) of Division 3 of the Business at�ess�ka Code, and�licenae is
in full fm and dTcCL fC�/1
License LI..,
Date Conuacmmr
ARCHITECT'S DECLARATION
I undersand my plans shall be used as public records
Licensed Professional
OWNER-BUMZER DECLAI A'110N
I hereby &Mrm that 1 am exempt from the Contractors License Law for the
following mason. (Section 70313, Business and Professions Code: Any city or county
which requires a permit to construct. alter. hnprom demolish, or repair any structure
prior to its issuance, also requires the applicant for such permit to file a signed statement
that he is licensed pursuant to the povisiona of the Contractors License 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 70313 by arty appUeart for a permit subjects the appllant to a civil penalty of
not more than five hundred dollen (3500).
❑ i, as owner of the property, or my employees with wages as their sok compensation,
will do the wok, and the structure is not intended or offered for sale (Sec. 7044, Business
anti Professions Code. The Contactors I w"= Law does not apply to an caner of
property who builds or improves thereon. and who does such work himself or through his
sum employees, provided that such improvements ere not Intended or offered for sale, if.
however. the building or improvement is sold within ane year of completion, the owner -
bulkier will have the burden of proving that he did not build or improve for purpose of
sale.).
❑ 1. as owner of the property, am exclusively contracting with licensed contractors to
construct the Project (Sea 7044. Badness and Professions Code:) The Conaserars U
cerae Law does not apply to an owner of property who builds or improves t emon. Lid
who contracts for such projects with a eontnetor(s) licensed pursuam to the Contractors
Lkemae Law.
❑ l am exempt under See. B k P C for this mason
Dale
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a Canifiate of Consent to self-Insum for Workers Compen-
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 malnuin Workers Compensation Insua ce, as required by Section
3700 of the Labor Codo, for the performance of toe work for which this permit is issued
My World rlt Co penes m 1 carrier and Policy number am, —s `
Curr Policy No -
CER'[ ICATE 0 EXEMPTION FROM WORKERS'
COMPPNSAMONINSURANCE
(This section need not be completed if the permit Is fa rte hundred dollen (3100)
or leu)
I certify that in the performance of the work for which this permit Is issued. I shall nes
employ any person in any mauner so at to becomo subject to the Worked Compensation
Laws of California. Due
AppBan,
NOTICE TO APPLICANT. if. after making this Certificate of Exemption, you should
became subject to the Workers Compcnntiop provisions of the Labor Code, you mus
forthwith comply with such provisions or this permit shall be deemed mrokrA
CONSTRUCTION LENDING AGENCY
I hereby affirm that tem is a construction lending agency for the prfermanca of
the work for which this permit Is issued (Sec. 3097, Civ. C.)
Lenders Name
Lenders Address
I citify that I have mad this application and stab that the above infomation is
coned I agree to comply with all city and county ordinances and a= Ism relating to
building coMmuction. and hereby authorize representatives of this city to enter upon the
above- property for Inspection purpose.
AICUNDERSTANDS
me to save, indemnify and keep harmless the City of Cupertino against
limemts, costa and expenses which may in any way accrue against said City
inof the granting of this permit.
A AND WILL COMPLY WITH AL4 NON -POINT
SignZ0MATERIALS DISCLSUREw Palo
Will the applicant or future building occupant sem or handle hazardous material
as defined by the Cupertino Murdgpal Cada Chapter 9.17, and the Health and Safety
Code, Section 25532(x)7 ®N/o
❑ Yes
Will the applicant or fu7No
Iding occupant use equipment or devices which
emit hr/Ardous air comtanntnanllred by tie Bay Area Air Quality Management
District?
4—d
dmts materials requirements underChapter6.95 ofthe Caiifor-
nixtions=W.25533and25534.1undosandthatifNebuilding
do=ant. that it is my maponsibility to 'fy tie pant of Ane
mqmet prior b i nce of a Crrtilj fart f Com,
Owner or aInhorized agent Date
(510) 525-9378
PERMIT INFO
PLUMB MECH
Job Description
NEW APT BLDG 14 A -D 3,219 SF
8/25/08 SEE #07120212 FOR SUBS.
Sq. Ft. Floor Area I $ 5 5 5 5 5 5 Valuation
32609056'
Required Inspections
Issued by:
Re -roofs
Type of Roof
Type
Date e'/— . 2e( -/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 '%>" or better
Y ry�t�'j1J -,y
CITY OF
CUPEkT1NO
CITY OF CUPERTINO
NEW SINGLE/MULTI FAMILY DWELLING
PERMIT APPLICATION FORM
1 /. W4
APN # Date:
32t* - d't - O 5(P• �cct-r� c/ 10 2 oc'7
Building Address:
Mailing Address (if different from building address):
Skrwk S "\kk -1601 S^v, LAoAco, Ck 94403
Owner's Name:
V i 1 w �•.. v��n� 1 wh�}� � �ov+
Phone #:
(vso '13t —345"1
Contractor:
hone #: 516
j
(K)C—,A- ave\ trl/5
Fax #: S%C' 525-066.6
Contractor License #: 82-530k C,
Cupertino Business License #:
Contact:II__
Phone #: to so x131
141CJAae-A DWAC,
Fax #: 1050 41 #3 " '✓I0001
Alternate Contact:
Phone #: Vgb g 31 ..
I'VPn HbS&
Fax #: 10 so 413
Single -Story ❑ Two -Story Three -Story ❑ Basement El Hillside ❑
Multi -family [ A artment [ Condo ❑ Townhouse ❑
Sq.Ft. Living Area (Including Basement & Attached Garage:
Sq. Ft. Garage (Detached Only):
3 12. %tet sir
Valuation:
Job Description: Aa k\%fA rWAA:l ,fAAjCA,
IAP --"�� 1 tiv v�� v1��s . -Tk•v�t .�` ..a to b� �.. ,�.r,,�,
��.� S,� o�� �. �1,�I,vbwN►�.c �.-�v �oawti �, �..s romn� i
Type of Construction (Usage Class):
Occupancy Type:
1 FR, 11FR ❑ 11, 111, V-1HR ❑ 11, 111, 1V V -N
Project Size: Standard ❑ Large❑ Major V
Green Building: Must attach completed Green Building Checklist to the plans
Green Building Points Achieved:
For help, contact Build it Green at www.buildit6reen.ora
1
kR
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
2 9
1RIREINSP
Apt Bldg repeat unit
Inspection fee
B
1RIAPTR
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 Plan
Check
B
1R.3HINSP
Dwellings Hillside
Inspection
B
1R3HILL
IR3HPLNCK
.... .._.._......
Dwellings Hillside Plan
Check _
B
-
1R3HREINSP
Dwellirigs Hillside
Repeat Inspection
B
1R.3HREPLNC
Dwelling Hillside Repeat
Plan Check
B
1R3ALTINSP
Dwellings Alternate
Materials
B
1R3SFDALT
1R3ALTPLNCK
Dwellings Alternate
Materials
B
1GARDTW<=1K
Detached Garage Wood
B
16ARDTM<=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
2/ �(
Planning/Residential
1BPWSVCS
Main Water Service
P
1BSWIM
Swimming Pool
B
1PCESS
For Ea.Cesspool
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
1BPSPRI-NK
For ea. Lawn Sprinkler Sys '
P
on any one mtr, incl.
-
backflow protect device
1BUSLIC
Business License
B
3 of 3 .