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BUILDING DIVISION PERMIT
PERMrr NO.
Bc'ff8"TOMESTEAD RD BLDG 17 A- WEST BUILDERS, INC. 07120204
OW 'S NAME: PERMTr ISSUE DATE
VILLA SERRA APT A CA LTD 1608 4TH ST STE 120 09/26/2008
ARCHITECrfENGINEEll
I hereby affirm that 1 am licensed under provisions of Chapter 9 (comma ting
with Section 700 of Division 3 of the Business and Professions Code my license Is
in full force and ellecL B6_1<_ O?�
Deck ` CCom actnr��1
CHITECCS DECLARA ON
t undeneand my plan shall be used as public recarda
Licensed nsed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractors License law for the
following reason. (Section 7031.5. Business and Professions Code: Any city or county
which requires a permit to construct. alter. improve, demolWk or repair any Met=
prior to its issuance, also requires the applicant for such permit to file a signed suumeni
that be is licensed pursuant to the provisions of the Contractors License Law (Chapter 9
(commencing with Section 700M 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
nee more than five hnmdred (1013113 (5500}
❑ C as owner of the property. or my employees with wages 11 their sole compensation,
will do the work, and the structure is not Wended a offered for sale(Sec. 7044. Business
and Professions Code The Contractors I I= Law does not apply to an owner of
properly wbo builds or improves threat. and who does such work himself or through his
own employers, provided that such Improvemenu are nes Intended or offered for sok. If.
Imweva the building or improvement is sold within one year of completion. the owner.
builder will ban the burden of proving that he. did nes build or Improve for purpose of
ale.). .
❑ L as owner of the property, am exclusively contracting with licensed contractors to
emnstmct the pmject (Sec. 7044. Business and Professions Code:) The Contractors Li-
cense Law does not apply to an ower of property who builds or improves thereon, and
who conawta for such projects with a contractor(s) licensed pursuant to the COnuactoes
License Lev.
❑ 1 am exempt under Sec . B h P C for this reason
Owner Due
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will malwain a Certircate of Conan to self -Insure for Workers Compe n.
sadan, as provided for by Section 3700 of the Labor Code, for the performance of the
wart for which this permit is issued.
❑ 1 have and will maintain Workers Compensation Insurance, as required by on
3700 of the Labor Cela for the performance of the wart for which this permit is Issued.
My Workee m nsatiru Inwran carrier and Polity numb
Cartier Policy No.:�er car.
MUCO
CE TIFICATB OF C17NPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be compkted ifthc permit h forone hundred dolls: (5100)
or less.)
I certify that In the performance of the wart for which this permit is Issued. l shall nes
employ any person In any manner so as to become subject to the Worked Compensation
Laws of California, Dau
Applicant
NOTICE TO APPLICANT. If. alter mating this Certificate of Exemption, you should
become subject to the workers Compensation provisions of the Labor coda you must
forthwith comply with such provisions or this permit &hail be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby alrum that there is a construction lending agency for the performance of
the wart for which this permit is issued (Sec 3097, CN. C.)
Lemice Name
!.enders Address
I mtify, that I have rad this application and sue that the above inInn atlon is
Col. 1 agree to comply with all city and county ordinances and state haws muting to
bei Wng constriction, and hemby aurhoriae mprescruadva of this city to aver upon the
a6ovNmad property for inspeel►an purposes.
(We) lo ave. indemnify and keep hum the City of Cupertino sgawst
Bali jod rasa and apcn which may to anyway accrue apima said City
in f Ung of this permit.
AP NT ANDS AND WILL COMPLY ALL ION -POINT
SO Oy'y-�
.Zia
Siprme 0f A Date
HAZARDOUS MATERIALS DISCLOSURE
Will tie liant or future building Occupant mare or handle haadmat material
as defined by the Cupertino MuniriQal Coda Cbaprer 9.12. and the Health and Safety
Cork, Section 25532(x)? p�/
❑ Ya No
Will the applicant or future building occupant. use equipment or devices which
emit hazardous air tmntamlnanu ss, fined by the Bay Ana Air Quality Management
District? �- (N/
❑ Yes o
I mA,.q the haxanioua mawrials requiramcnu under Chapter 6.95 of the Califor-
nia Halth Soctiam 75505.25533 anti 25534. l wW=ud thatif the building
does t a umaa. des It is my responsibility to 'fy the t of the
requ w be met prior to Issuance of a Catifcau f
Owner or l Date
SANITARY NO.
(510) 525-9378
BLDG
Job Description
NEW APT BLDG #17 - 1,205 SF
8/25/08 SEE #07120212 -FOR SUBS.
Sq. Ft. Floor Area
32609056/
Issued by: I
Re -roofs
Type of Roof
$555555
Required Inspections
on
CONTROL NO.
PERMIT INFO
PLUMB MECH
Type
Date ej z
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
CITY OF
CUPEItTINO
CITY OF CUPERTINO
NEW W SIN GLE/MULTI FAMILY DWELLING
PERMIT APPLICATION FORINT
/, )- 7/, a , I � P , ��,/
APN #
32� - d'l -' � 5 �P •
Date:
�cc*-�n� �•/ l O 2 oat
Building Address:
� oaao 1.1 ow�c��c� c� �nr►� , g\d � r1 rt 3
Malting Address (if different from building address):
I�ioO So�..�Nn No��o11,� �-e� 5��,�-e.l �Ob, S.►� i��,.�t�a, �D. �144�3
Owner's Name: o. +,�' Phone # : (050 alai -3 1
V i 1 w �•�. v�n}'.S I ww� 45
Contractor: hone #: 516 62. ..9 t3145
j
wc_,�- j Fax #: '6% IS 2- -S —0666
Contractor License #: 8Z53� 5
Cupertino Business License #:
Contact:
Phone #: (ASD 31 ••log b
1
Fax#: ��JO Gi31 `JiD�j,
Alternate Contact:
Phone #: 61:�
Tin Hu%& Of
Fax #: 01 3 j — 31o1*&1
Single -Story ❑ Two -Story W Three -Story ❑ Basement ❑ Hillside ❑
Multi -family Apartment [� Condo ❑ Townhouse ❑
Sq.Ft. Living Area (Including Basement & Attached Garage:
Sq. Ft. Garage (Detached Only):
I/ ZO6 S�-
Valuation:
Job Description: ��`�� 1�`� •}W„ ��,�
LLys
1/b� .` •�`', <<I .tea �t V • �I�WL'. vo` I,.�'`o vvcm�
le-A�wNc, CAAa I &1\0j4%ft\A%Ve mo-m*vRP)m
Type of Construction (Usage Class):
Occupancy Type:
1 FR, 11FR ❑ 11, 111, V-lHR ❑ 11, 111, 1V V -N
f.3
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.orQ
ot,
CITY OF CUPERTINO
r 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
r 2 a SS •
1RIREINSP
Apt Bldg repeat unit
Inspection fee
B
1RIAPTR
/
1RIREPLNCK
Apt Bldg repeat unit plan
check fee
B
IR3INSP
Dwellings Inspection
B
1R3SFDW
1R3PLNCK
Dwellings Plan Check
B
1R3REPINSP
Dwellings Repeat
Inspection
B
1R3SFDR.
1R3REPPLNC
Dwellings Repeat Plan
Check
I B
1R3HINSP
Dwellings Hillside
Inspection
B
1R3HILL
IR3HPLNCK
Dwellings Hillside Plan
Check_-_
B
1R3HREINSP
Dwellings Hillside
Repeat Inspection
B
1R3HREPLNC
Dwelling Hillside Repeat
Plan Check
B
1R3ALTINSP
Dwellings Alternate
Materials
B
IR3SFDALT
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 planning
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
/ 2 0--C
1PLLONGRNGR
Long Range
Planning/Residential
PL
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
park sewer
1BPSPRINK
For ea. Lawn Sprinkler Sys.'.
P
on any one mtr, incl.
-
backflow protect device
1BUSLIC
Business License
B
3 of 3 .