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07120142CITY OF CUPERTINO� BUILDING DIVISION PEij'r BUILDING ADDRESS: PEtMrr NO. 20800 HOMESTEAD RD, BLDG 6 A—D TBD .— TO BE DETERMINED 1 07120142 OWNER'S NAME: PE[AffrLS(IEDATE VS II A CALIFORNIA LIMITED 07/08/2008 PHOI� R 9 -NT SANITARY NO. CONTROL NO. .1O p LICENSED CONTRACTORS DECLARA77ON g1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing With Section 7000) of Division 3 of the Business ang0rulbassons Code, and my license is a y in full force and effect ���Q,2X171�l�1 jar License9 gpsa Lic. i F Data —7• Contractor ARCHR1iLTS DECLARATION I understand my pWta shall be used as public ntcords �yU C IT Licensed Pmfesaonal y :1 OWNER -BUILDER DECLARATION 3� x 1 hereby aiTwm that 1 am exempt from the Contractor's License Law for the in o following reason. (Section 703 IA Badness and Professions Cale: Any city or county which requires ■ permit to construct, alter. improve, demolish. or repair my structure �y prior to its issuance, she requires the applicant for such permit to Gk ■ signed statement that be Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 t- $ (commencing with Section 7000) of Division 3 of the Business and Professions Code) or y .. that be Is exempt rhemfrove and the basis for the alleged exemption. Any vloldan of Section 7031.3 by any applicant for a permit subjects the applicant to a dvfl penaity, of not more than five hundred dollen (5500). ❑ L as owner of the property, or my employees with wages as their sok compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Profadons Code: The Contractors License Law does not apply to an owner of property who builds orhnpoves thereon. and who does such work himself orthrough his own employees, provided that such improvements are not intended or offered for sale. IL bowevar, the building or Improvement is sold within one yen of complerlaa. the owner - builder wM have the burden of proving that he did not build or improve for propose of sale.?, ❑ L as owner of construct the pro) ease Law dos who con far [Janes Law ❑ lam property: am esdusively contracting with Bunted conefcloa to (Sec. 7044. Business and Profession Codt) The Ceotraaars Li- m an owner of property who builds or improves dremo, and kiprojects with a coouwwr(s) limned postal to the Cmtrattoes , B h P C for this manse Data PENSA77ON DECLARATION 1 hereby a it penalty of perjury one of the foilewing declatatlonc ❑ I have and will maintain a Ceniflale of Consent to self-inrAm forWarners Compen- sadon, as provided for by Sectio 3700 of the Labor Code, for the performance of the work for which this permit is Issued. ❑ I have and will maintain Workers Compensation lastrarim at required by Sectio 3700 of the Lsbor Code, for the performance of the work for which this permit is Issued My Workers rope ulon carrier and Policy number am: Q Carrier ti PolicyPk.: 1 S wow l $8 tMnIFICATE OF EXEMPTION FROM WORKFRS' COMPENSATION INSURANCE (ThB sectio meed not ba completed U the permit Is forono hundred dollars (f 100) or let) I certify, that In the performance of the work for which this permit is issued l shall not employ any person in any manner m at to became subject to the Worlams' Compensation Laws Of Call(aroit Dae Applkaat N017CE TO APPLICANT. If, after making this Certificate of Exemption, you should became subject to the Workers Compensation provisions of the tabor code, you must forthwith comply with rich provisions or this pesmlt shall be deemed mvolmd CONSTRUCTION LENDING AGENCY I hereby affirm that therm Is a construction lending agency for the performance of the work for which this permit is trued (See. 3097, Civ. C.) Lendces Name Lenders Address I eestify that I have read this application and sous that the above Information is correct 1 agree to comply with all city and warty ordinances and state laws Mating to building construction, and hereby authorize representatives of tris city to emu upon the above -rumored properly for impmlon purposes agree to save, indemnify, and keep harmless the City of Cupertino against [flu soar and expenses which may In any way accrue Main+said City In of the Swing of this permit. AP NDERSTANDS AND WILL COMPLY WrrH ALL NON -POINT Ns. � 8 SI Date HAZARDOUS MATERIALS DISCLOSURE WII the applicant or future building occupant nae or handle hazardous material as defined by the CupeNeopal Code, Chapter 9.12, and the Health and Safety Code, Section 25532(a)7 13Yes 67 Win to applicant or rutme building occupant use equipment or devices which emit humdous air contaminan rued by the Bay Area Air Quality Management Diwitt7 ❑ Yes o I the haandeun materials requirements under Chapser 6.93 of the Csiifor- rdaHalth yCadeSariont23503.25333md2S334lurrdcrarandthatffthebmldkg tea have ■ Icrharn. aha h is my resporndbilily b notify she omnpanht of the tequ Date REMODEL—NEW DECK RAILS, I BLDG Ft. Floor Area Number Issued by: Re -roofs Type of Roof Required Inspections BUILDING PERMIT INFO Type Date % �' 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 "A' or better y, CITY OF CUPERTINO IV ADDITION/REMODEL CUPEKFINO PERMIT APPLICATION FORM D �/aoi�a APN # 324W — OQ1 — 06(ol Date: CC44v%bew 101 2001 Building Address. .20'a00AgmtsbeftcL4OW4)SIC11#4�— Mailing Address (if different from building address): 1900 50%A*^ NfACWN. Svc MOi 5^^ a1J43 Owner's ]name: IrA vk qo�W.. *a Phone # : X0, tdY%,. •e Contractor: Phone #: W'G ?>%�IwrwS Fax #: 610 5Z'S—dSS5 Contractor License #: `BZr)254` Cupertino Business License #: TSD Contact: Phone #: ( it 4-�^Zk ukkC66W Fax #: Building Permit Info: Bldg. / Elect. [� Plumb. [� Mech. Hillside ❑ Job Description: What is being added? AoAmc�1%� H W^'�� h 'i�`r bV��t`�►�'� What is being remodeled?- eL J Are4e. CC- ASS 46,1%v, V. auwc�-- Remodel Includes Re -Roof: Yes No [/ If yes list number of squares Remodel Includes Structural: Yes i No ❑ Square Footage: Addition: ai 5 S� Remodel: Garage: Porch: Deck: "t 4 Other: 1 !!ZV Type of Construction (Usage Class): Occupancy Type: 1 FR, 11FRQ3 ❑ 11, 111,V -IHR ❑ 11, 111, 1V V -N [� Valuation: Please check this box if the project is a (JZ second -story addition ❑ Green Building Check list must be completed and attached to the plans. Green Building Points Achieved: ***For Office Use Only*** Over -the -Counter 0 r CITY OF CUPEf�TINO CITY OF CUPERTINO ADDITION/REMODEL FEE SCHEDULE Quantity Sq Ft Fee ID Fee Description Fee Group Permit Type ADDITIONS 1R3SFDADD PLLONGRNGR Long Range P l anni ng/Res i denti al PL 1R31NSP Dwellings Inspections B 1R3PLNCK Dwellings plan check B 1R3REPINSP Dwellings Repeat Inspection B 1R3REPPLNC Dwellings Repeat Plan Check B 1R3H]NSP Dwellings Hillside inspection B 1R311PLNCK Dwellings Hillside plan check B 1R3HREINSP Dwellings Hillside Repeat Inspection B 1R3HREPLNC Dwellings Hillside Repeat Plan Check B 1R3ALTINSP Dwellings Alternate Materials Inspection B 1R3ALTPLNC Dwellings Alternate Materials -Plan Check B 1PCESS Cesspool P 1PPRSEWG Ea. Private Sewage Disposal System P i 1PRSEVTER Sewers P 1BPSPRINK Lawn Sprinkler/Backflow P 1BPWSVCS Main Water Service P 1BSEISMICRE SeismicResidential B DECKSTR3SFDR% R / 1DECtK00 Deck (Wood) B / 1DE KRAIL Deck Railing B -<63. I CITY OF CUPERTINO ADDITON/REMODEL FEE SCHEDULE Quantity Fee ED Fee Description Fee Group Permit Type Sq Ft GARAGES 1R3SFDADD OR 1R3SFDREM 1GARDTW<=1K Wood Frame up to B 1,000 SF 1 GARDTM<=1K Masonry up to 1,000 B SF PATIO'S OPEN 1R3SFDADD OR MSFDREM iPATIOWOOD Wood Frame up to 300 B SF 1PATIOMETAL Metal Frame up to 300 B SF 1PATIOOTHER Other Frame up to 300 B SF PATIO'S CLOSED 1R3SFDADD OR 1R3 SFDREM 1PATIOENCLW Enclosed Wood up to B 300 SF 1PATIOENCLM Enclosed Metal up to B 300 SF 1PATIOENCLO -- - - - -- Other Enclosed Patio -- —_ � -- � up to 300 SF _ 1 COVPORCH Porch Covered B 1REROOFRES Residential Re -roof B Each 1.00 SF REMODELS 1R3SFDREM 1REMRESKIT Kitchen Remodel up to B 300 SF 1REMRESBAT Bath Remodel up to B 300 SF 1REMREOTH Other Remodel up to B 300 SF REMODEL PLNCK 1 STPLNCK Standard Plan Check B NOT FOR OVER THE COUNTER PLAN CKS. 3 of 3 A CITY OF CUPERTINO ADDITON/REMODEL FEE SCHEDULE 4 of 3 Quantity Sq Ft Fee ID Fee Description Fee Group Permit Type WINDOW/SLIDING 1R3SFDREM GLASS DOOR 1WINREP Replacement windows (ea 8 windows) B 1 WINNEWNSTR New Window (non- structural) B 1WINNIEWSTR New Window (Structural Shear Wall/Masonry) B 1 WINBAYSTR Bay Window (Structural) B 1BUSLIC Business License B 4 of 3 I CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20800 HOMESTEAD RD BLDG 6 A -D I CONTRACTOR: WEST BUILDERS, INC. PERMIT NO: 09080038 I OWNER'S NAME: VILLA SERRA APTS A CA LTD PARTN 1 1608 4TH ST STE 120 1 DATE ISSUED: 08/19/2009 I OWNER'S PHONE: 1 BERKELEY, CA 94710 1 PHONE NO: ( ❑ LICENSED CONTRACTOR'S DECLARATION License Class G Lic. q 025 5 Contractor vwim Date 8 '24, 91 I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. 1 hereby affirm under penalty of perjury one of the following two declarations: 1 have and will maintain a certificate of consent to self -insure for Worker's Compensation, 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 Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION I certify that 1 have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date_g'Zy, / ❑ OWNER -BUILDER DECLAP.ATION I hereby affirm that I ams exempt from the Contractor's License Law for one of the following two reasons: 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: I have and will maintain a Certificate of Consent to self -insure for Worker's Compensation, 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 Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 1 certil'y that in the perfornance of the work for which this perrnit is issued, l shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, 1 must forthwith comply with such provisions or this permit shall be deemed revoked. _APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date BUILDING PERMIT INFO: BLDG ELECT PLUMB MECH r— RESIDENTIAL r— COMMERCIAL I— JOB DESCRIPTION: REVISION: UTILITY CLOSET ORIGINAL: 07120142 Sq. Ft Floor Area: I Valuation: $2500 APN Number: 32609056.6AD I Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Date: RE -ROOFS: 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 "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE. I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which ernit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the ilralth & Safety Code, Sections 25505, 25533, and 25534. Owne or mtho ' ed agent: Date: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.)' Lender's Name Lender's ARCHITECT'S DECLARATION 1 understand my plans shall be used as public records. Licensed Professi S � CITY OF CUPERTINO CITY OF CUPERTINO REVISION/DEFERRED PERMIT APPLICATION FORM APN # Date: �� � � ��-P , (.D AI� Original Permit #: O -TI 20 1,4Z Building Address: .�./ 2,D800 1-1 J IM C STle-f1�-U (L-(3 l� Mailing Address (if different from building address): Owner's Name: Phone #: &- 57 iA(E✓7 Mk kc D L4 -LO -FC Contractor: Phone: Fax: yob- 7q (P — 5-o33 Contractor License #: 2535 Cupertino Business License #: 2q q Contact: Phone: S i D --- 7 7:� -077C) DA-VICF- O `. �t7--Y� Fax: Building Permit Info: Bldg JK Elect ❑ Plumb ❑ Mech ❑ Residential © Commercial ❑ Job Description: U-FiLriT\J UoSiZTTI S Is the project in the Wildland- Urban Interface Fire Area? Yes ❑ No ❑ Type of Construction (Usage Class): * Occupancy Type: 1-A, I -B ❑ II/III/V-A II/111 B, IV -HT, V -B ❑ ; j Valuation (cost of project) Prajeel Sate; Express ❑ Standard ❑ Large ❑ Major Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it to the application or if applicable, include in plan set & the sheet index. Points Achieved: For help, contact Build it Green at www.buildit2reen.om Revised 01/07/09 CITY OF CUPEkTINO CITY OF CUPERTINO REVISION/DEFERRED PERMIT APPLICATION FORM FEE SCHEDULE Quantity Sq Ft Fee ID Fee Description Fee Group Permit Type I 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1 REVCOMNEW Revision Commercial New B 1* 1 REVCOMTI Revision Tenant Improvement B 1* TI 1REVSFDWL Revision SFDWL B "1R3SFDW 1REVRESADD Revision Addition B 1R3SFDADD 1REVRESREM Revision Remodel B 1R3SFDREM 1DEFINSP Deferred Submittal not R-3 Ins ection B 1DS 1DEFPLNCK Deferred Submittal not R-3 Plan Check B 1DS IDEFR3INSP Deferred Submittal Inspection B 1DSR3 1DEFR3PLNCK Deferred Submittal R-3 Plan Chk B 1DSR3