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CITY OF CUPERTINisq
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BUILDING DIVISION pERNIIT
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WEST BUILDERS, INC.
BUILDING ADDRESS:
20800 HOMESTEAD RD BLDG 31 A-
PERMIT NO.
07120146
OW 'S NAME:
PERMrr MM DATE
VILLA SERRA APTS A CA LTD
1608 4TH ST STE 120
09/26/2008
PHONB:T o n'MT
SANITARY NO. CONTROL NO.
(510) 525-9378
ARCI.117EC'UENGiNEER:
BUILDING PERMrrINFO
BLDG ELECT PLUMB MECii
UCENSED CONTRACTORS DECLARATION
Job Description
1 bmcby affirm that 1 am licensed under provisions of Chapter 9 (commencing
with section 7000) orDivislon 3 of the Business and Professions Code, and my license is
NEW APT BLDG, BLDG 3 1 A— B 1 , 6 0 7 '
in full force and COWL
license ClLic. + �^
ass
SEE #07120212 FOR SUBS.
Date Co=raetor.
�`
LA
CMTEM DECRATION
1,,nderstand my plan shall be used as public meords
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am mtempt from the Contractor's License Law for the
following mason. (Section 70713, Business and Professions Code: Any city or county
which requires a permit to construct, alter, improve, demolish. or repair any awcture
prior to its issuance, also requires the applies= for such permit to file a signed statement
Contractor's License law (Chapter 9
Sq. Ft. Floor Area
Valuation
that be is licensed pursuant to the provisions of the
Division 7 Business Professions Code).
$555555
(eornmencing with Section 7000) of of the and or
that he to exempt thestdrom and the basis for the alleged emmption. Any violation of
A,pN Number
32609056:
Occupancy Type
Section 7031.3 by ary applicant for a permit subjects the applicant to a civil penalty or
not mom than five hundred dollars (SM
72'
❑ L as owner of the property. or my employees with wages as their sole compensation,
Required Inspections
nst
will do the work. and the structure is not intended or offend for sale (Sex 7044, Business
and Professions Cod= The Contractors License Law does roapply to an owner of
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property who builds or improves thereon, and who does such worst himself or through his
own employees. provided that such improvements ore not intended or offered for sale. if.
.
however. the building or improvemens is sold within one year of cempledon. the owner -
builder will have the burden of proving that he did not build or Improve for porpoae of
sale.)
❑ L as owner of the property. am exclusively contracting with licensed contractors to
construct the project (Sec. 7044. Business and Professions code;) The Coabacmra I.J.
cense Law does mot apply to an owner or property who builds or hnproves thereon. and .
who contracts for such projects with a contractor(s) licensed pursuant to the Contractors
License Law.
❑ 1 am exempt under Sex B k P C for this mason
Owner Date
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following decluae one
❑ I have and win maintain a Cmtifiato of Conserv to self -insure for Workers compen-
Won, as provided for by Suction 3700 or the Labor Code, for the performance of the
work for which this permit is Issued.
❑ 1 have and will maintain Workers Compensation Insurance, as required by Section
7700 or the labor Code, for the performance of the work for which this permit 4laue&
My We ompgpaatios 1 rarrce airier and Policy number am:
Policy Ne.:
CERTIFICATE OF P ION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit U for one hundred dollars (i 100)
or less)
1 artily that in the performance of the work for which this permit is Luucd. l shail not
employ any person in any mannerso as to become subject to the Workers' Compensation
.
Lava of California. Dare
Appliamt
NOTICE TO APPLICANT: If. tncr making this Certificate or Exemption, you should
become subject to the Workers Compensation provisions of the Labor Code, you mug
forthwith comply with Puck provisions or this permit shat be deemed mvoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that them is a construction lending agency for the performance of
the work for which this permit is issued (Sec. 3097. Civ. C)
Lenders Name
Lenders Address
.
1 certify that 1 have mad this application and gate that the above information is
correct. 1 agree to comply with all city and county ordinances and state lana relating to
building construction. and bereby authorize representatives of this city to enter upon the
doped property for inspection purposes
c) agree to save. indemnify and keep harmless the City of Cupertino against
j liabilid and expenses which in City
gmcn%cats may any way accrue against said
in co of the granting of this Permit.
A I NT ERSTANDS AND WILL COMPLY AL ON
All
/
by; Date ZU' ��
-POINT
sued
ONS.
Re -roofs
Type of Roof
Si g n alp q Vf-Abj
H NUS MATERIALS DISCLOSURE Date
Will the applicant or future building occupant atom or handle hasadous material
as defined by the Cupenion M pal Code. Chapter 9.12, and the Health and Safety
cum, en 2ss3z(a)7
All roofs shall be inspected nor to an roofing material beim Installed.
P P� Y g g
❑Yes Nm
0
If a roof 'is installed without first obtaining an inspection, I agree to remove
Will the appllesnt ser fun ilding occupant use equipment or devices whim
emh hrrardous air cortWninan mfmcd by the Bay Area Air Quality Management
all new materials for inspection.
Diattict7
❑Yes No
Iban barardousmaterials mquirementsunder Chapter Q95oflheCaiir«-
iia FNalth y seeriurts 25305.25333 and 25534.1 erne stand datirtbe building
sicca not a tensrn. that It b my responsibility to notify t of site
requ prior to issuance ora Ceruf
Signature of Applicant Date
All roof coverings to be Class''' or better
Owner erau t Date.
r
I lu:
CITY OF
CUPEkT1NO
CITY OF CUPERTINO 0'J1 Zo W o
NEW SINGLE/MULTI FAMILY DWELLING
PERMIT APPLICATION FORM
APN # �Z� r �• O s�o
Date: Dece ev lO 20o'1
Building Address:
A-6
Q
-;I osbo "O"e-ACw ck v*51 1 2
Mailing Address (if different from building address):
M00 5�,..�Nn Nor.�o11,�. ` -e 5�..`�-e� 16b S.►,\ �Aeo- o, CA 94403
Owner's Name: o. \; K
Phone # : (
Contractor:
hone #:
WZ—Jr ����5
Fax #: 51f, gZ {J .�pCJSJ'
Contractor License #: 853 \ 5
Cupertino Business License #:
Contact:11
Phone #: -
14%,c nOl�l DwdM
Fax #: 1060 q �34061
Alternate Contact:
Phone #: ••
TTS Husv
Fax #: (O bU 013 \ — 361601
Single -Story ❑ Two -Story W Three -Story ❑ Basement ❑ Hillside ❑
Multi -family [Z Apartment [/ Condo ❑ Townhouse ❑
Sq.Ft. Living Area (Including Basement & Attached Garage:
Sq. Ft. Garage (Detached Only):
1)4
Valuation:
Job Description:` ,W ,C�% • V.&�..P. MA%kavk�
\A 44ml.. "'S1w•raf, .,`R .0-A So 1dG to- A r�
lea s cots a. a1„ A0Wz\*u I +�w.,.Iv too -AA JV\ r oy%* PWA
Type of Construction (Usage Class):
Occupancy Type:
1 FR, 11FR ❑ 11, 111, V-1HR ❑ 11, 111, 1V V -N
�3 p�
Project Size: Standard ❑ Large E] Major i
Green Building: Must attach completed Green Building Checklist to the plans
Green Building Points Achieved:
hnin rn_+o +,n. ;iii ;t 1--w .
ot,
CITY OF CUPERTINO
NEW SINGLEMULTI FAMILY DWELLING
FEE SCHEDULE
Quantity
Fee ID
Fee Description
Fee Group
Permit 'Type
1RIINSP
Apt. Bldg inspection fee
B
1RIAPT
lRIPLNCK
Apt Bldg plan check. fee
. B
/
G
IRIREINSP
Apt Bldg repeat unit
Ins ection fee
B
1RIAPTR
b�
1RIREPLNCK
Apt Bldg repeat unit plan
check fee
B
1R3INSP
Dwellings Inspection
B
1R3SFDW
IR3PLNCK
Dwellings Plan Check
B
IR3REPINSP
Dwellings Repeat
Inspection
B
1R3SFDR"
1R3REPPLNC
Dwellings Repeat Plan
Check
B
IR3HINSP
Dwellings Hillside
Inspection
B
1R3HILL
1R3HPLNCK
Dwellings Hillside Plan
B
1R3HREINSP'
Dwellings Hillside
Repeat Inspection
B
IR3HREPLNC
Dwelling Hillside Repeat
Plan Check
B
IR3ALTINSP
Dwellings Alternate
Materials
13
1R3SFDALT
1R3ALTPLNCK
Dwellings Alternate
Materials
B
IGARDTW<=1K
Detached Garage Wood
B
IGARDTM<=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
1PLLONGRNGR
Long Range
PL
6 0 7
Planniug/Residential
1BPWSVCS
Main Water Service
P
l
/
1BSWIM
Swimming Pool
B
1PCESS
For Ea.Ceswpool
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 ca 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 .