07120162BUILDING DIVISION PERMIT
InutImn-6 HOMESTEAD RD, BLDG 10 A–I TBD – TO BE DETERMINED 1—n-1-20162
NEk'S NAME: PERhD'r Ib5l11! DAM
VS II A CALIFORNIA LIMITED 07/08/2008
REMODEL -NEW DECK.RAILS,
1 busby affirm that 1 wn liom-1 under
with Section 10(10) of Division 3 of Ne Business
in full force and effect
License Clea Lie. t _
W U 1 understated my plans "I W used u public records
6
g C 1 Licensed P=fcssioml
cy3 OWNER -BUILDER DECLARATION
C < i 1 thereby alarm that 1 1. exempt from the Contractor's C License Isar for dte
20 following rc won. (Saute 7 m so Butircn and Pronue. demolish.
Code: Any oily m aunty
Swhich rtquirust • permit re enmVae, dter. Wpmw, tlemW t t ora sig nY suumum
prim m its issuance, alar acquires th nnisio s of fora ch cores ar'surilense Land statement
< Nw W u licevcit pSenant m Ne ofDisiam ar the camu i. .drowse Law (s Code) r Sq
thammcne seem it Sectfomn and the
DiaiiiafroflMeged enond Ps. Any viCode)ur
Q — der io v exempt b samflwa and dte pro for the ds; the avmpdorc Any dolman of
.1..7031.5 n by say dolls for. parmR subjects; Nc.pplwnt x a ciYil Penalty of
Tart mom than Tier hundred dollars (SSW).
❑ l.uowmeror Weproperty,mmymoployenwith gmudc4xlccompewdnn,
will do Newark. ands, he Cmeisnotinxntletl orawdo forme(Sec.to as Business
and Pmf[Sd W ld,or }Y CanaaamrS LCAY oes dam Mt apply lf rt PMaV of
is
drum enywWWildstmid at such improve who dorssmbwmk Mmxlfar through h,
owu employ ImiprovldeA Nn one omp=wmaho rt not m ofe moaartd for We B,
mildehenumw. the building m imp=wmat V sued within arc )ear of im,now m, the pose of
milder will haw the burden of provin8 that bo tlitl not Wild m improv !w purpose of
Q I, u owner of tW pmixers, ora couarmwly coresetin6 aria littered ronoaetau to
come=% Na project (Sm. 7W. Business and Professions Code:) The Coa4aemr3 Li-
tten Isw does eat apply in an asTer or pn¢ny wim Wilds or imp=v%Nemon, and,
whoconuact, r such pmjccu with a contra%a(s) licensed pursuant to the Contractors
Licerre Law.
❑lam m u Sec ,Bd:PC far(yNu,�wp�on
Dox �`•c/
' O I ERS COMPENSATION DECLARATION
1 hereby +Qum under pemlry of perj=y arc of ae following decimations:
Ih mN WRImainWna Cer ricaxof Conanttoself-InsumrmWadxrsCompcn-
seuon, n provided fm by Section 3'1110 of the Labor Code, for the perfmman¢ of the
work for which Nis permit is issued.
❑ 1 haw and will mainWn Woulam. Compensation Imurvra, u rcgWrctl by S%tim
370() of We Isbm Cade, for the per mmwxe of Ne wart fmwhich Nis Permit is iamrd.
My Workces Com natural on lnwmnce cams% and Poliry_nurmbGe�ra�m:
Carlin. FI Policy Na.: ` -R'% IRS'
CERTIFl COMPENSATION
EMPIIONPRXNCE ERS'
COMPENSATION INSURANCE
(This scNa need not W completed ifft permit uforanc hundred dollen (SIW)
Or leu)
1 anifr Net in the performance of Ne work for which this Itearm is issued. I shall not
employ sty Person in any maorcrx u m become subject x the Wmkms'Coepe ions.
Isws of California. Data
AppllcNl
NOTICE TO APPLICANT. If, ager making Nu Cmufiax of rscmpuon, you should
become aubjm to the Wortmh Comp nceran provisions of the Labor Code you must
.J O forthwith comply with each pmvitiom or this permit soul W dccm.
ed rewme
P: y CONSTRUCTION LENDING AGENCY
F� IWrtbyatfirm wt ft. iaa Call2eeellnn lendgm
mgatey for an purnmeenea
C > the wart for which dtis Permit is inacd (Sm. 3097, ei,. C.)
14LJ Lander Name
0.
1<
7 Z ndera Address
V 0 1 certify, Nat I lame mad this application and show am dte aW x iNnwatian 4
)g, %mit 1 nine to comply with all ctity and county ad. and W, War misung x
0 Wilding comuumian, and hereby auNmire tepe,suuvm of Nis city x anter upon an
above-mentioned property for impaction purposes.
Q. (Wa)An,.
Tee m nue, indemnify and kap harmless IW City of Cupertino against
y Iiabilities,Ju g e ho.emho and mop asca which may in any way ne=c agsiut seid City
in eaves, of gracing of Ni, pmmiL
^ APPLI STANDS AND WILL COMPLY WI-II3 ALL NON -POINT Issued by:
SOUR U ONS, —T
ap fope`
Required Inspections
Date
Signuurco p ' ontracterDate Re -roofs l�
US MATERIALS DISCLOSURE Type of Roof
mill by Cupertor ino
Muni builipal Code,
gompaptr 9.M and the nOband Safety u dented OY 0te Cupertino Mu/nwipal Code. Chapter 9.1; and the HdN and Sakty
' pyo ®Na All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaininginspection, I agree to remove
Will dx appfinnt or In=ns Wading Nettleton ax egdpmaet m avec% Which If anns P
NOR Womdous air conhomim ave defined by ftBay Arta Air Quality Management all new materials for inspection.
❑Ya No
1 ham mad Ne ha Maur muerisiamquitemrnhowder Chepwr Q95 of Ne Califor-
WaHrslth Safety Code,Sa6.25505,;5533 and 25534.1 understand Netifdte Wilding
Jeer rot Nve • w•••l der it 4 my mxpamihility b roti(Y dee �YpNI of Jct
rale m w muwhmatpnimm;,aramenfacerdfleme p. Signature of Applicant Date
ow mm o' agent DawI All roof coverings to be Class'W' or better
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20800 HOMESTEAD RD BLDG 10 A-H
CONTRACTOR: WFST BUILDERS, INC.
PERMIT NO: 09080042
OWNER'S NAME: VILLA SERRA APTS A CA LTD PARTN
1608 4TH ST STE 120
DATE ISSUED: 08/19/2009
OWNER'S PHONE:
BERKELEY, CA 94710
PHONE NO: (510) 525-9378
❑ LICENSED CONTRACTOR'SDECLARATION
r r I—
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.N A [r- r �
F 1—COMMERCIAL �
` -' �
MECH RESIDENTIAL
Contractor !NgDate -may
I hereby affirm that I am licensed under the provisions of Chapter 9
JOB DESCRIPTION: REVISION: UTILITY CLOSET
(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:
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
Sq. Ft Floor Area:
Valuation: $2500
performance of the work for which this permit is issued.
1 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.
APN Number: 32609056.10AH
Occupancy Type:
APPLICANT CERTIFICATION
I certify that 1 have read this application and state that the above information is
correct. I agree to comply N%ilh all city and county ordinances and state laws relating
PERMIT EXPIRES IF WORK IS NOT STARTED
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
180 DAYS FROM LAST CALLED INSPECTION.
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
Issued by: Date:
9.18.
Signature Date 49�' -_24
RE-ROOFS:
❑ OWNER-BUILDER DECLARATION
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, 1 agree to remove all new materials for
1 hereby affirm that 1 am exempt from the Contractor's License Law for one of
inspection.
the following two reasons:
I, as owner of the property, or my employees with wages as their sole compensation.
Signature of Applicant: Date:
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
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
HAZARDOUS MATERIALS DISCLOSURE
declarations:
1 have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain a Certificate of Consent to self-insure for Worker's
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain
Compensation, as provided for by Section 3700 of the Labor Code, for the
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
performance of the work for which this permit is issued.
Safety Code, Section 25532(a) should 1 store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance, as provided for by
Additionally, should I use equipment or devices which emit hazardous air
Section 3700 of the Labor Code, for the performance of the work for which this
contaminants as defined by the Bay Area Air Quality Management District 1 will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
permit is issued.
health & Safety Code, Sections 25505, 25533, and 25534.
1 certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to the Worker's
agent: ��Zy tCompensation
Date
laws of California. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I mus
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
APPLICANT CERTIFICATION
for which this permit is issued (Sec. 3097, Civ C.)
I certify that I have read this application and state that the above information is
Lender's Name
correct. I 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
Lender's Address
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
ARCHITECT'S DECLARATION
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
I understand my plans shall be used as public records.
with all non-point source regulations per the Cupertino Municipal Code, Section
9.18.
Licensed Professional
Signature Date