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07120166 CITY OF CUPERTINO ��ss,,��g� /-� t!8� s.♦ / n�t" '� BUILDING DIVISION PEy�yyyi'r y1..01�:'l lit?C�VA`il Q �ION ' BUILQILlCa-ApQREi 07120166 HOMESTEAD RD, BLDG 11A-H WEST BUILDERS, INC. P W NEEER''S2iNNNAAAMIUIE: PERMn'01711DATE VS 11 A CALIFORNIA LIMITED 1608 4TH ST STE 120 07/14/2008 Oft N'ITI SANITARY NO. CONTROL NO. ARCHI)EC(ENGINEER: BUILDING PERMIT INFO REMODEL-NEW DECK RAILS, BLDG ELECT PLUMB MECH 0 0 0 0 O p LICENSED CONTRACTOR'S DECLARATION obi 1 hereby Affirmthal 1 am Roamed under provisions or Chapter 9(commencing ••_... ...-._._.`..- IOb Description i iNSction7OM)of Divksion3ofdm Susinessanditfe mCoe mylkc=is ^=H in full(once and.Item. LieenVpff6R=Lie.Y C F DaIG ConRxbr RCHfIECfS DECLARATION I understand my pima WII M1e need An public recoNs 6 H licensed Professional 5 GAINER-BUILDER DECLARATION at o f 1 hereby n(Erm that 11. exempt from Ne Contractors 4Any c law for the too O fallowing mason.(Section 7M 1.5. t.alter. and n,O,d moll Cale:Any city m county $ poor requires n permit re ennsuwL alter.improve.h penctsh,or repair any mumen, prior b its isswmo.alru requima the applinni farach pemil b file asi8nd wtement Nat ha pan a Hothead urat to the Fmvisiam Of NaX TOO Camiors license law(Chapbr 9 Sq.Ft. Floor Area Valuation a(FQ (commencing with Section 7")of Division 3 of The Business and Professions Cadc)w _ the he us exempt themfmn and The husk for the mkgcd exemption.My violation of Section 7031.5 by any applicant for•permit subjecu One applicant in a civil penalty of APN Number Occupancy e not mart Nm Run hundred dollars(SSW). P Y ']m'P ❑L o owner of Ola Amputy,re my wmumi ea ate wages ar they sole cempensatiw, will da Newark.and Ne auunure us cures Lnded reflected red farsak(Sec.70th,Owner of good Property Ow Cadre mTIA,pr CwnYbra(.ICILY max uch ar apply lf rt through is Required Inspections Own am wyces,pere f imprawch impo deaccon.and who dos auehwoek ar alt car Wvush hk now ,Thea iprng Or Nalsuchimpn mid wUaxnot intended efcaoReme,for ale.IL however,Ne building or i en of proAr inmidwithin om)ex of cmopktion,the owncr- Ann.).r will Nw du When of proHng that k did not build or improve for puryax of ale.). O 1.An owner of the pmpen,am mcluvwly conuamirig with liensed mntractoa To constrict the pmjea(Sec.7044.Bwinca and Professions Cade:)The Co alacmr's U. . Mom taw it=not apply in an owner of Property who builds or improves thereon,and who concis for such pmjecu with a cmvacbr(s)licensed puma,in pie Contrxtors Lk.Law. ❑I nm eaemps under See ,B k P C for this reason cone Data WORKER'S COMPENSATION DECLARATION 1 hereby aRm under penalty of perjury one of the following declarations: ❑I Nw aM will maintain•Cenificauaf Conscm b xlr-insure for WorkersCmmpcn- noon,as pmvidcd for by Section 37W of The Labor Cade.for the performance of tie wart for which This permit is issued. ❑1 have And will maintain Workers Compensation Insurance,a reprised by Section 3700 of the labor Code,for thc perfnomme n(ihe work for which thin permit iniinu i, My Worker's oro nsai ninsuruc caniar and Policy am: Carries Policy No.: s. Z IPICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE (Thussection need rot be cam plated 0 Ne permit Is for.hundret mous(S I00) or less) I certify dmi in The,pufmmana of the work for which this Permit k issi l shall not employ any person in my manner an An To haemic subject to the Warkeri Campenadim Laws of Califoron.Data Applicant NOTICE TO APPLICANT:IE after making this Certificate of Exemption.you should become mbja7 in The Workers Compensation provisions of Ne labor Code,you moo .J 0 forthwith amply with such porriam.m thus permit Nall be,dearmd revoked. '�� CONSTRUCTION LENDING AGENCY F— 1larebY afMn Nal them is a conson,dim lending agency for the perfomaea of Ili.moi one work for which Nus permit is issued(Sec.3097.Civ.C.) Q Lenders Name .7. Z Leaders Address U O 1 curtly that I haw read This application caul state Nu The above infomadm k IL Fcomae b.I agree camplY with ml city and county owmas laws nand a= relating to D U building coiuwcoon.and hereby,auNorire reprammal s of Nis city to enter upon The i, ahove-mentiunedpmpeny foriexpeninea puryoxa /`'^�lXN 'a. (We)as=m ave,indemnify ad tarp harmlea We City of Cupertino agafam Z tocoitiequern Of thecosismdofthat F mit. may in my way aaauc againn aid City U z in coiiarguence of the 6rmun8 of that pmmiL ^ AP NT UND>�STANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOU o�AnD�� 4��b Re-roofs SWAULM.rApplicunH UCOUSWbMRIALSDISCLOSUTUE Type of Roof Will the applicant or future Wilding oaupmt nam mlundk haudow maxum As deflned by the Cupenim Municipal Code,Chapter 9.13.and the Health and Safety ode, Section 25532(.)7 [3 Yen All roofs shall be inspected prior to any roofing material being installed. �L1No rIf a roof is installed without first obtaining an inspection,I MIT the applicant or(alum Wilding Occupant tax equipment a deviea which g Pe agree to remove e0msikc Tardnw mu air ccourninm defimd by the Bay AmaAir Quality Mmascmem all new materials for inspection. 0Yca �p r 11%ummadthehvardaumu=6m mquimmcwunder .CMpw6.95ofthe Califor. nus HcaINB: Ll WA la7imxhan iti my re omilbo1.1 indvumde m if Ne Wilding t eumntl w a tenmL Than it k my mapowhiliry u mtify six aeupani of the mybm uwhkh bemetpoor toinuarxcofa 'rx ra Pm. Signature of Applicant Dale owner car arNoda= ascot _Dat= All roof coverings to be Class'%fi."or better CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20800 HOMESTEAD RD BLDG 1 IA -H CONTRACTOR: VIrEST BUILDERS, INC. PERMIT NO: 09080044 OWNER'S NAME: VILLA SERRA APTS A CA LTD PARTN 1608 4TH ST STE 120 DATE ISSUED: 08/19/2009 OWNER'S PHONE: 6509313457 BERKELEY, CA 94710 PHONE NO: (510) 525-9378 ❑ LICENSED CONTRACTOR'S DECLARATION I— BUILDING PERMIT INFO: BLDG /� ELECT PLUMB� License Class v Lic. #> y25�� f—RESIDENTIAL T_COMMERCIAL r W MECH . Q Date 9 IZ4• � Contractor 1 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 ORIGINAL: 07120166 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 performance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $2500 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. APN Number: 32609056.11AH Occupancy Type: APPLICANT CERTIFICATION I certify that 1 have read this application and state that the above information is correct. I agree to comply with 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 ham;less 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. Signatu Date 10'.��%'� 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) 1, 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. 1 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, 1 shall not employ any person in any manner so as to become subject to the Worker's Ow ne or uthoriz agent: L7' Compensation laws of California. If, after making this certificate of exemption, I Date: become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 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 1 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 1 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