07120168CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20800 HOMESTEAD RD BLDG 12A -H
CONTRACTOR: WEST BUILDERS, INC.
PERMIT NO: 09080046
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'SDECLARATION
F r— r
BUILDING PERMIT
License Class (f_Lic. N VO Z5 ? J
INFO: BLDG ELECT PLUMB
F r—COMMERCIAL r
O�31 0—,'_X4' q
MECH RESIDENTIAL
Contractor Date 1
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
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: 32609056.12AH
Occupancy Type:
APPLICANT CERTIFICATION
I ce.r,)ify that -I 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, anJ 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.
Zr• S
Signature Date
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, I agree to remove all new materials for
hereby affirm that I 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:
I have read the hazardcus 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 Healih &
performance of the work for which this permit is issued.
Safety Code, Section 25532(a) should I store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance, as provided for by
Additionally, should 1 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 I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
permit is issued.
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
1 understand my plans shall be used as public records.
with al I non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Licensed Professional
Signature Date
CITY OF CUPERTINO r = .t•. s s "� ,« '� " '�--*�,
BUILDING DIVISION PERMITCONTRAC,17K, FOLtMAT ON
x7,.aTRsh.
BUIL 1 FSS: PERMIT NO.
I'IOMESTEAD RD, BLDG 12A–H WEST BUILDERS, INC . 07120168
NER'S NAME: PERMIT ISSUE DATE
VS :I.i A CALIFORNIA LIMITED 1608 4TH ST STE 120 07/14/2008
PHONES\I7'TINT SANnARY NO. CONntOL NO.
AacxrrscnENc119EER: REMODEL–NEW DECK RAILS, 'BLDG BEILDING PER LECr PLOo
MBMECH
O O O O
tins LICENSED CONTRACTORS DECLARATION AIR FAlieft
JobDescription
u 1 hereby affirm Nn 1 am licensed under previsions of Chapter 9(commencing '—^^^ ••^•^^-'
" with Sectwn TOfIU).f Division JafNC Buanev aM Prfcssiav Crae.aM mylken¢io
nth bon,ores and ercect. .
C
Fq De¢ Conuxmr
W cHrfECrS DECIAR N
LL 77 I undnvavJ my plana mall be unci as punlie rsorN
;yU
no Licensed Pmfewional
5 OWNER-BUILDER DECLARATION
i hereby aRm Nat I em exempt from the Gmtrmara Licence Isco far the
❑O following mown.(section]071.3.Business and Professions Cade:Any city or county
Swhich requires a Permit to construct,slmr,improve,dcmolLN,or repair coy structure
that he primbistwunedpumwun,to Ithe es hire visions of of for Contractors
ontracense Law
aedawmment
pp < (commincegwithSectamt00MofDiainion3of eoBusiness
mcmrauamnmmusCvpar9 Sq.Ft. Floor Area Valuation
Y�S
(commencing"nag wtN Section 700M and
the
Division r the
theeged euand on.My
Code)of
��^ the he u eampt therefvm arW the baro for the aimgcd exempt(ws My vloluion of
sector]0315 by airy applicator for a Permit subjects the appliamm to a civil pnulty of APN Number Occas Type
trot mom Nut five hundred dollars(5500} Occupancy YP
L as owns of six property,m mY enployca with xga w shear celecompenwuan,
aid dothewon,artathe she Cmebtoti%Lined Laved:fmaam(Sec.To ad,maninm
and property
wh Profession Calc The Cmtrecmrs red whe Law dao trot apply lf rt owns of Required Inspections
property who milds or i mpmvea thereon,and who ares ouch work himmlf ler Maugn his
over ler.ft hu,provided thuduh improvementsiswithin
are not intended ofcmm0ertd far ale B.
however.Ne avec a or den or pro, timid withinmeyear of nom umeforn.pan nom f
milder will low the buNm of Proving that K did ms build m improve for puryace of
❑1.as owner of Ne propeny am exclusively contracting with Raised com uclum or
comment But,project(Sec.]ON,Business and Protractors Code:)nm Contractors U.
neva Law does not apply m an owner of property who builds or improves themon,and.
whrconracn for such prejeas with a.carracurfa licenced pension to the Contractors
Licame Law.
❑I am exempt under See .B h P C for this reason
ne Date
WORKERS COMPENSATION DECL1RAn0N
1 hereby affirm under pcvhy of perjury one of the following decimations:
1WasleM will morineCen 3700 of ft Labor
invert a Performance
worn,r provided(m by Section 7]00 of Ne Inbar Code,for site pentamer¢a!the
cosh for which this permit is iwuN.
I have lend will munuin Waters Compensation Insurance,as required by Section
3700 of Ne labor Code.for the perfomance of Ne wars formic h NU pemait u issued
My Wo rex Co penaad nsunmre crier.d Poli numbcrate:
Cartier. Policy NOcl b
C'EWTIFICATE OF EXFMPf10N FROM WORKERS
COMPENSAnON INSURANCE
(nos ceedm mod ret becomplesed Uthe permit 4fmonehundnW doBan(SIM)
or mons)
1 anify Nat In Ne Performance of tho won Ire which this pectis Is issued,l shall not
employ any person in any manner an as an become subject to the WorWn'cmopedation
Laws of California.Due
Applicant
NOTICE TO APPLICANT:If.after making this Ceniftcate of Eaemptio t,you should
become objca to the wmh .C.Nnsmon Thornton.of Ne Isba Code you mus
.JO fonnwith comply with such poviaov m NU reW reked.
Permit shall be dmvo
z y coNSfRUCf10N LENDING AGENCY
F ^h Iherthyaf imthat them Isom.....don lending agency rmtile penrmma on of
eG>
the went,for which mea Permit is Wood(sec.709'1.Civ.C.)
Lenders Name
5 z lenders Md.
U C) 1 certify that I have read this applicauan shad sate Nu she above iMomaum is
D.;•' torten.I agree to empty with all city and county oNlnaves and sur lave relNng to
0 CSJ' building construction,and hereby aulmduc mplemnstives of Nu city to enter upon the
0. alcovetm maned ms,propertycosts
for inspection puryoces
(We)agree m saw.indemnify and kmp hamlew the City of Cupertino against
4�r In in consesenc ma rd,smarming expeveawhich mryin coy way acerae against wid City
U z in
Wlnl ALL NON-POINT Issued by: Date
s\
sagnuurt of App ICLUVOntracmtXI re Re-roofs
HAZARDOUS MATERIALS DISCLOSURE �— Type of Roof
Will No appliexm or future building mcupan1am..,handle haembus ma¢rial
as dcfned by Ne caper an Municipal Code.Chapter 9.1;and the Ha1N and Safety
.sectionz5572(.)]
❑Yns _5K All roofs shall be inspected prior to any roofing material being installed.
will the, linwt m tutu.building aecm m nus e m If a roof is installed without first obtaining an inspection,I agree to remove
Ire a w q it Qu m hm.ms whim g Pe
eDistrihaysmnns air conuminanu1111 us dcOuM by the Bay Area Air Quality Management all new materials for inspection.
❑Yes .
I hew mad theharamousmamrials requirtmew under Chapur6.97rfNc Calif.,.
nuttaltn,h sareyeoae,s�tia�+15M5. 533"V5s3a.lundenundthdtrth.boding
does cu mly new a um klbat It u my ma madmility to notify hhe occuPwt of the
regnimme w % Signature of Applicant Date
OwnermmNmi.edvgo 1 1 tism 1 All roof coverings to be Class';W'or better