07120169 CITY OF CUPERTINO
BUILDING DIVISION PERMIT �aCON ,R�. 7TOR INFORN ATION
PERMIT N0,
Bu1L�1��,�8REIIOMESTEAD RD, BLDG 13A—H WEST BUILDERS, INC . 07120169
OWNER'S NAME: - PQVArLSUEDATE
VS ]:]: A CALIFORNIA LIMITED 1608 4TH ST STE 120 07/14/2008
Of4FLr wI'Nl SANITARY NO. CONTROL NO.
ARCHM=NGINEER: BUILDING PERMIT INFO
REMODEL-NEW DECK RAILS, BLDG ELECT PLUMB MECH
3 c o LICENSED CONTRACTOR'S DECLARATIONNEW
O O O O
1 hacbY aflitm Nat 1 am Ikcmnd under provoiens of ebapter 9 fmmmencma •._....,... ..__�__ Job Description
M== iN Sedan]WU)toofDiviuen Sof dle Busises srtd P�'rso�fcssiov Cook,antl mylicevsis
m=N in full rte sudenaL 8 �i39s
j'a� Licensea Lt. Y
q Dau Convaclw
W7 ARCH[=rSDEC ON
w U I undersand my plans ahall W used u public records
u
e N Licensed Professional[S0� OWNER-BUILDER DECLARATION
1 Wrehy&,firm that I am exempt from Ne Convuton's license law for Ne
p O following rtason.(Suction 7031.5.Business and Pofesions Code:Any city or county
S_ which Minn.a permit As mrswcl.ler,improve,dem H h,or repair Any uncture
_ IS thatW iucensedc.aluantto the pro .cion of th,Contractor's
w(Chup at
ppr< (c mmecingwipSaUntmNcprovivW=3of Bummn's License Law(Chapur9 Sq.Ft.Floor Area Valuation
yl—$ (commencing with Sation]000)of DividonJoftW Businm and Pofessiav Code)ur
Nat M is exempt thcmfsom and Nd basis for Ne alleged&&eruption Any HolaMn of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
sot moa Nw five hundred dollen(SSW} P Y
.i I,as owner of Ne property,mmy employees with meds r Nem M. W..acnes
and M the wort,and Ne sh Com u rot mtaMs a ase do fursau(ply]01.1.Business
of
and erafdslons Catic:The Comrxmn's nd who law tlaa not apply ll an owner of Required Inspections
musturywhobuiMaorimphet such
himpr,andwbo doessucht rnot WMoh him.elfor edthrough bas
amemPleym,psoNdnd N&t such imPovemenu ve not inandnd ooRetnd fnsale H.
however,Ne buildinghu i n of fres.is saltl wi inn an yens of completion,Ne emer-
builder w01 love Ne bathe of proving that he tlitl rot Wim or improve far Purpoe of
ate.).
0 1.As awrcr of the Property-am exclusively examining with Insured contractors to
consutsct this project(Sec.7044.Business and Professions Code:)The Coomcters Ll-
ce ore Law deer nos apply As an owner of prupcmy who builds or improves Nereov,and.
w W convacu far such pmjccu viN a conwnnt(s)licorsetl pursuant m de Canaatan's
L'ici.law.
❑lamxecmprunda See ,B&PCfathureasen
41.1 Dam
WORKER'S COMPENSATION DECLARATION
1 hereby sinners under McMy of perjury one of Ne fallowing declarations,
C]IMandwillmainwnacWrimmof Conwntmelf-ivmrwwo sCompcn-
wlmn,as provided for by Sado.37W of the Labor Code.for the perfonnana of Ne
work for which this permit u issued.
❑1 ban and will maintain Workch Compevatlon I..,as required by Section
3]W of Nc labor CaM.for the Performance of Ne wok fowhidt Nu permit is isuetl. '
My Warton'.cmepensada rams earn ad Policy numYbLs �^
Cartier. c, Policy No.: _y"V
ERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Olus auction reed no,W carnpk.ed If de Permit is faonc hundoddo0an($100)
or mss.)
1 ardfy that in the peiformara of the work for which this Permit is issued.I shell nos
employ any person in any mwner so As m become wbjw to the Wmiscis Comp meadon
Laws of Callfomii Due
Applicant
NOTICE TO APPLICANT:If,allot making Nu Certificate of Exemption.you shm:5
became subject m de Wmke/s CamPeviOon Provision of the Lasa Codc,you mai
0 O foMwiN comply with inch provuinv er this permit Mell W deemed revoked.
z'y CONSTRUCTION LENDING AGENCY
(-+ I hereby afnm Utes dem u a covwcdnn lending agency for she performance of
C' Ne,work for which Thu permit u issued(See.3097,Civ.C)
fy Q Lender'.Nam.
7 z Lender's Adders
U O I certify Nal 1 ban rad this application and sole Nu the shove infonvUna is
IL F' carma 1 agree to comply with all city and county adinaneea and sate lam relating to
0U Wilding construction,and WrebyauNorire rtpreeenatins of this city m ener upon Ne
ahovc-m,judgments.
Pmpcnt fan'inspection pulpwhich
F 4 (We,)agree to ave.indirmily and keep humus the City of Cupsroom ageivt
C.Z liaM seuj.c.orlu,epaace rd,apnea which may in wy way accrue gainstsud City
.)Z APPLI qucnce NURSndNDS ANDhis WIL Issued by: Date
APPLICANT U ERSTANDS AND WILL COMPLY Wfrlf ALL NON-POINT
50 /
�}(�ab Re-roofs
u.9115 me o n
pplscasucM clor ate
HAZARDOUS MA ALS DISCLOSURE Type of Roof
Will the applicant err future Wilding a WLamre or lundu bxMMd material
ex dented by Ne Cupertino Municipal Cade.Chapter 9.13.and Ne Health and Safety
cod,
Sefion 25532(a)? �Nu
Oyer❑YAll roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection,I
Will Ne,applicant or future Wilding occupant lex equipment or Mvi¢s which g agree to remove P
Duuta Amous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
t]Yca I�MIu
I have sad the haaNass maurfau requimmenu under Chapter 6.95 of the Califo.
nice
ate* All roof coverings to be Class'"or better
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20800 HOMESTEAD RD BLDG 13A -H I CONTRACTOR: WEST BUILDERS, INC. PERMIT NO: 09080047
OWNER'S NAME: VILLA SERRA APTS A CA LTD PARTN 11608 4TH ST STE 120 1 DATE ISSUED: 08/19/2009 1
OWNER'S PHONE: 6509313457
❑ LICENSED CONTRACTOR'S DECLARATION
License Class e Lic. # 825015
Contractor
W911
Date 9 •7--1
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:
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.
APPLICANT CERTIFICATION
1 certify 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
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
indemn;fy 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. —_
Date IS'Z1-
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
I, as owner of the property, or my employees with wages as their sole compensation,
will du 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.
I 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
Compensation laws of Califomia. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, l 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. I agree to comply Nvith 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.
Signatu
Date
BERKELEY, CA 94710
PHONE NO: (510) 525-9378
BUILDING PERMIT INFO: BLDG. I—
ELECT r- PLUMB f—
MECH F RESIDENTIAL r— COMMERCIAL f—
JOB DESCRIPTION: REVISION: UTILITY CLOSET
Sq. Ft Floor Area:
Valuation: $2500
APN Number: 32609056.13AH 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 Appi
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. 1 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 emit hazardous air
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
Health & Safety Code, Sections 25505, 25533, and 25534.
Om gent: 4 2y
Date: a
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