07120170 CITY OF CUPERTINOns«t '�' "�'
BUILDIN G DIVISION PERMIT RECONTRACTORINEyO�It1VIA.TION a:
BUINc rESS: PERMIT NO.
Mr
HOMESTEAD RD, BLDG 16A—H WEST BUILDERS, INC . 07120170
ONER
W 'S NAME: PERMIT MUE DATE
VS i. [ A CALIFORNIA LIMITED 1608 4TH ST STE 120 07/14/2008
ONEA WrliNT SANITARY NO, CONTROL NO.
ARC HTTECTIENGINEER: BUILDING PERMIT INFO
REMODEL—NEW DECK RAILS, BLDG ELECT PLUMB MECH
STAIR O O O O
Boa PAIIH
LICENSED CONTRACTOR'S DECLARATION lob Description
e 1 kmby affirm mal I.m Ettn><a under pmviuoiu of CTapmr 9(rommcncing ---^-`--' - ^-^^^
ewill,on 1OflU)ofD Abst .3 f ft Businuaand Prarutluru Cale,and my I...is
iqba nr.Bmra,naert 9253`1$
Liam cl a Lied
30 Dam camnaar )¢]
£t: ARCHITECTS DECLARATION
Ss,p s r un nun my pbtu amf k uwd u public mcoMa
0yU
g G 1 Licensed Pmfcsiana
5 OWNEm racy pt from
mDECLARATION
1 kmso .m.(Suet mat 1 sou.Burin rrum w Cssim.Could:
UAny c law for w
I O O following mason.(Scout.7031.5,n,Mer.aw Nn.d.m ns Cade:Any city m county
ourn
C
$On which mquima n permil m c rocs;da k amu improve,de rosi,t fi repair,any awavm
•zi primms ficO.shme.subso.esquires MAttimcul for smhpmmr's f..le a Lw(ned Cha,em
< this he ulimn.J purswntmwpmviaions afwConuacmr'sUttme law(Chapmr9 Sq.Ft.Floor Area Valuation
,1 9 (commaming with Section 7000)of Division 3 of w Businees and Pruruaiom Code)or
thsh k Is eaemFt thuefmm shod w bans for w alleged erempuan.Any violation of
Schon 7031.5 by any applicant for a permit subjects w applk.t to a civil penalty of ane APN Number Occupancy Type
not mom mail Rw Instated dollars(SM P Y YP
01.uow.uofwpmpeny,mmyrmployenw0 wgnuwu.leeamp.nsedon,
will Pr thewons and w he Com or noU.mnded or am,do sante(Sec.7UM,B nscr of
and property
bis los Tk canuacmr,Liana Law mil not apply lf,t awar a Required Inspections
properlywhos.p mimprovesch imprendwho donsmhwork himsenar through his
Own .Meta,providedpthat suchimpmsemenu am not CAr OfrulPhor .the owner,however.Neunc Miorior,o rovi.u.Mwithinares)earorcmnpleuorwowmr-
builder will lose w buNcn of moving that k did not naod m improse for purpow of
um.).
0 1.as owner or the property.a.exclusively contracting with Banud ronaumrs in
construct the pmjca(Sec.7061.B.m.and PmfeWans Cade:)Tk Conmemra U. .
..Law don not apply as an owner of Drapery who builds or bom ovu wtmn,and.
who conuacu for such gojecu with aronaaur(s)licensed pursuant to w Conuacmrs
Lice.law.
❑I sou esempt nods,Bee .B A P C for this mason
w e Dau
WORKER'S COMPENSATION DECLARATION
1 bemby of i m under penalty of perjury arc of the following dech aulons:
0 Il"veandwillmunWnaCmifrawofC mentwxlf-inaumfarWmkchCompen-
nation,u provided for by section 3700 of w Labor Code.for w perfarmana of w
wart for which this perm,is issued
0 I have and will mainuin Wormer Compensation Insurance,as mgoimd by Section
37W of the Lab.Code.fm the pertormuce ofw work for which dos permit is meed. '
My Wor s ororm3��u an 11n(='�amx carrim and Policy musbacm arc:oys
Cartier I Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu sadmm mad notkcomplemd ifthe permit is fmmm hu.thcd donnas($100)
mus.)
1 anify wt in w Da(m n.a the wart for which this permh is issued,)Mall.m
..play any pend.in any manner.u to become subject to w Wmken'Compewuon
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,afwr making this Certifica n of Etmpuon,you should
become subject an the Worters Compcvation provisions of the Labor Code.you most
.,z forthwith WMPly with such proviaans or this permit Nall k domed makrA.
z '•' CONSTRUCTION LENDING AGENCY
C7
[-t lamuby which thi out wmua nd(Scc. len ding agemy fmwpeNormemm of
Eli r�-r Le work for which this;permit is issued(Sec.3097,Civ.C.)
Q Lenders N.
N
Law
J z es Adamss
U C) I cocifY that 1 hose read this'Pli.M..and sum Nu w amm information is
Is,F eOrrecl.I Agra to eawPly with all City and county mumaML,and aYw lawn mhoing to
DU Wilding cdnsruaion,and hemby aulhorim mpmaenmuvn or this city to enmr opnnw
Mon-mentioned Property for inspection uer purpowhich ms
F 4 (WO agms m ave,iwemnify and Ymep hsn.las w City of Coperom against
ar h incoiuc,mmoc of Mc
eapeueeront. may in any way uaa agamt said City
U,'� in consequence of w RSTA&Ornfins of this permit
&PPLICANT UN RSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
S tt��.
Slgnamm afApplrgnuConaacu - � 4)4 Re-roofs
HAZARDOUS fATER1AIS DIScI OSURE Dafi� Type of Roof
Will the appliammforme building ovopntsmre.hawk huudoum annod
as,defines by w Cupertino Municipal Codc.Chapmr 9.12,and w Hcalth and Safety
Cedc,Sexists,155311a)7
pyo No All roofs shall be inspected prior to any roofing material being installed.
Will w applicant or(Tamm Wilding aavam uv:equipment Or devim Mich If a roof is installed without first obtaining an inspection,I agree to remove
Disoic omm.all conumi...us u defined by Ne Bay Ams Air Quality Management all new materials for inspection.
DYn �No
I have read w kurd-fisou.mrials aWimmcnu under Chapmr6.95 ares Califor-
nuHaithkSafdyCudc.Smiuns25305.25533 amt 553.l undvaund wlifw WiWbtg
da4"Ti currtnlly h mnanl mal it u my w-sPoruihilitY u mdfY w cup" of w
mqm mar�ar .cr. Signature of Applicant Date
Owncr or auNori td agent /h D All roof coverings to be Class'%¢"or better
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20800 HOMESTEAD RD BLDG 16A -H CONTRACTOR: WEST BUILDERS, INC. PERMIT NO: 09080048
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 1 BERKELEY, CA 94710 1 PHONE NO: (510) 525-9378 1
❑ LICENSED CONTRACTOR'S DECLARATION
License Class G Lic. # 8�3-6
Contractor AJ&1
Date P<ZY• 7
1 hereby affirm that 1 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:
1 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
I 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
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.
Signature
Date t?'2 l f
❑ OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for one of
the following two reasons:
1, as owner of the property, or my employees with wages as their sole compensation,
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
construct the project (Sec.7044, Business & Professions Code).
1 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.
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.
1 certi:y 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 California. If, after making this certificate of exemption, 1
become subject to the Worker's Compensation provisions of the Labor Code, 1 must
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
I certify that 1 have read this application and state that the above information is
correct. 1 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
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.
Signature __ Date_
BUILDING PERMIT INFO: BLDG I— ELECT I— PLUMB r
MECH F RESIDENTIAL r– COMMERCIAL r
JOB DESCRIPTION:REVISION: UTILITY CLOSET
Sq. Ft Floor Area:
Valuation: $2500
APN Number: 32609056.16AH 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 Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
1 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 1 store or handle hazardous material.
Additionally, should 1 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, SeFtions 25505, 25533, and 25534.
Oyp+ r autho iz agent: s
Date: 8 __7Y
CONSTRUCTION LENDING AGENCY
1 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 Address
ARCHITECT'S DECLARATION
1 understand my plans shall be used as public records.
Licensed Professional