07120171 CITY OF CUPERTINO
BUILDING DIVISION PERMIT '-0NTRAA t,,Q*INTQRIVIATIQ'lY
a�l
BUIE, ING D ESS: PERMIT NO.
J.OE�S� HOMESTEAD RD, BLDG 18A-H WEST BUILDERS, INC. 07120171
WNEWS NAME: PBRMITISSUEOATE
VS I.I. A CALIFORNIA LIMITED 1608 4TH ST STE 120 07/14/2008
HONB:A I)'1'N SANITARY NO. CONTROL NO.
ARCHTIEC(ENGINEER BURRING PERMIT INFO
REMODEL-NEW DECK RAILS, BLDG ELECT PLUMB - MECH
SCFAIR u00 LICENSED CONTRACTOR'S DECLARATION IobDescription
4U§ l kneby alfmot that l am licensed muter provisions of Chapter 9(mmmencing ••-^^^ --^�T^--
with
rose anddo 5«uon' anJof Ne Businrs�and Profession Code.end my licensee
N in full ffeenDar
j'/A? lice: Lk.N
CC= Dao: It ARC M SsiteTS DECLARATION
D 1 uMcsuan nJ my plNal4l1 h d u public records
k QIn Lh mrd Prefessionel -
3 OWNER-BUILDER DECLARATION
1 hereby a1Brm that 1 am ucmpt from the Convenor's Uee:m Law for the
a o following mason.(Scetiun 7(B 1.5.Bmincas and Professions Calc:Any city of county
3 Pi which requiem•permit to c:nstrucL cher.improve.demolish,«repair any amectem
priono its issuance,also require Ih applicant forsuch permit b Glc a signed seatemem
that he is licensed Ferment to Ure Provision of dm Commencer Umn.e Law(Chapter 9 Sq.Ft. Floor Area Valuation
Yx
om$ (cot be,0mgwith ScNoom sand)of Divuionr of Neegeinessandon.Any viCorkof
IM,h k emmpt thmefrtm and Use basis for doe alleged eaemptiou Any violation of
Sectimt 7031.5 by army applicant f«a pends mbjmu Ore applicant to a civil penalty of APN Number Occupancy Type
nen,mom than son,hundred dollars(55001 P Y YP
0 base ofthepropertymmywploymwithamgnntheasoleeom don,
will do the work sod the mucwm es not mantled err offered knak(Sec.7041.Eastman;
and Prokssians Code The Cmtrstnls License Law ren not apply b an ower of Required Inspections
properly who builds or i m proves thereon,and who dm such work himself or through his
awn employsms,provided the,such improvemms em IbI intended«onmed fmsaln H.
hmmm,Ne building«improvement is mid within one)ser of mmpkuon.doe owner-
builder ,will haw f burtlea of proving that he did not build or improve for purpe m of
akJ.
0 1,u owner of the property am eslmively conmding with licensed mncamors b
mntrum the project(Sec.704.,Busines and Profession code:)The Contravenes Li.
cease law don not apply he an owner of properly who builds or Wpmm dam um.and.
who contracts fur such Projects with amnvsmd.)licensed pmarunt no the Cmvsbes
License aw.
0 lmnea
ptceSe ,BkPCfortheseamn
ee '
Das
WORKERS COMPENSATION DECLARATION
I bereby affirm under penalty of perjury rote of the following dmlaradms
❑1 have and will maintain a Certificate of Consent to self-Were fm Workers Compm.
sada:.
work: provided fm Schon 3]00 of the labor Code.fm site Rrfarmanm enf tie
for
which this permit is isuM
0 1 have and will maintain Worker's Compens0on Insurance,as mquimd by Schon
3]OOof the labor Code,for dN performance of the work forwhich this permit u issued.
My Wodk Com Inmanm curter and Policy number�:
Carder.. Ftp Policy No.: J t'(
CERTIFICATE OF EXEMPTION FRO M ORKERS'
COMPENSATION INSURANCE
('this amlon reed cath completed lithe permit is f«one hundred dmlarffs IOD)
or lms)
I cmifv the,in the performance of the wort for which this permit is issued,I shall nm
employ any person in my remrceran s to become subject to tic Workms'Compenadon
laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Cedifim a of Eameptl n,you sbOO9
become mbja,as the Wmkc a Cempenadon provisions of the lab«Cade,you mus
.,O forthwith comply with such pro
vidans or bis permit Nall h deemed revoked.
ry CONSTRUCTION LENDING AGENCY
F.m l hereby arum that theres.cnmatncdon lending.gency for site perforece.a
C> the work for which this permit is issmtl(Sc..309'1.Civ.e.)
aLenders Namc
z Lender.Md.
U O 1 ratify that I have mad this application and team than the above information is
Ig, ^ conett 1 agree to comply with all city and county eminences and seats laws nesting to
Q CT.^J building coawcGan.and hereby mNoda repmaenutim of does city to cnw upon Nc
r 4 above-mmuomd ehl.Propertytet for Inspection purpwhich ms
(We)agree to ave,indemnify and keep harrelry doe City of Cupertino against
mFi Z IiNinnesludgm rt that
costs and miles XmriLhmay in my way acerae ageW,sald City
U,z in consegucnco of doe granting of this Permit
m-+ APP NT UNDE STANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOU EGU TI
4(0)CE Re-roofs
siywureof ApplicanvComsen« k
HAZARDOUS XATERIALS DISCLOSURE Type Of Roof
Will Oe applicant err future building omupanaebm«handle haramom material
as dcBmd by tie Cupertino Municipal Code.Chapter 9.12 arm Ih Health and Safety
ode.
Section 35572(e)?
❑Ym 171 No All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or(future building occupam use equipment or devim which If a roof is installed without first obtaining an inspection,I agree to remove
cod'haramnes air ccouminanu as defined by Ih Bay Arca At,Quality Management all new materials for inspection.
District? L P
GYns N No
I haw mad Ne hvardons materiaes rcqui ermas ureic,Chepbr6.95 of the Calif«-
niaHwlthkSafc,yCadc,Smdms25505.2 533am125534.ImtlmaaMNmifdc Willi
Once sly ve.tenana dot b es my msp:ndhiliry b notify thq3_1
of Ne
repent mar`: re ren prior,:ismanee of a Ccrtill � Signature of Applicant Date
Owner or anthmired 0gen, �' All roof coverings to be Class'%W'or better
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20800 HOMESTEAD RD BLDG 18A -H
CONTRACTOR: WEST BUILDERS, INC.
PERMIT NO: 09080049
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
BUILDING PERMIT INFO: BLDG r ELECT 7 PLUMB r
License Class C/ Lic. # 825395
T_ T_
r
Contractor W-r2l ( Date 8.24•5
MECH RESIDENTIAL COMMERCIAL
I hereby affirm that 1 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: 32609056.18AH
Occupancy Type:
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
corri:ct. 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 tliz above mentioned property for inspection purposes. (We) agree to save
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
indemnity and keep harmless the City or Cupertino against liabilities, judgments,
180 DAYS FROM LAST CALLED INSPECTION.
costs, and expenses which may accrue against said City in consequence of the
grant n;, 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 9 •Z
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
I 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).
1 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(x) should 1 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.
Health & Safety Code, Sections 25505, 25533, and 25534.
1 certify that in the performance of the work for which this permit is issued, l shall
-not employ any person in any manner so as to become subject to the Worker's
Ow er r authori et gent:
Date: 8.7
Compensation laws of Ca!ifomia. If, after making this certificnte of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I must
Al
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCIG'ION LENDING AGENCY
I hereby affirm that there is a construction lending agency fur the perfomwnce of work's
APPLICANT CERTIFICATION
for which this permit is issued (Sec. 3097, Civ C.)
I certify that 1 have read d -is 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 rccords.
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Licensed Professional
Signature _ Date