07120173 CITY OF CUPERTINO x m? r.amw 3 fen- "' is
BUILDING DIVISION PERMIT =CONTRACTOR INFURMAT+ION'-
ra,;.�;.na....,. ,
PERMIT NO.
BUILp�r�g�f�cEsi�OMESTEAD RD, BLDG 22 A— WEST BUILDERS, INC . 07120173
WN 'S NAME: t PERMnISSUEDAIE
VS II A CALIFORNIA LIMITED 1608 4TH ST STE 120 07/14/2008
HONR:ARTNT SANITARY NO. CONTROL NO.
ARCHRECTfENG1NEEa: BUILDING PERMIT INFO
REMODEL—NEW DECK RAILS, 'BLDG ELECT PLUMB MEcx
O O O O
X00
LICENSED CONTRACIDR'SDECLARATION ' bDescrition
1 hereby aM.Nut I am licensedSoDescription
under previsions of Chapter 9(commencing ""'^^^ ^^'^^^
with Satian of Division 3afNc Buvnavand Pr.feadons Code,and mylicusau
n in full farce and d.reft
i U."m ley IJc.g
q Da¢ AR HContractor
S W RE(.TS DECLARATION
d
UI understand my plans uu ll be used public mcnNs
U."m�r
g Licensed Professional
y0� OWNER-BUILDER DECLARATION
F I hereby annes Net I am eaempt from the Contractors License Law for the
O O following mason.(Section 1031.5,Business and Professions Code:Any city or county
�i which rcqulras a permit to coruuucL cher,improve,demolish,or mpair any swetum
-i< prior to its issuance,alsoml.irn tom applicant f.,soch permit to IIIc asi,md statement
sNat he is llccmnd mau
purno the provisions of tie Contractors L'icom Law(Chapter 9 Sq.Ft.Floor Area Valuation
Yt- (commencing with Section 701Y))of Division 3 of the Business and Professions Code)or
Nat be u eaanpt themlmm and the basis fa tax alleged exemption Any violation of
Section 7031.5 by airy suppliant for•permit sub)ecu Ne applicant in a civil penalty or APN Number Occupancy e
not mom Nan five hundred dollum(m). p y•fay�1p
❑I.as nater of the preprn3•.or my employees with wages as their sok eompemwtion,
will do the work.and tom suuctum u not intended or offered forsale(See.7D16,Business
and emfesslons Code:The Contractors Liana Law doer nut apply N an ow.,of Required Inspections
property who builds orimpreves thereon,indolent docssuchwork himselfor through his
own employees.prorlded that such improvements...I intended coffered(ornate If.
however,the building or improvement W sold within one yes or completion,tom owner.
WIIM will low the berder of proving Nat he did out Wild or improve for purpose of
sale.).
❑1,u owrcr of the prepeny,am emotively contracting with licensed contracmn to
constmct the project(Sec.7064.Bminca and Preassions Code:)The Comacmrs L4
are Law dos out apply to an career of property who Wilda w improves themon.and
who contracts for Such Mjecis with a eonaXbt(S)licensed pursuant to the Contractors
Iscena law.
❑lamaemptunder See ,B&PCforthumsson
rte Date
WORKER'S COMPENSATION DECLARATION -
1 hereby affirm under penalty of perjury one of the,following decimations
❑1hamandw lmaintains CenifimuofConsentmmlf.insomfar Wor sCompm-
.dan,as provided for by Section 3700 of the Labor Code.for the perfommwa of dre
woh for which this permit is issued.
❑1 have and will main o Warkers Compensation Inmurana.u required by Section
3700ar Nc labor Code.for One terformanco of the were for which this permit is issued.
My Worse mpLemai�>m]lmrs.amia and Policy num W,ase:
Came 'Fs• `kms/ Paltry
CERTIFl Op EXEMPTIONFROM
RO WO
COMPENSATION INSURANCE
(Thdrus m rad rot W complercd doom permit u foroue harm eddellus($100)
or Ins.)
1 artery that in the performance of the untie for which this permit is issued.l shall not
employ any person in any sooner art as to Wcome subject to the Workers'Compeareauoo
Laws of Ceromia Due
Applicant
NOTICE TO APPLICANT.IL after causing this Certificate of Exemption,you shwd
become subiea in the Workers Compensation previsions of the labor Cade,you most
.J z forthwith comply with such provisions or this permit she W damr4 reve ea&
,zy O CONSTRUCTION LENDING AGENCY
[-m r I hereby erurn Nat Nem mmm
is.ection lending agency for the performance or
tic the work for which this permit h Issued!(Sue.3097•Civ.C.)
W Q (antlers Name
z Landers Address
U Q 1 anify that 1 have read this appil,"..and state Nu Ne above information u
(T. E•' correct 1 agree to comply with all city and county omivances and some laws rowing to
U Wilding conssmmioa,and hereby wummi.represenuuvnof this city t.enter upon the
aWve-mcnudgm property for Inspection puryhma
F y (We)agree to save.indemnify and kap hum tress the City or Cottonton against
Ur/) toccitia.Judgmcnu.eowmnd eapmtaa which may in any way acme against tend City
Z i consrgaeeee sur the ting.,Nim permlL Issued by: Date
,-. A
�—
HAZIRDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicama Or fuuue Wilding aavpantsare orhasedle hammen s material
as defined by the Cupertino Municipmg:ade.Chapter 9.13,and the Ha1N and Safety
Section 25532(.)7 0Yn y'rva All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding occupant use equipment or dcvias which If a roof is installed without first obtaining an inspection,I agree to remove
emit hrnNnns air contaminants as defmmd by Ne Bay Ana Air Quality Marugemcnt all new materials for inspection.
Dior cm7 p
❑Yee >qNo
1 have read the hvardnnsmateriaW requirements under Chapurg.95 of Ne caller.
miamal
� — All roof coverings to be Class'nar or better
am'
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20800 HOMESTEAD RD BLDG 22 A -L
CONTRACTOR: WEST BUILDERS, INC.
PERMIT NO: 09080051
OWNER'S NAME: VILLA SERRA APTS A CA LTD PARTN
1608 4TH ST STE 120
DATE ISSUED: 08/192009
OWNER'S PHONE: 6509313457
BERKELEY, CA 94710
PHONE NO: (510) 525-9378
❑ LICENSED CONTRACTOR'S DECLARATION
F_ r
r
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic. #
MECH RESIDENTIAL COMMERCIAL r
ContractoryV (151Date 9 2~ ' �
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.
I 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
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: 32609056.22AL
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 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.
Signatu Date �'Ly '
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).
I hereby affirm under penalty of perjury one of the following three
HAZARDOUS MATERIALS DISCLOSURE
declarations:
I 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. I 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 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.
liealth & Safety Code, Sections 25505, 25533, and 25534.
I certify that in the perfortance 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
On' p
z i
Compensation laws of Calilbmia. If, after making this certificate of exemption, I
Date: G •
become subject to the Worker's Compensation provisions of the Labor Code, 1 most
I 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
forwhich this perinit 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
I 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