07120174 CITY OF CUPERTINO *R5 %�.ix. •fr �+�"'- s'
BUILDING DIVISION PERMIT CONTRACTOR INFURMg10N '
� �i;,�'k_ vY.w�ma,',•,�,ren �� 5-nti' t3xd�
BUILDING ADDRESS: PERMIT NO.
20800 HOMESTEAD RD, BLDG 24A-H WEST BUILDERS, INC . 07120174
OWNER'S NAME: PERMIT ISSUE DAIS
A CALIFORNIA LIMITED 1608 4TH ST STE 120 07/14/2008
, q caro SANITARY NO. CONTROL NO.
ARC11=1ENGINEER: BUILDING PERMITINFO
REMODEL-NEW DECK RAILS, O EO PLO O
X00 LICENSED CONTRACIDR'S DECLARATION ' Job D'escri tion
1 thereby affirm that,l am licensed under provisions of Chapter 9(commencing •-^^-- ----^^^ P
Z� whitSection'")of Dividon 3afthe BudnevatW Profession Cadc.aM Ilk..is
_O m
to
full to=and cffecl
p v�Z Lice.ClM Lk.N S - a
ETC Da Cmna.aar
pp ARCHIECI'S DECLARATION
C 1 understand my plus Nall be used u public mcords
D
40 t; Licensed Professional
3OWNER-BUILDER DECLARATION
�7 I hcrcby s(Rrm that I am oempt from tip COnoactor'a liter.Law for roc
CaO following nsson.(Section 7101.5.Business and Profasiuu Calc:Any city or County
$(Li which requires a amil W mnsvuct,alkr.improve.dcmolkh,err rcpob any NueW.
_Zay- p^or to its issuance.also requires dp applicant for such permit w file a signed statement
than he is licensed pursuant to the provisions of the Conuacmrs Ucen.Law(Chapter 9 Sq.Ft. Floor Area Valuation
3 (commencing with Scedon7000)of Division 3orup Buainessm
and Pfessiom Cods)or
03—
that he's eumpl therefrom and the bub for the alleged exemption My violation of
Section 7031.5 by any applicant for a permit subjects the applicant W a civil penalty of APN Number araC DQGu
Out mare than firs hundred dollen((SMP Y Type
0 I,as owwer of the Property,or ery employes with wages u their mit compensation,
will do the.,it.and We svucturc Is Out intended urolfered NO ask(Sec.7044,Bud.
ane Profuaiou Cada:Too Centrxbh Lima.law Baca Col apply W an owwer of Required Inspections
property who WBdsorimpmves thiseon.and who d«asuchwokhim.Borthmugb his
ownemployeu,provided theta ch improvements am not intended eaaResed forsa e.B, -
howevu,the building es improwmmt is mid within one yen of cempletic n,the names.
builder will have the bathes of proving Wal he did ml build in improve for purpose of
.k.).
0 1,as owner of the property am uclusively contracting with Restated Conuamars W
contrast the project(Sec.7060.Buaiws and Profeetkrf Code:)Th ConbscWrs U.
cera law does not apply.an owner of property who builds or improves Wercoa,and,
who contracts for such pmjem with a comneWNs)licensed pursuant.tip Committee
Lice.taw.
❑Iamucmp wore Sec ,B&pCfmthbmuMm
caner Date
WORKERS COMPENSATION DECORATION
1 hereby affirm under penalty of perjury orc of dW(.hawing dechushome
❑1 haw and will maintain a Certificate,(Comee s.self-iuum Fmw0M1<ls CMp Ch.
action,u p.ikod f.by Sx6on 3700 of the Lobo Code.fa the perfama.Co of up
weak(or which this Permit is issued.
❑I have and will mamourt Workers Compensation I...as myuimd by Settle.
3700 of the Latta Code,fir thepedinmance.fda,work tea which this permit is issued '
My Work/e�
" Policy No.:num n`—C6�i
CERTIFICATE OF EXE MON FROM WORKERS'
COMPENSATION INSURANCE
(Thbseetion weed twtbeca.pkied if the permit is fora.hundeddoBan(SI00)
tar Luc)
I certify that in We performance of tip work for which this permit se based.l shad not
employ any person in my mouner.an W become subject.the Wedius Compeuation
Laws of California Dan
Applicant
NOTICE TO APPLICANT:If.after making this Cenificam of Exemption,you should
become=him W tho worker's Compensation provisions of the labor Cade you must
.J.7.' forthwith comply with such provisions or this permit shall 4 deemed revoked.
z O CONSTRUCTION LENDING AGENCY
[—n 1 hereby alum the Wert I..Couuuction lending akem,far the performance of
CG the work for which this permit Is Iasad(Sec.3097,Civ.C)
QLender,Name
r7 z Lemiera AM.
U O I certify that 1 law read this application and sou this the above information is
HConed I agree W comply with all city and County Ordinances and sue laws minting he
OU building eon.uetimn,and hereby authorlm mpre..tatives of WU City W once upon tip
[T7 shove-muuawed property r foie inspection purposes
gy (We)agree to save,indemnify and keep harmless the City of Cupertko against
y Wbilitica.iudgmenu,eau andupe^su which may Weeny way amneagbulsaid City
U Z to Consequence of the ganfing of this permit
CANT UNq RSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
s0
c
HAZANDOQ ATERIALS DISCLOSURE Type of Roof
Will the appliant or future building occupant stere orbardle hamrdou material
u defined by tic CuPenino Municipal Code.Chains'9.13.and We Health.d Safety
arse
Section sss3g(a)7 All roofs shall be inspected prior to any roofing material being installed.
Yu rl:
rF If a roof is installed without first obtainingan inspection,I agree to remove
Will us applicant in um.building by ft Bl u.equipment a dcviaa which P
eDmn�c Tardnu air conaminanu u defined by Ne Bay Ara Air Quality Maugcmcnt all new materials for inspection.
C]YC' kA.
I have mud We haursos mauriab mqubements under Chapter 6.95 ufthc Calif..
his Hnith&Safety Code,Sections 25505.25533 and 75534.1 undersand that ifthe building
Jou rpt cumaay M cn.1.Cuts It b my responsibility he utility ft occupant of tip
.qct
mrizedagIM p All roof coverings to be Class'A.a'or better
CITY OF CUPERTINO BUILDING PERMIT
BUI1.6I-4; ADDRESS: 20800 HOMESTEAD RD BLDG 24A -H I CONTRACTOR: WEST BUILDERS, INC. PERMIT NO: 09080053
OWNER'S NAME: VILLA SERRA APTS A CA L"I'D 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
❑ LICENSED CONTRACTOR'S DECLARATION
License Class Lic. # 5-4503ciS
Contractor L"� oz, Date D-
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.'] agree to comply with all city and county ordinances and state laws relating
to bni!ding 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.
❑ OWNER -BUILDER DECLARATION
1 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 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).
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 I'or 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 suety manner so as to become subject to the Worker's
Compensation laws of California. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I 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 %vith 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 ELECT PLUMB
MECH r RESIDENTIAL r COMMERCIAL r
JOB DESCRIPTION: REVISION UTILITY CLOSET
Sq. Ft Floor Area:
Valuation: $2500
APN Number: 32609056.24AH I Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITIIIN 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(x) should I 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 I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
health & Safety Code, Sections 25505, 25533, and 25534.
Ow, agent: —
Date: .0- y•
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 Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional