07120175 BUILDING DIVISION PERMIT 7�rCONTRACTOIi INF'QRMATION
BUILDING ADDRESS: PERMIT NO.
20800 HOMESTEAD RD, BLDG 26A-H WEST. BUILDERS, INC. 07120175
OWNER'S NAME: PERMIT ISSUE DATE
411 VS :II A CALIFORNIA LIMITED 1608 4TH ST STE 120 07/14/2008
Si wI,NT SANITARY NO. CONTROL NO.
ARCHTIEC tENGINEER: BUILDING PERMIT INFO
REMODEL-NEW DECK RAILS, BLDG ELECT O PLO MECH
30o PATI
LICENSEDC'ONIRACMWSDECLARATION O ascii tion
1 mucby ail ml that 1 are licensed under provisions of Chapter 9(commcucing --- ------ -•---•------ p
Z� wiNSw,om 70(10)rkf Di " nlrkfthe Busumm"Pawasi ns Code,arWmYlkense u
<<O H u roll loses.cad erten 'J
7q� LIcense w Lk.N J
�- Dao: Comrumr
eq Ol]yr' AICNI]ERSDECLARATION
u tial my plots shall W used as public accoNa
t too In Licensed professional
OWNER-BUILDER DECLARATION
i�f 1 Wmby affirm that 1 Sm stamps from the Conumetor's Uccnse law for the
i.
20 following mason.(Section 70 L5.Beat..and Profusions Colo:Any city or county
S_ which acquires a perenh m construct,that.improve,muralist.m repair my smature
-Zi priorte its imuame.alau requimstheapplicamforsuch pennittofiicasigncdamicmens
Fxx that he is licensed pursuant to the provisions of the Contractor's UcemeUw(chapter 9 Sq.Ft. Floor Area Valuation
a}Fs (earn. dog wilt Secdan 70lN1)of Divuirkn]rkf the Butineco and Professirkv Cale)m
- that W-sumps thoeaslrom and the basis far the alleged Codon.Any violation of
Satish 701.3 by any applicant for a permit mbjecu the applicant to a civil penally of APN Number ane Occas T
rot mom than five hundred dollaISMP Y Type
IS
0 I,u owmr of Ne pmpeny,or my uoployees with wagu m their sole compewdon,
will dolcusiolc We: he CoreranotnamedeLaw data
w an owner
and Pty who u code:The contractor's Liana Law dam not apply to rd owner or Required Inspections
prolaemwerebasildtorImpmveuthereon,andwho daosuchworkhimself dtwor Sawn.
two the
Wilding
or i Jul such hmprovemmu art m imerdM m oRemd fo sale R,
sutlerhowever.Ne building ar improvcrmnt u sold within et uear of mmove for the oseo-
builder will have the Wden of proving that W did int build m improve for purpose of
role.). -
0 1,u owner of the progeny,.m exclusively...trusing with Roamed ronhectors to
construct the pmjen(Sec Hiss.Business am Pmrossiou Code:)The Contractor's U.
c now law dors not apply to.n owner of,roomy who Wilds or improves thereon,sed.
who contracts for such projects with a conuanor(s)licensed pursunt to the CantaactoYa
Linty taw.
❑I oh exempt under Sac B k P C for this moan
Date
WORKER'S COMPENSATION DECLARATION
1 hereby arum under penalty of pmjory arc of the following decimation,
❑1 have SM will maintain Section
37M of C e Loth to Code.f ore tie Workeer ce of the
smirk,,r provided Ise hY SeNsu 1]08 of the labor Code,for the perfomarnc o!the
wok for which this pmmis u issued. -
0 I have and will maintain Werther eo ewass ion Insurance.u acgdacd by Section
17M of Ne laWr Cods.fa She x6ormame alum won fnrwhich this permisis issued. '
My Worker's Compete u1Mn,Wurmm earn v and Policy number ate:
Cae��G- TV^'/� Poliry Ne.: 6� 2-UO�
m
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(rho readen had hos ha complcwd if the permit Is furans hundred chapter(SIDE)
m Wk)
1 certify that in the perfomauce of the work for which this Permit is issued.I shall not
employ any Perron in my master m m to become Subject to the Wartos'Campensatlon
Laws of calif nam Dam
A,Ihaurt
NOTICE TO APPLICANT.If.also making this Certificate of Eumption,you should
instance.ubjal to the WorkcYs Compensation provisions of dm Loiter Code,you most
.J O forthwith comply with such Providoot w this permit shall W dcemrd revoked.
z F. CONSTRUCTION LENDING AGENCY
I hereby Nirm than Nem ua constmcRm Imclin,.gam,for She perfmmatne of
C i the wart far which this permit h Wood(Sec.1097,Civ.C.)
0 Lender's Nauru
,Z t<nder's Address
U Q 1 cmdfy that 1 have mad We.,ties ..and sure this the Shave informathun is
U. cormcL I agree to comply with all city and county callowness and a=ilM Sulam,to
O Wilding cmoduuction,and hereby aurhode,reproscnu ns of this city to roto upon un
above-mentioned property for inspection purposes
(We)agree,scrto cove,indemnifyand trap may
theCityof aguarsnard Ory
Z in
gjnce of theou,cots and gnating ofpcuuwhich may in my way acrnnagainst mid Gly
U Z rn csLICANTc of DFRSTANDS AND WILL COMPLY WITH ALL NON-POINT
S
—
HAZARD S MATERIALS DISCLOSURE Type of Roof
Will Ne a Cupertino
o funre handing oaupamsMre ,a d then eadoud Ida,
as defined by Jac Cupertino Municipal Code,Chapuer 9.11,Such the Health mJ Salety
ache,Satish 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yu y.)�aVo
\ If a roof is installed without first obtaining p an ins ection,I agree to remove
Will true applicant or future Willing coupons use equipment o xviec,venter
e0msi�lu'rad,m air ronuminms m dcOmd by the Bay Amo Air Quality M.rogcmcot all new materials for inspection.
wO
❑Yu Q a
I have read the has dem nca ormis acquiacmmu under Cloquet G95 of Jm calilsr-
nuHcaiN&Softly Ceche.Secures 253715,25311 vnJ 255N.1wdciRand thaifJre Wilding
d
`—I (4 e All roof coverings to be Class'%{."or better
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 30800 HOMESTEAD RD BLDG 26A -H
CONTRACTOR: WEST BUILDERS, INC.
PERMIT NO: 09080055
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
r r r
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic. N RZ-'�851 -5
r r
MECH
+ `j`Z'
Contractor N� � � "
Date lS
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.
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
Sq. Ft Floor Area:
Valuation: $2500
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.
APN Number: 32609056.26AH
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 a:l 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
indemnity 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 understanJs and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
Issued by: Date:
9.18.
SignatureDate �•��
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 H ith 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
1 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 I 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 1 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, I shall
not employ any person in any manner so as to become subject to the Worker's
Owns uthor' ed agent:
�•ZY• S
Compensation laws of California. If, after making this certificate of exemption, I
Date:
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.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
APPLICANT CERTIFICATION
for which this permit is issued (Sec. 3097, Civ C.)
I certiN.that I have read this application and state that the above information is
Lender's Name
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
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.
Li,,ensed Professional
Signature Date