07120177 CITY OF CUPERTINO a :11��!w' .+.ttf✓ria � -r -%'-' "3'T(`�`
BUILDING DIVISION PERT - 4lTQk��,� �?�y'�!
PERMIT NO.
Bu1Lgdlic,�34DgEsHOMESTEAD RD, BLDG 30A— WEST _BUILDERS, INC. 07120177
N/''S1�NSAUMlE1: PERMIT ISSUE DATE
40 VS :1:I A CALIFORNIA LIMITED 1608 4TH ST STE 120 07/11/2008
PHONE:^1111'^, SANITARY NO. CONTROL NO.
(510) 525-9378
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG EIFCr PLUMB MECH
300 LICENSED CONTRACTOR'SDECLARATION 7obDescri tion
w I hereby AIR.Wt 1 Am lira ued under pmvitions of Chapter 9(commenting p
with Said..7M)OfDheision 3 oflbo Banco.and Profusions Code.And my If,..I. REMODEL—NEW DECK RAILS, STAIR RAILS, PAINT & NEW
full forte and eff
j�Z Liccmc Clue ls.g 1,S 3q WATER HEATER.
RCHI�`p Dam TS DE or TI
7W7W smail he
DECLARATION
w U 1 underssanJ my Ptsm shall W used m public ranods
g G6 1 Licensed PofcstionAl
3 OWNER-BUILDER the ConTION
C 2 0 1 hereby afflmt on 1 am.Bump from the Contractors :My Law for Ne
C o following reason.(Snit.1 oresur.Business and Rofrsskiu Cale:Any m m county
Oo which its isso a permit re cmmruc.after,improm,demdLN, fi repair my.tectum
_iy piorthiuictumspaionatiso n rta lW SMions of for such permit cense LawJsatemcm
iia (carne sbameapnntion7 m)ofDivimm�rdtecontexmr:u�ox�w(chapm 9 Sq.Fe Floor Area Valuation
�{ 9 (eommcncingwiNSecti.n1000)of Oivuionr di Alleged
essmdon.Any
Cade)or $6976
S — than he ts exempt therefrom and or brats for the aileged excmptim.Any vklatim of
Shim thess l by Any Applicant fora permit subjects the applicant to a civil penalty of umber Occupancy e
tet team Nan rte..mama dollars(swm. 32609056 .'°'.�WP Y�'P
0I,uooucrofsiteprWwy.mmyemploycowi0wg uthelesolecomprn Oon,
willdothework.andtheswctumisnotktendedorofferedfors o(Sec.1 ,Buemass -
and Professions Code:The Comrxthes Lkrnx Law dors rot apply th An.war of Required Inspections
property who Wilds Or imprmes d ert.n,ard whodoueuchwmkhimeelforNmugh his
awn employees,provided Nal such improvements art an,intended oroffered forsale.B.
however,the building or impmvunenl'u mid wilds one year of compladm,the owner-
builder will hare de Wrdem of Moving Nal he did not Wild or improve for purpose of
sale.).
❑1,As owntr of the Property,Am exclusively cmtracting with licensed car mcmrs to
construct Ne pmjem(Sec.10/4,Business and Professions Code:)The Cmtraemr's U.
ve law don ml Apply in An owner or propert,who Wilds or imporm neerem,and
who contracts for such projects wit a contractor(a)licensed pursuant th the Contractor's
L.keve law.
❑Iameacmptunderste ,BkPCforthanisson
Data
4 Pact WORKERS COMPENSATION DECI RATION
I hereby affirm under peoRY of Perjury me of the following trelanumc
I have and will mainsin a Cedfime of C.mem th elf-imam for Workers Comp:.-
saum,As p m,ided far by Section 3100 of the Labor Cade.for did performsnm of the
work fm which this permit I.issued.
❑1 hate and will maintain Wortees Compensation Inman¢,as mi ubcd by Sonia
3100ofdm labor Coo,for the eformarec afde wars fofwhich this permits issued.
My Worse Compemauonn xt, mcalfiefand Poliaynrnberao:
Cartier. �G fU1/1 Polity No.: [wIYJ4i�..—GC
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
mus xNm road not W completed Iliac permit is foram hundred dollars($IW)
or kms)
I codify Nu in the performance.f the wart for which this pomdl Is issued.1 shall not
employ any person in any mamerse As an became subject in the Workers'Comperuaum
Laws of Ci lifiarm.Data
Applicant
NOTICE TO APPLICANT:If,After making this CedOmte of Exemption.you should
become subject An the WOokam s CmnPensethon pmvisiom of No Labor Code you mean
,J O foMwith comply with such po annow or this Meant shall W damed makcd.
z rA CONSTRUCTION LENDING AGENCY
F I Wmbyalfum thn Neff is.cotuvuctim lendingageney for de Performers of
Ri the work for which dust Permit u issued(San.3097,Cir,C.)
0 Isnder's Name
z Lanese.Addm..
U O 1 certify lost I hire mad NIS application and soon dust the abom idu..a.is .
lL coact 1 agree in comply wine all city and cowry odiiunv and sus haws rtladng to
C) Wilding construction,and hereby Wourirz¢pmsenuums of On,city in toter upon the r
r{iq above-mmntim tesPr:ny fan imPecti.n'brpbwhich ms
I„ 0. (We)agree to ave,indemnify and kcey hnmlm site Cly of Cupertino gains,
y liabilities.intimates.foe cousane e.PemnsIlounfing Of the mit. may in any nyxcrncagainslsaid City
(]z APPL�ucntaUNDERSfANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURC 0
ULALu ±6,tog- Re-roofs
Sgnuurt of AlmuantViono elor I Data
HAZARDOUS MA ALS DISCLOSURE Type of Roof
Will No applicant or tomo Wilding acoupmtsom or handle huadom material
As de0md by de CuPenino Municipal Code,Chapter 9.11 and the Health and Safety
.same.u532fa>1 Yes All roofs shall be inspected prior to any roofing material being installed.
RNa
7� If a roof is installed without first obtaining P an inspection,I agree to remove
W2[111 ft Applicant or future Wilding ucmpam sax equipment or davimt which
tmh hun dam air cmmmina u u defined by the Bay Am Air Quality Management all new materials for inspection.
District?
❑Ya u
n1hamcadsirehasardmsmaterialsequimmenuunder Cy pV r6.95ofl Califof-
doesdomeaidt&Suety Cade,Sectioru25303.]5531 an025334.1 umkrsmnd thulfNe Wilding
ret c Y ham•ten .Nn it u my respomihilitY m nmify de.ccupsnt of de
ho,imontntr hue m armlssuarecoflCmific.se rot �a Signature of Applicant Date
Gwmuni.mbmi.iIngem Dam All roof coverings to be Class'R*'or better
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20800 HOMESTEAD RD BLDG 30A -H
CONTRACTOR: WEST BUILDERS, INC.
PERMIT NO: 09080058
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
PERMIT BLDG F ELECT r
vs scv, 5
BUILDING INFO: PLUMB
License Class Lic.# a
MECH RESIDENTIAL r COMMERCIAL r
Convactor W �� Date � "24 '
I 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
ORIGINAL: 07120177
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: 32609056.30AH
Occupancy Type:
APPLICANT CERTIFICATION
1 certify that I 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
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.
Signature Date Zi•
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
1 hereby affirm that I 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)
1, 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(x) should I store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance, as provided for by
.Additionally, should f 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.
I certify that in the performance of the work for which this pem:it is issued, I shall
not employ any person in any manner so as to become subject to the Worker's
Ow thorizeMent:
Date: 'if 5
Compensation laws of California. If, after making this certificate of exemption, l
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.
CONSTRl1CTION LENDING AGENCY
1 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 certify that I 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