07120179 CITY OF CUPERTINO '�'
BUILDING DIVISIONPERMIT �-CONTRACTOR TNFORMATIQN-
x
BUILDING ADDRESS: PERMIT NO.
20800 HOMESTEAD RD, BLDG 32A—H WEST BUILDERS, INC. 07120179
NER'S NAME: PERMIT MMMATE
VS :fI A CALIFORNIA LIMITED 1608 4TH ST STE 120 07/11/2008
MONE:A grTT1 SANITARY NO. CONTRGL NO.
ARCHrrECrfENGiNEER: BUILDING PERMIT INFO
REMODEL—NEW DECK RAILS, 'BLDG ELECT PLUMB MECH
uaij LICENSED CONTRACTOR'S DECLARATION
UF 1 hereby aifirm that 1 am licensed under prvidom of Chapter 9(commencing -"^^^ -- _ .,,.. - O )escrlptlon
z with Section]D011)o(DiNsion So(Nc Business and Professions Oodc,ad!my lloenxb
n full fame and effm Z(J
3II� [iccmcC Lic.J
h,q Dax COntrannr
F ARCHITECTS DECLARAMON
1 understand my plans shall W used as public manrtls
pVI-
yG J Licensed Professional -
te
OWNER-BUILDER DECLARATION
COO hems reason.(Bon Nat 11. exempt t;a the Contrackesium Co License law far
ft
E p O fallowing ul. Permian]BSreasons.aircu hatl Prrtkom Cam:Any city err rn ture
$�i whim Rtsin a permit re ccalter,Wprsu hpcoriti fi repair any structure
pri�r b,lcensed .A.. requires tie,pPlican(for hachpcmitp f.=La (Chapter
ESC (Commincingsedpurction7 )ofDitiomofNeCfinal andPreelaw(Chapm9 Sq.Ft.Floor Area Valuation
s;k-$ than a is exempt
Section an the basis
n 3for Of use Busincu,nd on.Any
Cade)or
of
Nat he a exempt Nerefrm and the mob fa the alleged exception.Any violation of
Section 7031.5 by any ppii.,for.permit subjects the,applicant W.ciAl pereally of ane APN Number Occupancy e
mat mart than EK hundred doll.(S500]. P Y TYP
1,as owner of da property,or my wplayces with wages as Ne'vhalccanpewuon,
whit dolhewoh,
and Prfessiam Cot Nr eTshwe aOuamnbb.Cnbmr'ianteLicensended orLaw does cal mapply in rrts,...of Required Inspectionsections
pmpenywbo Wildsoimpmvu tharonandwho
dousa:hwak himself ed Waugh deb
Owvanployeui dingprenlded!
ori Nat such impmwmrots err net arofintended a l d...for sales If. '
wilder Nebuilding a'unprwmsnl4hallwithin rexyen of completion,tlxowna-
sak.). .vW haw Uc Wrden of prying that he did nm build or Improve for purpose of
tile.).
❑1,u owner of the Property,am exclusively...do&with licensed mnoxmn In
construct the Pmjec1(See.]Dad,Bain-and Prfessiom Code:)The Coneacter's U. .
cente Law does net 0,b an owner of property who builds or impryes themes,and,
who Contracts;for such pmjeeu with a ronvxbrts)licensed Pursuant b use Conoactafs
License law.
❑Iamuereptunder See ,B&PCforthisrcahan
Date
WORKERCOMPENSATION DECLARATION
1 hereby affirm under penalty of perjury,ane of the fallowing tleclanuom:
❑Iheveand wBl munWna Cenifiam of Covemxxlf-buurt fa WarkCsCompen- -
worl,f u hick W fPe by Scesian 5700 of Ne labor Cole,for Ne performance a(dte
wok far which Wspemmitb iaued.
❑I baw and will maintain Worker's Compensation Insurance,as required by genion
5780 ofthe labor Code,for the paformara ofde wart for which this penotis issued. '
My Warker's Compoessineqbuturstance artier arta Polity number are: �y
GMer. Policy N. K 61 H 6 L-4Zc
CERTIFICATE OF REMMONFROM WORKERS'
COMPENSATION INSURANCE
(This eeCtion need rpt be completed If t e permit Is for sae huadmd doBN D IQB
M I=)
I Unify that in NS Performance a the work fa which this Permit is Wood.l"I net
--ploy any person in any scork,ha as b become subject to use WorkerCom,..that
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:IL afar making Nb Certificate of E,amption,you should
become Subject b d(e Walker's Compcu,uon provisions of the labor Cade,you must
.J z forthwith comply with such provision or this Permit shall he decmrA rewkcd.
z y CONSTRUCTION LENDING AGENCY
(—m I herby affirm dot Nem is a contrction boding agcney for de per(ormara of
C > the work for whim this perrb Is issued(Sce.MI,Civ.C.)
Q Leract's Name .
:0
z Lenders Addreas
U Q i Certify that I haw mad this application total sum Nu the above union inion is
Py COMM 1 agree W comply with all city and county ownuas and aux laws rebung to
.� Wilding coruvucuan.and hereby,harhodm xpresenuum of this city in enter upon Its:
ancd
[Ll aWw-muufica dgmprperst forexpenon purpcwhich
(We)agmen to saw,indemnify and temp harmheu tie Cly of Cupertino against
i,lZ in consequence
Of thecoatind expeseumit. maylo any way acaue agunslseil City
V z in wnxquem a(Ne granting of Nu permit.
AP ANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
D�—
xA2ARDous MATERIALSDISCLOSURE Type of Roof
WIII NS applicant m future Wali ode,Chaptaom or hatWh:Heahir.1 Safety ety
u deBrwW by the Cupeniva Mwicipal Cade.Chapter 9.11,and the HeaIN and Safety
de,Section 25533(x)?
Dyes �No
All roofs shall be inspected prior to any roofing material being installed.
W^,n rte, liant err mbm Wilding occupant use,a If a roof is installed without first obtainingan inspection,I agree to remove
w e P equipment a deHas which P
cmi(harardnn air ccmeminanu u defined by Ne Bay Ara Air Quality Management all new materials for inspection.
Mark,? ..�`TT�rrr
Dyertb-
I haw mud the hasamuus maxrialsmquimmcnu toxic,Chaperd.95 ofthm Cali(ary
nb Halth&SafayCadn Sectim 255115,25577 ani 255M.1 unda..W doifue Wilding
d
IDtw All roof coverings to be Class';W'or better
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20800 140MESTEAD RD BLDG 32A -H
CONTRACTOR: WEST BUILDERS, INC.
PERMIT NO: 09080060
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
BUILDING INFO: BLDG r
License Class & Lic. # 825��
PERMIT ELECT PLUMB
r F
� I
MECH RESIDENTIAL COMMERCIAL
Contractor I Date ',2��f
IJ
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
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: 32609056.32AH
Occupancy Type:
APPLICANT CERTIFICATION
I certify that I 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.
Signature Date
,
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 I am exempt from the Contractor's License Law for one of
inspection.
the following two reasons:
1, as ovner 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
constn:ct the project (Sec.7044, Business & Professions Code).
1 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, 255339 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 1 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 I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
permit is issued.
I lealth & 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
Ow L
Date: f W.
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.
CONSTRUCTION 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.)
1 certifythat 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, Scction
9.18.
Licensed Professional
Signature Date_