07120180 CITY OF CUPERTINO
BUILDING DIVISION PET CONTR`ACT(1R'I '�URMATeIO,1V�..
BUILDING ADDRESS: PERMIT NO.
20800 HOMESTEAD RD, BLDG 34A-B WEST BUILDERS, INC . 07120180
WNER'S NAME: PE'RMITISSUEDATE
VS 11 A CALIFORNIA LIMITED 1608 4TH ST STE 120 07/14/2008
00RAw1'N SANITARY NO. CONTROL NO.
ARCHITECUENGINEER: BUILDING PERMIT INFO
REMODEL-NEW DECK RAILS, BLDG O O PO lMECH
oo LICENSED CONTRACTOR'S DECLARATION
u 1 bmeby affirm that 1 am limnsed under pmvidans of Chap et 9(commencing ------•- ••---•-•---• O escriptlon
'a ori Smdon7")ofOMsion3ofdn Budneasrrd Aofessions Code,arndmyliccmais
u in full force and efrea Q�� p
gni Lluve Clans Lk.x O GST-
-t,0 Da Cmano'ee LN_S'i
qq vwwyu 11!!�� ARCHITECTS DECLARATION
W< 1(umk nd my plans shall W used as;public moonlit
n
g C ti Licensed Aofcuimul
.�A
5 OWNER-BUILDER DECLARATION
f 1 hereby alErm Nu I am exempt from the Canmaeors License Law for the
E 00 following woe.(Saction 703 IJ,Busrmeu sand Profrations Cods:Any city or county
5$ which requiros a permit to construct.arm.improve.demolish,m repwr any suumurt
Prlor to its iuumrec..Iunquims the applicator for such permit to Eleasigmdsuum=nr
< tiwheuliccnsedputsttanUoOmpmvisonsofdeConOacuralicomclaw(CNpmr9 Sq.Ft. Floor Area Valuation
xis (commencing with Scction 7")of Division 3 of the Rusinw and Proressions Code)or
ERE that he Is exempt Nemfmro and the basis for the alleged exemption.Any violation of
Section 1031.5 by say applicant for a permit sobprut the applicant on a civil penalty of APN Number Occupancy e
cot mare than 0w hundred dolWs(S51I0). P Y •'ry)'P
❑1,as ower of the property,or my emplayea with wages as their sale compeeauon,
will do rhe wart and the struc,u e Is rot rounded or offered far sale(Sac.7044.Burma
and Pmfeadons Cadc The Contractors License law don Out apply th an Owner of Required Inspections
propeny who builds or impmwa thereon.end who does such work h anal(or through his
awe employes,provided saw such improvements are not intended or offered for sale.If.
however,de Wilding w improvement is sold within Orc year of completion,the owne-
Wilder will lave the burden of proving that he did Out Wild or improw for purpose of
ak.).
❑1.a owner of the Property,am exclusively caneating with licensed contractors to
construe the pmjen(Sec.7044,Busimas and Pmfestions Cade:)The Cantranmrs Li.
ve law dors oat apply th an owner of,sporty who builds or improves themen.and.
who contrau hornets projects with acontrnar(s)licemed puraant to the Crum ctafs
Lirsnx law.
❑lren.....under Sec ,B At P C far this won
m Dau
WORKERS COMPENSATION DECLARATION
I hereby affirm murder penury of perjury,arc or the following hclarationi '
❑I hsve and will maintain a Cetibcam ofComent to self-insurefaWadutaCamper-
anion,to pmvided for by Section 3700 of the labor Code,for use performaoa of the
work for which this permit is ivued.
0 I haw and will maintain Workers Compensation Insuranm,as,required by S=mion
3100 of the labor Cade,far the performance of the work farwhich thk pmmir is wood.
My Workers ComponyyaYoe btaran¢carie and Policy num rfareya
Cosier. 4IT: g V A-tr� Poliry N'
CERTIFICATE OF EXEMPTION MOM WORKERS'
COMPENSATION INSURANCE
mail sectors mad not he completed if sae permit is franc hundeaddelar($100)
or Ices.)
I certify,that in the pmfarmsame of the work for which this Permit u Waned.l shall oat
employ any Person in any manner u u to bccom=abject to the Workcn'Campwauon
Laws of California.Data
AppBon,
NOTICE TO APPLICANT:If,after making this Cct iftau of Eaempnion,you should
Woman subkct th that WO*&S Compensation proviaiom of the labor Cede YOU most
.,.Q roMwith comply with aueh po risans or this parent,shall W doomed rewked.
'Zy CONSTRUCTION LENDING AGENCY
I hereby alarm Bat Nero u a conswaian lending agency for the pedcurmance,of
p:
the wank for which this Perri,k issued(Sec.3091,Civ.G)
Ifl 0 Lenders Name
z lender's Add.
U Q 1 certify dist I Not read dds application and sum Nu the show tantamount is
n. ^. Comm 1 agrn to comply with all city send county mahmares surd Santa laws relating to
SV^ Wilding conswcuoo,and herby station. ,.boom of this tiny on ererupon Ne
.1. above-mentiaoed
Property for..,.purposes
(•<y IWc)agree to ave,indemnify and keep hermlea the City of Cupertino against
.•t z
liabilities,areq,)udgmeno,eosu and0(th which may In any way¢cont against said City
U z me vegmmc of tau[[ ting of Nu pumiL
^ AP
.tint
HAZARDOUS or tot US MATERIALS DISCLOSURE Type of Roof
WIII theapplicantare futureWilding receptor store1,handle HaNOvmamrW
ss hBmd the Cupeniv Municipal Cath,Chapter 9.11,and the Health and Safeny
ah.
Session 15531(x)1 All roofs shall be inspected prior to any roofing material being installed.
Ya �Na
wn the, hon,ar future buildin occo ant mm If a roof is installed without first obtainingan inspection,I agree to remove
co B P equipment at M.sna which P g
DimktT�nm air conuminanu u de0ncd by the Bay Ara Air Quality Management all new materials for inspection.
❑Ya �jJa
I haw mad the huaNauantmeriais requirements mulmo rp006.95 afthe Califor-
nuHealthkSafetyCade.Seetwes 5D5.15533 and15534.1undnvvmtl rhnifthe Wilding
dais
ID All roof coverings to be Class')iy'or better
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20800 HOMESTEAD RD BLDG 34A-13
CONTRACTOR: WEST BUILDERS, INC.
PERMrF NO: 09080061
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 I—
License Class 9"'i Lic.4 9Z53gS
BUILDING PERMIT INFO: BLDG ELECT PLUMB
f— T_
r
Contractor W5 ( Date 67-2y. f
MECH RESIDENTIAL COMMERCIAL
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:
1 have and will maintain a certificate of consent to self -insure f6r 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: 32609056.34AB
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.
pp
Signature Dateoaz
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:
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 (See.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. 1 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 I 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 permit is issued, l shall
not employ any person in any manner so as to become subject to the Worker's
:)wne
fir' f
Compensation laws of California. If, after making this certificate of exemption, l
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 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, acid 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