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CITY OF CUPERTINOtw+s+
BUILDING DIVISION PERMIT
rCONTRAGTOR INFORMTION'
TO
E
BUILDING ADDRESS:
PERMITNO.
20800 HOMESTEAD RD, BLDG 59A—
TBD —.TO BE DETERMINED
07120181
W RS NAME:
-
FERMIIISSUEDATE
VS :C:I A CALIFORNIA LIMITED
07/14/2008
ONik
SANn7ARY NO. CONTROL NO.
ARCHITECnENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 [� C 0
LICENSED CONTRACMWS DECLARATION
Jb Description
d unr provisions .1' ay mmencing
1 lenity ath.,1 am licensede Chapter 9 (co
o
with Section 70th) of DiHsion 3 ofthe Budnev ad Professions and my lkcmu
REMODEL—NEW DECK RAILS, STAIR RAILS, PAINT & NEW
qCode,
in full fmcar'— A
msd en ���3 1
uamC1 Lk.g ' 1
9
WATER HEATER,
Dora Contractor u'✓J
l y )IARCHIECTS DECLARAOON
W
u rsund my plans shall usod as public records
Licensed Professional
OWNER -BUILDER DECLARATION
L hereby affirm that 1 am exempt from the Contractor's License Law far the
following won. (Section 70313, Business had PrortASWAS Code: My city m county
which requires a permit to cnnswo4 a@r. Improve, demolish, nr mpsir my s=to.
prior to its issuance, alw requires the applicant for such permit to Ek asigned sutr+^mt
Ina he is licensed to the of the Comnntor's1-cense Law(Chaptor 9
Sq. Ft. Floor Area
Valuation
purseam previsions
(commencing with S dm 7000) of Division 3 ar the Bou^ and Profmions Cade) w
$6976
that he is exempt themfmm and the basis for the alleged exemption. Any violation of
Section 70313 by M applicant for a permit subjew the: applkmt to a mil penalty Of
B7� Number
O ccas araC
Occupancy Type
not more thfire
m hundred dollars (S5M.
32609056 .4`JAH'
❑ I.uaww4 of din pmpeny,ormy wployens with wageasthe'v role compemtion,
will do the wark and theswcturt is ant intended or offered for sale (Sec.7W. Business
ad Pmfewau Cade: Inc Conusmr's Liana Law doe nal apply to an. of
Required Inspections
Property who Wilcismimproves thercommul wind daexsuchwork himselforthrough his
Own ampl^yecs. provided that such improunmmu an, not inlmtleE oroffetN for sale If.
however Ne building or Improvement u sold within one yearof completion. the owmr-
builder will barn the burden of poling that Its did not Wild or improve for psrpos of
sok.).
0 1. u owner of the property am exdmively contracting with licensed conmcmrs in
casutmet the project (See 7044, Business also Proressians Cade:) TW Contra m's U.
ante law dao act apply to an owoer of property who builds Or improve thereon, and
who contracts far such projects with a comraaor(s)Ii... purmammIW Contractor's
License Law.
D lentexemptundarSee ,B&PCfnr Udsrnam.
vex Dan
WORKERS COMPENSATION DECLARATION
1 hereby affirm oder penalty of perjury, One of the following detlantions:
0 IhaveadwillmNnalnacC Timm OfCarontoYr-imumrwWarker'scmn .
scion, a providW for by section 3700 of the Inbar Cade, far the performance of the
wart for which this permit is (ssaG
0 I have and will estimate Worker's Compensation Insurance, as required by Section
3810 of the labor Code, for the per(armartoe clubs wort for which Nu permit is issued.
My Wwkcceri`�CalImpeneyy. Insurance canine ad Poll, oumber am:
Cartier: l Polley
ATE OF
CERIIFlCATE OF
CE FROM
FROM WORKERS'
ISATIO INS
COMPENSATION INSURANCE
(ITU soctim need not be completed if the permit is loran, hmdrddrelWs ($100)
or leu)
1 certify, Nat in the performance of the work for which this Permit is Wood. I "I not
employ any person in my mmner so as m become subject to the Warless' Cmmpemtion
Laws ^fcalifomia. Data
Applicant
NOTICE TO APPLICANT: IL after making this Ccnificato of Exemption, you should
became Subject to the WOrkefs Compemtion pronmons of Inc Labor Lade you man
forthwith comply with such provisions or this permit shall W deemed rooked.
CONSTRUCTION LENDING AGENCY
1 hembY alfirtn dust there u a ronssati^n knding agony far the performance of
the work for which this permit is issued (Soc. 3077, Civ, C.)
Lender's Name
'
Lender's Address
I motif" that I haw red Unix, application and sum that Ne above information is
cmacL I agree to comply with all city had county ordinaoas ad ansa laws relating in
Wilding conisation, and hereby authOns repmnm In, of this city to emr upon due
aWve-mentioned papery for mica puryaua
(We) agree to save, idcmniry and kap harmless the City of Cupertino against
co
liabilities, expeis may to my wayomaagainstand City
lexpeo ,ofthecostsand
Aeonseq<
p to
HAZARDOUS MATERIALStDISCLOSUREMedi
Type Of Roof
f.a. b
WIII do applicant or rums building Occupant atom or handleamew motorial
at deflned tie Cupertino Mmicipal Code. chapter 9.11, and the Health ad safety
ode. ScNm 25532(.)7
oro
❑Yas
�o
All roofs shall be inspected prior to any roofing material being installed.
Will mea Bcanl or future Wilding occupant use
PP g p equipment w deity which
If a roof is installed without first obtaining an inspection, I agree to remove
g
air camfined by the Bay Arta Air Quality Management
eDWricaiardnns minana u de
all new materials for inspection.
DVe/o
I have mad the haeardous matoriab mquirements under Chap ar6.93oftW Califor-
nia Hmith & StdcYCode. sections 255M. n533 and 25534.1 understand thuifdc Wilding
.
does netcurendy
oto
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20800 HOMESTEAD RD BLDG 59A -H
CONTRACTOR: WEST BUILDERS, INC.
PERMIT NO: 09080079
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 L Lic. # �z��� S
r r r
VOBI
MECH RESIDENTIAL COMMERCIAL
Contractor DatC6 •�
1 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: 07120181
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: 32609056.59AH
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 acid 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 z�
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 1 am exempt from the Contractor's License Law for one of
inspection.
the following two reasons:
1, 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 (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, 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 I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
permit is issued.
Ilealth & 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 agent:
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
forthwi:h 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, 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