07120182 CITY OF CUPERTINO
BUILDING DIVISION PERNIIT kCOrITRACTQRINEO1Vf�TZQN
BUI I GA KESS: PERMIT NO.
�88� HOMESTEAD RD, BLDG 60A-H WEST BUILDERS, INC . 07120182
NER'S NAME: PERMIT LEVE DATE
VS :11 A CALIFORNIA LIMITED 1608 4TH ST STE 120 07/14/2008
PHONEA R'I'M SANITARY NO. CONTROL NO.
ARCIMEC rENGINEER: BUILDING PERMIT INFO
REMODEL-NEW DECK RAILS, 'BLDG ELECT PLUMB MECH
0 0 0 0
a o LICENSED CONTRACTOR'S DECLARATION ' lob Description
1 hereby aRem that 1 am Removed minor Previous"of Chapter 9(cnmmcseing .._......_ ..__
Z wiN&ction7")of Dlylalon3uf Nc Businessar (ossium Code.andmyliccmmis
^?ve in full forte and effect
Lieenm wa Le., 2 3qS
Da¢ O "red ave
e ARCHITECT'S DECLARA'nO
I 1 d my plans"I W need as While rccorde
Licensed Professional -
''y 3 OWNER-BUILDER mDECLARATION
'c o c 1 hrecto.from Na,1 a.1. cumpt from Ne Contractor's License: nyc Law for the
C O o following reactor.(Sasou 7031.5.Business and vet durioll Code:Any city or county
IRE! which rets isu a permit re cores alNr,improve,de permit
i li repair any soomeee
Z`
prior Nitsisswnn.Jwngo the provision of far mchpelaltm RteadlLa(atsmmenl
that he is licensedit pursuant to the of Diuo"of de ConuacmrilJa"elsio(Chapur9 Sq.Ft. Floor Area Valuation
Yds (comm eming
roverniNSudon10ndthe iubfrofthe
egeBusiness
moand Prsfcain"Code)of
r3-. Nat We exempt thercfmm and the bssu for the alleged ex<mptioa Any violation of
Section 7031.5 by np•applicant for a permit subjects de applicant N a civil penalty of APN Number Occupancy't,� e
rum enure dun five hundred dollars ISM P �' T•7 P
D 1.as owner of the property.in M employees with wages w Heb sole merpe"adon,
will do the vonk and the surmurt u not immodest is offend for sale(Sec.7044,Besia••
and Pmfessiow Code:The Conuacmes License Law docs ml apply N an owner of Required Inspections
propeny who buildsmireprovesHenan,and!whodatasato worklmoself erruuo sigh his -
owoemMed ployme.Pmvthat such improvements art not ince dN moRened for Pic 11.
however.the building or improo m at Is mid within orm year of compledW.the owner,
Wilder MO Nn the burden of proving that k did rot build or improve for purpose of
ole.).
D 1,as awwr a the Property.am embeively csnumm,with licensed conuacNn to
commet the project(Sec.7004.Business and Professions Code:)The Coouacsah U.
come Law don not apply N an owner of property who builds or improv Merton,and.
who convects farsueh gojesV with a esntruaor(s)licamed purauant m the O oraetoh
License Law.
D lam exempt undm 5 ,B&P C for Nio mama
40 ser Dam
WORKERS COMPENSATION DECLARATION
1 hereby Mr.under mea ty of perjury arc of de following declarauo":
❑I haw and will maim an a Ce tiBcau of Comenuo self-imam for WorkefsCompen-
nrion.ss provided for by Secuon 3700 of dm labor Code,for Nc perfmc neem of the -
work for which this permit is isswl
D 1 haw and will immune WorkeYs Compcmation Imuunca,ss minimum!by Section
3700 of tie Labor Cecile.for Nc per(ormanca of tiro work for which this permit or issued.
My Worka'.Comp mmuon IS rang carrier and Policy mmm6 art:
Cartier. -�Policy Na:
CE FICA OFEKEMPDON FROM WORKERS'
COMPENSATION INSURANCE
Thasoctlon rcN ret M camplemd lithe Permit 4 Forane hundred deBvn(5100)
or Less)
1 certify Nat in the perfomee,a the work for which this permit is issued.l shall not
employ anypcuon in my m rmarm as N become subject o the Waken Compemausn
Laws of CJiromia.Dam
Applicant
NOTICE TD APPLICANT'.If,after making this Certificate of Exemption.you should
become Subject Nue WorkcYs Compe"adon provisions of the Labor Cede,you raw,
.,O forthwith comply with such provisoes or Nu Permit shall he deemed ml
ote
rZ Vy CONSrRucnON LENDING AGENCY
'r. 1 hereby afrum that siert is a construction lending agency for Ne Performance of
I>: 7 the work(or which Nis Permit is issued(Sec.3097,Cin C)
tV Q Lender's Name
z Lendet's Addreut
U0
1 Fou"that I have mad this application and sum Nu Nmove ove information is
LL ^. nmmL I agree 40 comply with we all city and county ordinances and alaws relating N
O SV' building construction.and hereby auNotlr,representatives of this city is color upon Nc
above-menudgmuoned propotty Pori apcnion purposes
W (We)agree to save,indemnify and keep hamlets dm City of Cupertino.'amen
h in commiserate
of mecwuend esPemcemit. may in any way aecme agalmtsald City
V z APPPLII NT UNDER NDS ANDSwung of WILLWILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUR
Dr—
HAZARDOUS
MAI Ars DISCLOSURE Type of Roof
Will to applicantor future Wilding acupentnoemimin le hamdow material
u de0ocd by the Cupiumso Municipal Code.Chapter 9.11,and Ne Health and Safety
.S❑Yu—y.u531(a), All roofs shall be inspected prior to any roofing material being installed.
�ilo
WIII the. "'and or(neem buildin acs ret am If a roof is installed without first obtainingan inspection,I agree to remove
PP g w Area
Air u w devise whin P
emit hvandow air mnumi"nu ss definN by the Bay Ana Air Quality Ma"gcmcnt all new materials for inspection.
Disuin7 P
Dyes E7.tiu
1 have mad the ha allouaJ�mamriais requirements undo CMpmr 6.95 of Ne Califor-
niaHwlN&SafnyC .Sec uom25505,25533and25534.lm&n dthaifdebuiWng
dovedy
mm All roof coverings to be Class'%}"or better
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20800 HOMESTEAD RD BLDG 60
CONTRACTOR: WEST BUILDERS, INC.
PERMIT NO: 09080080
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:
License Class 4�-- Lic.# �S3SS
BLDG ELECT PLUMB
MECH r RESIDENTIAL r r
COMMERCIAL
C
g :2- V '
Contractor Date 7
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
ORIGINAL: 07120182
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
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: 32609056.60AH
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 harml;,ss 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 bz. 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:
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)
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).
1 hereby affirm under penalty of perjury one of the followirg 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 fur 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 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.
Health & Safety Code, Sections 25505, 25533, and 25534.
I 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
Owner` p�zy
Compensation laws of California. If, after making this certificate of exemption, I
Date: t7 ,
become subject to the Worker's Compensation provisions of the Labor Code, f 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 certify that 1 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