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CITY OF CUPERTINO+r-
BUILDING DIVISION PERNUT
TRA.C' QRI�iVk'ORMATIOIV'
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BU B�IHra.ff"YIOMESTEAD RD, BLDG 61A -H
TBD - TO BE DETERMINED
PERMrT NO.
07120183
OW NERUSHNAUMJE:
PERMIT ISSUE DATE
VS II A CALIFORNIA LIMITED
07/14/2008
ONEA ATN
SANITARY NO. CONTROL NO.
ARCHI'VEZVENGINEM' •
'
BUILDING PERMIT INFO
REMODEL -NEW DECK RAILS, 'BLDG ELEcr PLUMB MECH
C7 O O O
LICENSED CONTRACTOR'S DECLARATION
' '
Job Description
I bacby anlrce tat I un licensed under pmvisom of Chapmr 9 (commencing
" -' ---'— -
with Smdon7q )of Division5ofdu Buunusand Professimts Cale,andmylicenseu
in lull force,nd art +.
JJ
leena clue Lk.d
Da Conuacmr
ARCHr7ELTS DECLARATION
1 understand my plans awl be tend u public records
Licensed Proressool
OWNER -BUILDER DECLARATION
I botchy allirm that I M ceempt from the Contractors License Law for the
following moon. (Section 71131.5, Busness and Proftennns Calc: Any city or county
which requires a permit to consm4 alter, improve, demolksh, or repair any s rectum
! priorm its i"...0. sequins Ne applicam forsuch permit to file a si,.dsuumcnt
'fiat W is licensed pursuant to the provisions of the Contractees License Law (Chapter9
Sq. Ft. Floor Area
Valuation
t (commencing with Section 7000) of Division 3 of the Business and Professions Code)or
Net M tr eaernp therefore and the buns for the alleged rumption Any violation of
APN Number
Occupancy
P Y ZYPe
Sandon 7031.5 by any applicant for a permit subjects the applicants to a civil penalty or
as mon Nan rive hundred dollars (35001
D 1, u owner of the pmpsuy, ser my eroployco with wages u Meir vele compenwadon,
Required Inspections
veld de work and Ne sW u nminundede tarsale (See. ]014,
Cmc
to Owner of
and Profnsons Cam The conuxoA License Taw dao not apply 1f am owner ser
Law do
popnY who builds a impovu thermm and who dos such wmk himself a duough his
awn employers, proNded Net tueA imProvemenu tie nos inundW aaBend roe seat. if.
boweer die Wilding impo within of you of mmpkuoq du owe
u provingof
builder will haw the burden of poring Nu K did not Wild a improve ra purpose ser
ate.).
D I, as maitre of the property am ucloively contracting with licensed contractors o
muvuct the project (Sec. 7044, Between and Professions Cade:) The Contractors U,
.
conn Law does not apply an an rower of property who builds or improws Mercer, and,
fartab projects withaeontracderts)B¢rtsedp.00tothe GntraYors
whence,
License law.
Law.
❑1. uempt undo see ,BhPC fm Nu masov
wrc Dau
WORKERS COMPENSATION DECLARATION
I hereby a0bm under petWty, of perjury ms or the following deelaradons:
D Ihave and will maintain a Cenirscate of Cmtsent to self -inure fa Waders CamPen-
-
ation. u povided that by Section 3700 of the lather Cods, for the performance of the
work for which this Permit is issued.
D 1 haw and will maintain Workers Compensation Insurance. as teciuised by Section
3700or the Labor code, rear six performance of Ne wet for which mus permit is Wood.
.
My Wor[k�W�Co pe on Imo ance artier and Policy number
1a1mc:}p�1
Grta hl X V Policy No.: --Ik�sjCs V L l^
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
fThs aecuon tecA net he completed lithe: penis IarnronchuttNed doll. (3100)
a lea)
1 astify that in Ne performance of Ne work for which this Permit Is issued. l shall mo
-
employ anyperaan in any maeMr an as to how= subject in Ne Wofkers'CompCNaden
Lam of California Dau
Applicant
NOTICE TO APPUCANP. If, after making this Ccnillcao of Exemplum. yon should
become subject in tM Waters Compensation provisions of IM Lahr Code, you most
foMwith comply with such provisions or Nu permit shall de deemed noted.
CONSTRUCTION LENDING AGENCY
dist thou li s agency far the Perturmuao of
1 hor 30
cRrm
ed (m .
which 7, Cing
tim work for which Nis permit 4 load (Sec. ]097, Civ. C.)
lendees Name
lenders Address,
1 certify Nat I have read this application and suns Nu tW sWw, imfo..tiun u
-
caret 1 sync to comply with LI city and county Ordinances and suns laws missing to
building convection. and hereby authadm represcntativea of this city to cnacrupen Nc
above-mcnudmedgme popery for inspection urfamawhich
(We) agree o wave. indemnify and omp hasmleo do City of Cupertino against
judgments. carms
ouind espvssNooich rosy in oYnyaceroe againslsaid Gty
in Consequence
in cortsegaxe of Nc grenunB of this permit
Of ft
U
AP
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applicant Or Nan building ottupantsorc or o mdle havNoo mausal
se d -Mod by do Cuperiaa Municipal Cade. Chapter 9.11, and the Health and Safety
CWc, Sectioo 8532(x)?
Dyns �T.
All roofs shall be inspected prior to any roofing material being installed.
Will 1W applicant orfutureWilding asupant um equipment or devises which
If a roof is installed without first obtaining an inspection, I agree to remove
emir harafdno air contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
Deistic,?
Dy. { No
I have read the huandont mu niab requirements under omNe, 6,95 of Ifo Odifor.
nu Health A, SafetyCode, Soctio s 8505.25533 and 25514.1 undcsuvtd dist ifdtc building
does ret cunemlly hew a Nat it 4 my responsibility te tmdfy site cecupat of six
antpNranissuanceefaCenlfoa
regain
GS
roog or better -
All f coverings to be Class'1W'
Owner ser mtasem ate"
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20800 HOMESTEAD RD BLDG 61A -H I CONTRACTOR: WFST BUILDERS, INC. PERMIT NO: 09080081
I OWNER'S NAME: VILLA SORRA APTS A CA LTD PARTN 11608 4TH ST STE 120 1 DATE ISSUED: 08/19/2009 1
I OWNER'S PHONE: 6509313457 1 BERKELEY, CA 94710 1 PHONE NO: (510) 525-9378
❑ LICENSED CONTRACTOR'S DECLARATION
License Class4/-- Lic. # ! 34i5
Contractor 09 1 Date R 24 -C
I hereby affirm that 1 am licensed under the provisions of Chapter 9
(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.
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.
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
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (b1'e) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
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
9.18.
Signature
Date V Z t -
❑ OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
I, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
I, as owner of th:, property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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.
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.
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
Compensation laws of California. If, after making this certificate of exemption, 1
become subject to the Worker's Compensation provisions of the Labor Code, 1 must
forthwith comply with such provisions or this permit shall be deemed revoked.
A.PPIACANT CERTIFICATION
I 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
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
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
9.18.
Signature
Date
BUILDING PERMIT INFO: BLDG r ELECT r- PLUMB r
MECH r RESIDENTIAL r COMMERCIAL r
JOB DESCRIPTION: REVISION UTILITY CLOSET
Sq. Ft Floor Area:
Valuation: $2500
APN Number: 32609056.61AH I Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by:
Date:
RE -ROOFS:
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
inspection.
Signature of Applican
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
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
Health & Safety Code, Sections 25505, 25533, and 25534.
Owne o Z y
Date: O
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
1 understand my plans shall be used as public records.
Licensed Professi