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CITY OF CUPERTINOBUILDING
DIVISION PERMITCOl�iTRACTOILINFORMA.'CION�,�;.
BUI 1 A �8FFSS:
HOMESTEAD RD, BLDG 64A -L
WEST BUILDERS, INC.
PERMR NO.
07120185
NEWS NAME:
PERMIT ISSUE DATE
VS .11.11 A CALIFORNIA LIMITED
1608 4TH ST STE 120
07/14/2008
PHONEA RTNI
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
REMODEL -NEW DECK RAILS, BLDG ELECT PLUMB MECH
l� O O RlbtibSO
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 heaebY affirm Nal l am Hem u el under provisions of Chapter 9 (commencing
• ^ —^^ • •^ • ^^^
with Section 70Rn (Division 3ofdm Businer and Professions Cade, and myliccnscu
in full for 1 amd effect
Lurnm w Lim. N
.
Dam Cot r
DELL
ARCNRECI'S DECLARATION
1 undcruanJ my Plans dull W used as public necoNs
Licensed Pets sound
OWNER -BUILDER DECLARATION
I hereby mnnm that I not exempt from the Commoner License Law for the
following mown. (Section 78513, Business and professions Codc: Any city or county
which mquirea a permit to ennsuun, alar, improve, demolish, or repair any structure
,Her in its lssum e. afw requires the applicant for such permit to file a signed comment
that he is licensed purmanl to the provisions oflhe Contnetors Li¢nm Law (Chapter9
Sq. Ft. Floor Area
Valuation
(commencing with Semon 7000) of Division 3 of the Busiuear and Professions Code) a,
Nat he u scampi therefrom and ft basis for the alleged exemption. Any violation of
section 70513 by any applicant for a permit mbjcw the applicant to a bvil penalty of
..dsFN Number
Occupancy Type
P Y yP
not mart Nm Ove hundred dollvs ($5011).
0 1, u owner of tine property, or my cmployma with wages an dash mla compormi om,
will do the wort, and me structure is ant intended or oRenW for cam (Sec. 7014. Business
Required Inspections
and Pmfeselone Coder The Caro mme, Lt. Law der not apply to an manner of
property who builds m iroproses thereon. and who does such work himself or through his
awn employer, proviArd that such homers manus am nmlinmMrd oraRetN Im.ssle V,
however, Ne Wilding or improvement is mid within ons year of completion, the owmn-
builder will have Ne Widen of moving that he did not Wild or improve for purport of
sale.).
0 1, as owner of the property, am aclmivcly contracting with licensed convenors to
construct the project (Sec. 7014, Business road Professions Cade:) The Contractors U.
.
cense Law does not apply in an owaan of property who builds or liniments thermn, and
who contracts far such prejens with a cmntsactat(s) liunsed pursuant to the Commisc ore
License Law.
0 lamesereptundnsec. ,B@PCfmthumasan
nee Das
WORKER'S COMPENSATION DECLARATION
I bunchy alRm under penalty of perjury man of Ne fallmaing declarations:
Ihzm and will mainoina Certifiwm of Consmttoseif-iasum fm Workers Compeo-
-
suion, m pmvided fm by Section 5700 of de Isbor Cade. for Ne perfomume of Ne
wank far which this permit is issued.
0 1 haw and will maintain W ' Compensation Insurance, u imputed by Session
57W of Ne labor Code, for use perfonmmem of the wort for which this permit u issued.
'
My Workers Cape n�Inmrance cenricr and Policy nnuulmbbeer�
Carrier.^ l�s'!n Polity No.:q
CERTIFICATEOPEXEMP170N FROM ORKNS
COMPENSATION INSURANCE
(Thu section need not m completed lithe permit ufmouehundred dodos (SIM)
or leu)
1 certify viol in the perfmor. of Ne work fm which this permit u issued. I almaI am
employ any person in my mannerm as to become subject no the Workers! Compensation
Laws of California. Dam
Applicant
NOTICE TO APPLICANT: If, a0er making this Oci ifaute of Exemption, you should
become subject to dm Worker's Compensation previsions of the Lather Cade, you most
forthwith comply with such provisions or Nu permit shall he doemnt rewind,
CONSTRUCTION LENDING AGENCY
I hereby afros thm Nem is a cossuoctima lending agency for the PMoroauce of
Ne work for which this permit in issued (Sec. 5097, Civ. C.)
Lendm`a Nurse
Lcmbaa Address
I canny that I haw mad this application and eons that the above information is
toren. l agmc to comply with all city and county ordl=and sum laws nclaung to
Wilding construction, and hereby soNmim reprommu has of this city to new upon the
ahoVe-mentioned propcny for iatp
as
(We) agree to live, indemnify and keep hanaleas tiro City of L'uperlino against
which rel
Iia ar
cow and upemu which may in my war orotic a6sinst said City
consequence, of
inconsequence o(Ne ¬ing of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITHAL{ NON-POINr
NO
Issued by: Date
so6R
cmi VCuntracmrShim
HAZARDOUS IBAYERIALS DISCLOSURE
Type of Roof
Will the appiloanl or (alum Wilding oceumentstom or handle hmaNans mammal
ss deBncd by the CupeNno Municipal Code. Chapter 9.12, and the Health and Safety
. suction sss52(.)7
❑Yns �t4u
All roofs shall be inspected prior to any roofing material being installed.
Will Use appliamn art futons Wilding —pant use m devices evices which
If a roof is installed without first obtaining an inspection, I agree to remove
Nnm air conuminanu as deRrred by the Bay Area Air Quality Mansgement
all new materials for inspection.
Disuict7
0Yns No
I have read Ne hvardws mamma, requtoments undcrChapter 6.9Softhecdifm-
eHcal"SafnYCodm Secum n 25505, 73555 and 25534.1 undnvvW then ifNc building
dJmm�rmm�
Signature of Applicant Date
All roof coverings to be Class'."
g or better
gent
Owner anmmariaed agent Dam
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20800 HOMESTEAD RD BLDG 64A -L
CONTRACTOR: WEST BUILDERS, INC.
PERMIT NO: 09080086
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 PERMIT INFO: BLDG r
License Class Lic. a 0Z5 31
ELECT PLUMB
r �
T_COMMERCIAL
.�MECH
?r
Contractor �> Date S t ,�
RESIDENTIAL
1 hereby affirm that I am licenscd under the provisions of Chapter 9
JOB DESCRIPTION: REVISION UTILITY CLOSET
(commencing with Section 7000) of Division 3 of the Business & Professions
ORIGINAL: 07120185
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: 32609056.64AL
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.
O
Signature Date
RE -ROOFS:
❑ OWNER -BUILDER DECLARATION
All roofs shall be inspected prior to any rooting 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:
I, as owner of the property, or my employees with wages as their sole compensation,
Signature of Applicant: Date:
wil l do the'work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
1, as owner of the property, ain 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:
1 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 1 store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance, as provided for by
Additionally, should 1 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 1 will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
permit is issued.
Health & 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
O authorized agent: Q C
F,
Compensation laws of California. If, after making this certificate of exemption, I
Date: 1
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, 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 harml,;ss the City of Cupertino against liabilities, judgments,
ARCHITECT'S DECLARATION
costs, and expenses which inay 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_