07120186Z'
�ZR
nF�
5yU
gt6v
yob
�OC
s§R
_Z>
CITY OF CUPERTINO
,,"M•. '~x "*a�'-_� ''
TIO,�N
BUILDING DIVISION PERMITC�NTRAC`TORINFOlt,
BUIL
D%MVE`AOMESTEAD RD, BLDG 66A—L
WEST BUILDERS, INC.
PERMrr NO.
07120186
NER'S NAME:
PERMn MUEDATE
VS It A CALIFORNIA LIMITED
1608 4TH ST STE 120
07/14/2008
PHONE>1 ' PN'
SANITARY NO. CONTROL NO.
ARCHITECfsENGiNEER:
REMODEL—NEW DECK RAILS,
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
PATNIP E;
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
Job Description
under of 9 (commencing
1 herby a0a .last l am Iidw
"'- """ •--" "'"'"' P
B andPnorns
Code'
in fuSection7 doer' "n3oftie Budnruamd Prelosdem Crode, and myliccnseu
in full forte and eD �'
Lice se Lle. N
Da Ce 1 79,11
DEC1acre Olf� N
DEC
ARCHDbe
wac
1 undcrsunJ my plans shall ad used u public records;
'
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm Net I am exempt from the Contractor's License Law for the
following mase. (Sadon 703 1.5, Been. and Pmfessim s Cade: Any city err county
which requires a permit to coruvun, alae. Improve. dcmnlw. Or repair troy structure
! prior in its Issuance, also requirm the applicant for Such Permit to rile a signed marmenl
Net he It licensed N the of the Comeactor'a License Law (Chapter 9Sq.F
FlFloor Area
Valuation
pursuant pmvisloru
(commencing with Section 7000) of Division 3 of the Bum. and Profeeiom Code) «
! that he usem empt tnamfmand Ne thou f« the alleged tumptirm. My violation of
Section 7071.5 by sty applicant far a permit subjects the applicant to a civil penalty of
APN Number
Occupancy T
P Y YPe
not moan five huadmd dollars (5300).
re N
I. u owmr of the property. or my employers withwage, as the'v tole eompenution,
Required Inspections
will do thew«k and the ouclum u not intended oroffered fersau (Ser. 10x4, Bushmsa
and Rorcadou Cade: 'nM Contrenor's L ikame. Law dao rot apply to an owner of
Property who builN«impmvea tluxrnn. andwho doessuch wort hisawifor WouN his;
awn employers, provided that smh improvements meant intended araRered formic. X.
hwevv, me building «improvement Is sold within oto yea of completion. the owner-
Wdder will have ala wac eo of purring Nat he did ml build or improve fm purpose of
Mole.).
0 1. as no of the property am amlashvely contracting with liarued contractars to
cammect the project (Sec. 7064. Buarmeu and Pro(est ans Code:) The Contractor's Li-
_
cense Law does Mot apply N an owner of pmpeny who builds or improves thereon. Nd
who convects for Much project, with a conusclo (s) licensed postom to the Contractor's
License Law.
Lamexaoptunde See .B&Permthtsmuw
«r Dmc
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of Ne following declantiou:
❑ Ihave and will maintain a Cenificeo of Coment to self-iuumforWorker'sCompen-
ution, u provided for by Section 3700 of the Labor Code, for the performance of the
wast f« which Ods permit is issued.
1 have and will maintain Worker's C'nmpemilion hamar¢, as required by Section
3700 of the labor Code f« the peRormame ofthe watt far which this permit u handed.
'
My We Pa woura«a tamer and Pat., nu fp�a¢1 mt{�7 ,{--m
Camey. 1 �� Policy No.: v 1 If u ` v"1
'
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(Thisseetiom recd rot bccomplead if the permit is foronehundred Mom (SI00)
or less)
1 ccmi that in the performance of tie wait fm which this permit is issued. l shall not
employ mypermn in my ..r to as to become subject to the WerterN Compensate.
'
Laws of California. Due
Applicant
NOnCE TO APPLICANT: IL after m king this CEniOeato a Exemption, yes should
became subject m Ne Woram't Gompcmalim, provision of the Lahr Code, yatr a=
forthwith comply with such pmvisou or NU Permit shall he darned muted.
CONSTRUCTION LENDING AGENCY
1 hemby affirm the mem u a comuuuctine leading agency for tad performance, of
In work for which this permit is iasmd (Ser. 3097, Civ. C.)
Lender's Name
1<nders Address
I certify Net I have read this application and some Net the above information is
emrm 1 agree to comply with all rimy and county emirs. aid sure laws model to
building construction, and hereby authGrine mpreseawives of this city to Enter upon tad
above-mauoded Pmpeny, for imprecates purposes
(We) agree to Move, indemnify and kap harmless the City of Cupertino against
expo•... which may in icy wyacomE againstsaid City
Iiacoitlamonsoc
in ceruequence of the granting of this pini.
of the
PLICANT
ATERIALS DISCLOSURE
Will that applicut m Futuro bmtilding aecupul mom or handle hasaadeu material
as dcRned by the Cupenino Municipal Code, Chapter 9, 11, and the HeaIN and Safety,
. Section 25532(&)
C3 Yes No
Ir
All roofs shall be inspected prior to any rooting material being installed.
Will the, Bcmt or bdildin Occupant tax or which
PP t P ea
If a roof is installed without first obtainingan inspection, I agree to remove
P g
emit hmaNnm air cantaminanu u dcfiad by tad Bay Area Air Quality Managemcm
Air Quality Mmali
all new materials for inspection.
District?District?.s
P
Dy. C] N.
re
I have al tm= materials rte uiremonts umkr Chapter 6.95oftheCalifor-
Io&SafctyCede,SEedw nM5.Z5533a B534.Imderw ifN Wilding
d an Mandy s anise Nu it u my respomibility to notify the ocnpmt of Ne
require
D`btta
II CITY OF CUPERTINO BUILDING PERMIT
I BUILDING ADDRESS: 20800 HOMESTEAD RD BLDG 66A -L I CONTRACTOR: WEST BUILDERS, iNC. PERMIT NO: 09080087
OWNER'S NAME: VILLA SERRA APTS A CA LTD PARTN 11608 4TH ST STE 120 1 DATE ISSUED: 08/19/2009 1
OWNER'S PHONE: 6509313457 1 BERKELEY, CA 94710 1 PHONE NO: (510) 525-9378
❑ LICENSED CONTRACTOR'S DECLARATION
License ClassQ� Lic. N
Contractor ky-% Date 8 ''
I hereby affirm that 1 am licensed under the provisions of Chapter 9
(commencing with Sectiun 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.
I 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. 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.
SiEnat e �
Date 8 t
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
1, 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 the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
1 hereby affirm under penalty of perjury one of the following three
declarations:
1 have and will maintain a Certificate of Consent to self -insure for Worker's
Compensation, as provided for by Scction 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
I 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, I
become subject to the Worker's Compensation provisions of the Labor Code, l must
forthwith comply with such provisions or this permit shall be deemed revoked.
APP'LI'CANT 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. (Nk 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
BUILDING PERMIT INFO: BLDG r ELECT r- PLUMB f—
MECH r RESIDENTIAL r COMMERCIAL r
JOB DESCRIPTION: REVISION UTILITY CLOSET
Sq. Ft Floor Area:
Valuation: $2500
APN Number: 32609056.66AL 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 Applicant:
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. 1 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 lhe.Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
Date: -L7
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance of work's
foi 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 Professional