07120187BUILDING DIVISION PERMIT
BUIL 1 FSB:
HOMESTEAD RD, BLDG 68A -H WEST BUILDERS, INC. 07120187 rcnmu mu
NER'S NAME: PERMIT PSUE DATE
VS '.C7: A CALIFORNIA LIMITED 1608 4TH ST STE 120 07/14/2008
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cad myliccmcis
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I underoand my plebs NUI be used as public records
Licensed Prefessi... I
OWNER -BUILDER DECLARATION
1 bemhy aRrm Nat 1 em eacmpt from she Contractors License Law for tW
following mason. (Section 703 1.5, Business and Ptofetim s Cede: My city or county
which requires a permit m ctmslmcl alto. vnpvwe. demolish m repair any structure
prier m its issuance. aLsu requires the Applicat, (or such permit to file a signed stammem
Nat he is licensed purmat to the poviaiom of the Common'. Decree law (ClAqu.9
(commencing with section 7000) of Division 3 of due Business and Prof.i... Code) or
dun W is exempt therefrom and dte bssu for the alleged eaemptiou Any violation of
Section 7031.5 by arty applicant for a Permit mbjecu the applicant in a civil penalty, of
not more than live hundred dollars (SSW).
❑ 1. o owner of the property, m mY moPloyw with wage u thea alecomprmtiw,
will de dxe wort and the stmctum u not intended or offered for sale (Sec. 70M, Business
and Profession Cade: The Contractees Liam law dos an, apply At an owner of
property who Wilds or improves down. aMwire daeamch wok Wmselfor through his
awn employws, pmHded that such impmvemmms are not intended auRered fms9c, a.
however, the building or improvement le mid within one year of completion, the owner-
huilder, will have the burdm of proving that he did wt build Or impose for purpose of
1, As owner of the property, am eimlusvely co4amint with Recresed antractm to
oommrom the prof ct (Sec. 7044, Business and Professions Code:) The Cmarxsees U.
cede Law daca not apply m an owner of paeparty wW builds or improvea there., and
who <wu tcu for such pr jecu with a contractor(s) licensed purmam to the Conuarsaes
License Law.
❑ Iam.mnr petunia a ,B&PCrmthiaressom
Date
WORKER'S COMPENSATION DECLARATION
1 hcmby ifirm under Penalty of perjury one of the following deelaratiov:
I ha+e and will munuin • Certiftom ofComem m self -insure for WorkeesCompw-
ation, as Provided for by Section 3700 of Rte Labor Code. for the performamx of the
1 have and will maintain We lro's Compensation Inamance, as required by Sued"
0 of dm labra Code, for the performance of dxe work for which this permit is issued.
wt be complexed ifthe penin is for. humbeddefars ($IO%
Required Inspections
I eertify that in the perione. of the work for which Nis permit is bound. I shall wt
employ any person in any manner an As in become subject m the Workers' Compensation
Laws of Calitomia Dam
Applicant
NOTICE TO APPLICANT: IL a0cr making this CenlfCam of Emmpion, you .should
become subject to dm Wohers Compemetion pmvisiom of the Ishan Code, you muss
.J ,z forthwith comply with such povisioru or this permit shall W deemed mvakc 1.
ti O CONMUCTION LENDING AGENCY
l hereby affum that dem is a emermctian lendingfor the performance of
a > the work for which this .)
4 Lenders Namc penni, b issued (Sec. l(191, Civ. C.)
z Lemurs Address
U O 1 comfy that 1 haw, send this application arm sum than dtc above information is
IP. ^. co meL I agree m comply with all city and county oNamea inand sum laws relating m
� rV' building construction, and hereby mthodne repmsenudves of this city m cnmr upon the
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued b
SGL K�"FGI ILAnnTft y' /
HAZARDOUS MATERIALS DISCLOSURE `.
Will the applicant or future building OMWAOL stun orhandle hasardous maxedal
As deftned by ft Cupertino Municipal Cade. Chapter 9.13. and the Health and Safety
Section 25533(.)7 ///���
W❑ Yu -
ll dm applicant orfutureWilding occupant use equipment or devicen which
emit havardnus air coularmanat As defncd by dxe Bay Arta Air Qmdity Management
Diemen
❑ Yea PF Nu
Cenificam of Oc aname'.
rix
Re -roofs
Type of Roof
Date
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 'W' or better
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20800 HOMESTEAD RD BLDG 68A -H I CONTRACTOR: WEST BUILDERS, INC. PERMIT NO: 09080088
I OWNER'S NAME: VILLA SERRA APTS A CA LTD PARTN 1 1608 4TH ST STE 120 1 DATE ISSUED:.08/192009 I
OWNER'S PHONE: 6509313457 1 BERKELEY, CA 94710 1 PHONE NO: (510) 525-9378 1
❑ LICENSED CONTRACTOR'S DECLARATION
License Class Lic. 9 �
t3�6
Contractor 021 Date B X-2-14.
I hereby affirm that I 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.
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.
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.
Signature Date 21'-
❑ OWNER -BUILDER DECLARATION
1 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:
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.
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 Califomia. If, after making this certificate of exemption, 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.
APPLICANT CERTIFICALDN
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. (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 f— PLUMB r—
MECH r RESIDENTIAL r— COMMERCIAL r
JOB DESCRIPTION: REVISION UTILITY CLOSET
ORIGINAL: 07120187
Sq. Ft Floor Area:
Valuation: $2500
APN Number: 32609056.68AH 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 1 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.
Own S•z-Y•
Date
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
I understand my plans shall be used as public records.
Licensed Professional