07120188BUILDING DIVISION PERMIT
In""lnn'T" OMESTEAD RD, BLDG 69A -HI WEST BUILDERS, INC. 107120188
NER'S NAME: PERMITLSUEDA'IE
VS :[I ACALIFORNIA LIMITED 1608 4TH ST STE 120 07/14/2008
am basted under previsions of Chapmr 9 (commencing
n 3 o(dse Busimns and Profmism. Coodde.aml my limucce is
Lk.g IC-4S3r11 ,,
:,-U
1 understand my plans shall be used as public records
spr< LeonettiPrefcseemul
`70J OWNER -BUILDER DECLARATION
2 � I 1 hereby &Tm that 1 am exempt from this Conuanofa Lgccom law for Ne
❑ O following moon. (Samtion 703 1.5, Business and Pref.m. Coll: Any city or ..my
$ 9 which requims a Permit to consume arms. improve. demolish, or senior any suunum
moor w iu Wuamn. also mquims tbe apptieant formch hermit m Rk a signed stskment
_ HA thea he e, licensed pursuant to the provisions of the Conuamr'a flame, law(Chapter9
8 (commencing with Section 700M of Division 3 of the Business and Pmfmsiam Code)or
that he Is nsempt therefrom and tbe base, for the alleged memption My Holatian of
Section 7031.5 by any applicant for a permit subjects the applicant Or a civil penally of
not mom Na ftw hundred dollars (5300).
0 1, as owner of the propane, or my employee with wages as their sale compensation.
will do the work. and tedawcture Isnot intended or ofcred for aak(Sec. 7()44. Bud.
and Prefesoons Coon, The Conuacmes License Law does Out apply to an owner of
pmpeny Wm buildsoriminnwa thermn,and whodossauch workhimulfortlwugh he,
own emplayerts, Provided that such improvements ase not imended mOlfemd forale. B.
however, the building or imp onossnt is sold within cm year of compkdon. the owter-
builder, will haw dw bmden of pmNng that No did not b dk or improve for puryo¢ of
sale.).
0 1, as Owner of the property, am inclusively contracting with lianned conmactma to
cmutroct doe project (Sec. 7044. Business and Professions Code:) The Cmtrw.tmes U.
ave Taw does not apply to in owner of property who builds or improves thereon. and
who contracts for such projects with a commensals) Boomed pursuant m the Contractors
License law.
O lamesemptunder Sm. .BRPCfardbi. m
40 er Dau
WORKERS COMPENSATION DECLARATION
I hereby affirm under porosity of perjury, era of the fallowing deciarationr.
❑ Thaw and will mainuina CeNfimts of Comentmself-iwtse far WorkeYs Campeo-
adon. as provided for by Seedon 3700 of the labor Code, for the performance of the
wart for which Nis permit is iata;d
0 I ban sand will maintain Workcri Compensation Insurance, as required by Section
37()()of the limo Cage. for the performance of tbe were: for which on. permit is issued.
My Wmkets Com mad Imuamm anier and Policy number are:
tinier.S Polity FROM
C IFl COMPENSATION
SATIONOSURAN E FRS
COMPENSATIONINSURANCE
flltlssmlm reed mtheeompktW ittbe pewit is foram hundred doRaas ($100)
or less.)
I enrol than in the perfomems Of the work for which this Permit e, issued, l shall not
employ any person in any mummer an as u become subject in Ne Worker' CompemsWm
laws of uir.mia. Dau
Appllcsum
NOTICE TO APPLICANT If, afkr making mu Ccnificaa of Exemption, you should
become subjen to the Watra/a Compensation provisions of the Lamm Code, you muss
.J z forthwith comply with man pmvidom or me, permit shall be dammed sewkcd.
z CONSTRUCTION IF.NDING AGENCY
1Mmb (11m that there is a comuction lending agency for the Ministrant, of
Ci Lft erwork for which the, permit u issued(Sa. 309'i, CO. C)
len
zz ders Name
.7 Ia.Mets Add.
U O 1 certify Nat 1 haw read tors applicatim and sum Jut the aWac iadmmatiun 6
emmeL 1 agree m comply wits sit city and county ordinances and stain lawn relating to
U
Wilding construction, and hereby auturnom minassentatim of this city in tons upon the
above-mmtiomd property fm inspectim pmpeaes
fr't y (We) agree to ave, indemnify and keep harmless the City of Cupertino against
In IianiumJudgmmts, costs and espouses which may in any way amine against said City
U ,Z in consegmme of the flooding of this permit.
►
APPLIC6NT UNDE NDS AND WILL COMPLY WITH ALL NON -POINT
soya . _ A 10 (&
HAZARDOUS MATERIALS DISCLOSURE
Will dse applicant orfume building occupant sire orbamic haaNim m icrisi
as defined by the Cupertino Municipal Cods, Chapter 9.13. and on, Health and Safety
Section 25533(a)?
I]Y. �n0�
Will the .pplim., m'f X. Wilding oavWnt use equipment or &A. which
emit hmmiOom air mmaminanu as defined by the Bay Ams Air Quality Mmtagemern
D6uica
ED Y" No
na Heallh& safety Cede,5ecdw255o5.25333 and 25534.1 nodcrsund desifine Wilding
does mspunamility m notify tia: omupao of the
REMODEL -NEW DECK RAILS,
Required Inspections
Issued by:
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 69A -H
CONTRACTOR: WEST BUILDERS, INC.
PERMIT NO: 09080089
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) 525-9778
❑ LICENSED CONTRACTOR'S DECLARATION
F r— r
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class L Lic. N 8�
F F r
Contractor 4131 Date 8:24. h
MECH RESIDENTIAL COMMERCIAL
1 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: 07120188
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
Sq. Ft Floor Area:
Valuation: $2500
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.
APN Number: 32609056.69AH
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 arid 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.
Signature Date
RE -ROOFS:
❑ OWNER -BUILDER DECLARATION
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
1 hereby affirm that 1 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).
I hereby affirm under penalty of perjury one of the following 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 for 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 I 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 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.
1 certify that in the performance of the work for which this pennit is issued, I shall
not employ any person in any manner so as to become subject to the Worker's
O ' 8 �Zy, 47Compensation
laws of California. If, after making this certificate of exemption, I
'� Date:
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 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