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CITY OF CUPERTINO
BUILDING DIVISION PERAUT
E01' I`R CT(}R ��ai�MAT10_ :
BUILDING ADDRESS:
PERMIT NO.
20800 HOMESTEAD RD, BLDG 63A-H
WEST. BUILDERS, INC.
08040229
OWNER'S NAME:
PIItMl'IISSUE DATE
VS II A CALIFORNIA LIMITED
1608 4TH ST STE 120
05 05 2008
PF10N§�h R'T'TT
SANrrARY NO. CONTROL NO.
ARCHrrECr/ENGINEE R:
BUILDING PERMIT INFO
UNDERGROUND WATER PIPE ONLY
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
I licensed Chapter 9
FOR INEW WATERI I�
1 hereby affirm that am under provisions of (commencing
with Section 7000) of Division 3 of the Business and Professions Code, and my license is
in full face and effect
License CI Lic. N
Dam hen Contractor C Ms -.b V-k PW At (3 t e
ARCHITECPS DECLARATION
1 understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
following reason. (Section 7031.5. Business and Professions Code: Any city or county
which requires a permit to construct, alter, improve, demolish, or mpair.any structure
prior to its issuarice, also requires the applicant for such permit to rile a signed statement
that he is licensed pursuant to the provisions of the Contracmrs License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
APN Number
Occupancy Type
Section 70315 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars (S500).
❑ 1, as owner of the property, or my employees with wages as their sale compensation,
Required Inspections
will do the work. and the structure is not intended or offered for sale (Sec.7044. Business
an owner of
and Professions Code_ The Contractors es License Law donot apply toe
ns
q P
properly who builds or improves thereon• and who does such work himself or through his
own employees, provided that such improvements are not intended or offered for sale. If,
however, the building or improvement is sold within one year of completion, the owner -
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
.
❑ L as owner of the property, am exclusively contracting with licensed contractors to -
construct the project (Sec. 7044. Business and Professions Code:) The CDanactor's Li-
ccnse Law does not apply to an owner of property .who builds or improves thereon, and
who conuacus for such projects with a contractor(s) licensed pursuant to that Contractor's
License Law.
❑ I am exempt under Sec . B & P C for this mason
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations.
❑ I have and will maintain a Certificate of Consent to self -insure for Worker's Compen-
-
sadon, 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 Woftes Compensation Insurance, as mquimd by Section
3700 of the Labor Code, for the performance of the work for which this permit is Issued
My Worke s Compensation Laurance carrier and Policy numberam:
Carrier. e_% ? Policy No.;r
CERTIFICATE OF EXEMPTION FROM WORKER
COMPENSATION INSURANCE
(This section need not be completed If the permit is for one hundred dollars (S 100)
or less.)
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 Workeri Compensation
Laws of California. Date
Appficam
NOTICE TO APPLICANT: if• after making this Certificate of Exemption, you should
become subject to the Worker's Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed mvokcd.
)
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
the work for which this permit is issued (See. 3097, Civ- C.)
Lends Name
'
,
Lender's Address
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 auto laws misting to
building construction, and hereby authorize representatives of this city to enter upon the
above-mrationed properny for inspection purposes.
(We) agree to save• indemnify and keep harmless the City of Cupertino against
liabilities judgments. costs and et which m In an ova acctuc a y
) j gm Pca� flY Y Y against said City
in consequence of the granting of this permit.
' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOU NS.
t
Re -roofs
'
Type of Roof
Signature of Applicant/Contractor Date
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code. Chapter 9.IZ and the Health and Safety
Code, Section 25532(a)?
❑Yes
All roofs shall be inspected prior to any roofing material being installed.
If a roof installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment err devices which
.is
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑Yes ❑No
I have mad the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Hcalth & Safety Code Sections 25505.25533 and 25534. i understand that if th c building
does not currently have a tenant, that it is my responsihility m notify the occupant of the
requiir�r it w c be met prior m issuance of a Certificate of Occupancy. o
v }nl �' O
Signature of Applicant Date
All roof coverings to be Class "B" or better
Date
Owner or authorized agent