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CITY OF CUPERTINO
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G�NTItACF+C R I R �tTIfI :.
BUILDING DIVISION PERIVHT
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BUILDING ADDRESS:
PERMIT NO.
20800 HOMESTEAD RD, BLDG 29A—
WEST BUILDERS, INC.
08040233
OW 'S NAME:
PERMIT ISSUE DATE
VS II A CALIFORNIA LIMITED
1608 4TH ST STE 120
05/05/2008
PHOWEh o mnT
SANITARY NO. CONTROL NO.
(510) 525-9378
ARCHITEC IENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
I Chapter 9
Job Description
I hereby affirm that am licensed under provisions of (commencing
with Section 7000)ol'Division3ofthcBusiness and Professions Code, and mylicense is
UNDERGROUND WATER PIPE ONLY FOR NEW WATER HEATERS
full f in force and effect. f
in ullfGaas life
Lic.a
DOES NOT INCLUDE GAS OR ACUTAL WATER HEATER NEEDS
Date .��,�,. rtR Contractor
ARCHITECT'S DECLARATION
SEPERATE PERMIT
1 understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors 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 repair any structure
prior to its issuance. also requires the applicant for such permit to file a signed statement
that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
$15 0 0 0
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
AMumber
OccU anC e
p y Typ
Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of
net more than five hundred dollars (s500).
3 2 6 0 9 0 5 6. ZzlAL
L as owner of the propctry, or my employees with wages as their sole compensation,
Required iced Inspections
es Ll
will do the work and the structure is not intended or offered for sale (Sec.7044, Business
and Professions Code_ The ContractorLicense Law does not apply to an owner of
property 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.).
1, as owner of the property, am exclusively contracting with licensed contractors to-
constma the project (See. 7044. Business and Professions Code:) The Contractors Li-
cense Law does not apply to an owner of property .who builds or improves thereon, and.
who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's
License Law.
0 1 am exempt under Sec , B & P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 haw and will maintain a Certificate of Consent to self-insum for Workers Compen-
satlon, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is Issued.
.
❑ 1 have and will maintain Workers Compensation Insurance, as required by Section
3700 of the Labor Code, for the performance of the work for which this permit is issued
My Worker' Compensation Insurance carrier and Polity number are:
Cartier. d Q 9 Polity No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Phis section need not be completed if the permit is for one hundred dollars (SI00)
or less)
I certify that in the performance of the work for which this permit Is issued, I shall not
e-mploy any person in any.maancr so as to become subject to the Workers' Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: lf. after making this Certificate of Exemption, you should
become subject tothe Workers Compensation provisions of the Labor Codc, you must
' forthwith comply with such provisions or this permit shall be dcemed revoked
j
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 (Sec. 3097, Civ. C.)
Lenders Name
,
Landers Address
j 1 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
j liabilities, judgments, costs and expenses which may in any way accrue against said City
' in consequence of the granting of this permit.
CANTND DS AND WILL COMPLY WITH ALL NON -POINT
i APPL�Frm.
Issued by: Date
souRN
S' 4'
Signature of ofAppl ntractor Dater
Re -roofs
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety
Cc, ic, Section25532(a)? ��
Yes ben
All roofs shall be inspected prior to any roofing material being installed.
El
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or Cuture building occupant use equipment or devices which
emit hazardous air contaminants u fined by the Bay Area Air Quality Management
all new materials for inspection.
District?
El Yes o
1 have read the hazardous materials requirements under Chapter6.95 ofthc Califor-
nia Heal th & Safety Code, Sections 25503. 25533 and 25534.1 understand Not if the building
does not currcoy have a tenant, that it is my responsibility to nodry the occupant of the
requ' n hie must be met prior to issuance of a Certificate of Occupancy.
Signature of Applicant Date
{ ' (� - 08
All roof coverings to be Class "B" or better
Owner
or authonxed agent Date