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CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
C�TRA�'QR iFf3R11�AT�4N
BUILDING ADDRESS:
PERMIT NO,
20800 HOMESTEAD RD, BLDG 61A-H
WEST BUILDERS, INC.
b804O234
OWNER'S NAME:
PERMIT ISSUE DATE
VS II A CALIFORNIA LIMITED
1608 4TH ST STE 120
05./05/2008
PHOkft P rT T l
SANITARY NO. CONTROL NO.
ARCHITEC IENGINEER:
BUILDING PERMIT INFO
UNDERGROUND WATER PIPE ONLY
BLDG ELSCr PLUMB MECH
LICENSED CONTRACTORS DECLARATION
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Description
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
.-... _... . -.. -.-. T. -.. _ _..-..-. ,Qh
with Section 7000) of Division 3 of the Business and Professions Code, and my license is
in full force and effe&-
Licenseq li
Date '7- O' Contractor C1W C t'H 13 t k
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ARCHITECTS DECLARATION
I understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
i hereby affirm that 1 am exempt from the Contractors License Law for the
following reason. (Section 70315, 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
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
APN. Number
OccupancyType
YP
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars (S500).
❑ L as owner of the property, or my employees with wages as their sole compensation,
Required Inspections
will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business
and Professions Code: The Contractors License 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.).
❑ I. as owner of the property, am exclusively contracting with licensed contractors to_
construct the project (Sec. 7044, Business and Professions Code:) The Contractors Li-
,
cause 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 Contractors
License Law.
❑ 1 am exempt under Sec , B & P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm ender penalty of perjury one of the following declarations:
❑ I have and will maintain a Certificate of Consent to self -insure for Workers Compen-
sation, 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 Workers Compensation Insurance, as required by Section
3700 of the Labor Code, for the performance of the work for which this permit is issued.
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My Work Compensation Insurance carrier and Policy number am:
Carrier. �%�� Policy No.: 6
C11t5'iFICATE OF EXEMPTION FROM WORKER
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($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 m the Workers' Compensation
Laws of California Date
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject m the Workers Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shag be deemed revoked.
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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
,
Lender's Address
I certify that 1 have read this application and state that the above information is
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corecL I agree to comply with all city and county ordinance and state laws relating to
building construction, and hereby authorize representatives of this city to enter upon the
ahove-mentioned property for inspection purposes
(We) agree to save, indemnify and keep harmless the City of Cupertino against
liabilities, judgments, toss and expenses which may in any way accrue against said City
in consequence of the granting of this permit.
APPLICANT UND ANDS AND WILL COMPLY WiTH ALL NON-POINTIssued
by: Date
SOUR�REGUL NS.
Re -roofs
I I V7
Signs of ApplicanUContracter Dam
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applicant or future building occupanLstore or handle hazardous malarial
,
as defined by the Cupertino Municipal Code- Chapter 9.IZ and the Health and Safety
Code, Section 25532(a)7
Yes boo
A11 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
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑ Yes a
i have read the hazardous materials requirements under Chapter6.95 of the Califor-
nia Heal th & Safety Code, Sections 25505, 25533 and 75534. I understand thin if the building
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does not currently have a tenant. that it is my responsibility to notify the occupant of the
require ants w ich mast be met prier to issuance of a Ccnifieate of Occupancy.
Signature of Applicant Date
L� - J , 6 -y�
All roof coverings to be Class "B" or better
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Owner or authorized agent Date