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07120122CITY OF CUPERTINO, BUILDING DIVISION PERMIT --'Cilf GTQWINFORMATIQN 9 ¢.:tt _�'zA ,,,_ BUILDING ADDRESS: PERMIT NO. OL 20900 HOMESTEAD RD BLDG # WEST BUILDERS, INC. 07120122 Wtk'g1*ME; PERMn ISSUE DATE VILLA SERRA APTS A CA LTD 1608 4TH ST STE 120 09/26/2008 PHONBT SANITARY NO. CONTROL NO. (510) 525-9378 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CO DECLARATION Job Description umler provisos of C I afnm That 1 w emend Under P 9 (mmmc.I. P fth.ad odin, with Section 701MB afDividon 3 of me Business and Profusions Codc.and my license is ionhereby70 I. full rorte,nd ercaLsa�� _ License CI Lk. g Dab Conmmmr DECLARATION A Hit 8/25/08 SEE #07120212 FOR SUBS /1 /� )�7 /' W use I urlMuuml my pins mail he used u ebbe rtcordr // i, ,�„D� /1 /1 � // l� �/r5i `444//`" LLL --- I la // �j(/!iL-Y-r.�� C/�IY�_ J�/ Licensed Professional MNEM-BUILDER DECLARATION I Immby air,. that 1 am exempt from the Contacmra Liccmc Law for the following mason. (Scuon 7031.5. Business and Pmfessam Code: My city or county which requires a permit m constucL &her improve, demolish, or repair any museum prior b its Issuance. aim "of= the applicant for inch permit to file a signed statement Out lb is licensed purvunt te the provisos of the Contractors keens, Law (Chapter 9 Sq. Ft. Floor Area Valuation (commencing with Section 7000) of Division 3 of the Business and Professions Chum) or $555555 Nu he is exempt therefrom and the basis for the alleged exemption, My violation of Semon 7031.5 by airy applicant for a permit subjects me applicant in a civil porosity of p,pp� Number Occas Occupancy Type not mom man five hundred dollars (5500). 32609029 : V 0' L o, ueer of the property, on my wntendedwire urges 0ev sok wmpesalon, r will tlofedue work andbc mumunturots Licodo Lawdd(oralepply Mao.Busnw and Professor code: The Contractors Licosa Law dna ms apply lf an owner of Required Inspections propery whowheron, and who doessahwmk m Wmgnh his mm employees, provi m s,progthat wN impmvematr in not intended oroffeed fmin, boweveera the Wilding or improvement sold within one year ofcompetian,meowner- uilder will haw 0e buNa of provingmat he did ms ndlo or impure for purgs¢ of uleJ. ❑ 1. as owner of be property .. exclusively competing was li¢mW contamma to construct the project (Sec. 70th. Business and Pmfestium Code:) TAe Contractors U. _ cese Law doer not apply In an owner of pmpeny, who builds or improwa Merton, and, who contacts far such pnjems with. eontrnemr(s) licensed p rsuam to me Contractors Lketue Law. Iwu emptunder See ,B&Pcmrmumwmm Date WORKER'S COMPENSATION DECLARATION 1 hereby afEm under penalty or perjury mon of 0b following declamdom: ❑ lh rove wftlmalnWnaCmifiamef Comentwulf-imwfm Wartcrscmnpery adm, u provided fm by Sado. 3700 of I labor Code, fm du prfomance of the wort for which this Peril is issecd. ❑ I have said will malnssin Workers Compewuon Insurance, as required by Section 37W.1 the Labor Code, Tor the peRamance of me work for which this permit is issued. ' m se: My Workers rep auon Iran a carrier and Polityn=r A Cartier. '� Polley No.: jask Doo CERTIFICATE OF EXG ONFROMWOMKERS' COMPENSATION INSURANCE mus section need waWcompleted film Permit is fmane hundred dollars ($100) or less) I ecri fy met in the Perfommce of tfb work for which this penis is issued. 1 mail no, employ any peon in any munerm as in bamsb subject b the Wmmua ComPeouthe Laws or California. Date Applicant NOTICE TO APPLICANT: If. after making this Ccnificate of Ecomption, you should become subject to the Workers Cwpsidon provisions a the labor Code, you most forthwith comply with such Provisions or mu petit shall be dcemed mvokcd. CONSTRUCTION LENDING AGENCY I hereby aMm mat mere I.. m ernmeti m lending agcney for me prfomana of the wart for which this Permit t insists (Sec. 3097. Civ. C.) Lenders Name !antlers Address I certify that 1 have and Otis application and all that 0c above inforemon I, comcL I agree m comply wit all city and comfy ordinances and sum laws relating to building conmuetion, sed hemby aumorim re ireunuuws of this tiny to nater upon the above -mon' wd prepay fm impction purpmes . (W rte to save. Indeomify and kap hm aloas me City .f CupeNno against liabilities, g nt,eoasarWaPe-•"• which mayin MYwayWcrue aWmlaafd City int e the Shunning W Lar mu permit. I ERS IC ERSTA AP NDS AND WILL COMPLY WI ALL N N -POINT 50 TIONS. Issued by: Date Zb Re -roofs Sigmuma VCmtrcbr Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will me applicant m future building occupant stare orhandlc hmardas material fired by tib Cupertino Mun' 'pal Code. Chapter 9.12. and the Health and Safety de. Section 25532(x)? CYa Na All roofs shall be inspected prior to any roofing material being installed. Will the applicant car future Wilding aavpam use cyuipmont m divines which If a roof is installed without first obtaininginspection, I agree to remove an iection P g os m G i7. h air cuminant%� defined by me Bay Area Air Qualify Management all new materials for inspection. tric t? Ossa �fN. I gut ma the harardwsmabrials mquiremmmumkrchapbr6.95oldb Ciiler. nice HeslthdAlto�'.ode.Sceumo25505,25533ud2553 .lis =dthaifthc Wilding deacon cu n h e ..4" if h my respsibility b naify de aavput of Ue require `. ad nn tometpriorblssance.f.ccouseb Ocmp at 7 Signature of Applicant Date All roof coverings to be Class';W' or better owner m a art ,p on Dam u 4 -K CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20900 HOMESTEAD RD BLDG 75 A -D CONTRACTOR: WEST BUILDERS, INC. PERMIT NO: 07120122 OWNER'S NAME: PROMETHEUS 1608 4TH ST STE 120 DATE ISSUED: 09/26/2008 OWNER'S PHONE: 6509313457 BERKELEY, CA 94710 PHONE NO: (510) 525-9378 9 LICENSED CONTRACTOR'S DECLARATION r r BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class �T. Lic. #8� 71�� � r Contractor AV15 C.7 mu\t,D C-(2,. Date 110 MECH RESIDENTIAL COMMERCIAL I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: REMODEL DECK,STAIR RAILS & PAINT ADD HOT WATER (commencing with Section 7000) of Division 3 of the Business & Professions HEATER 6/18/10 PER JEFF GREEF PERMIT DESCRIP Code and that my license is in full force and effect. 7/9/10- REV#1- REVISE STAIRS EXTERIOR((FEE'S,07120154)-S,07120154)ISS'D 9/9/10 I 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 Sq. Ft Floor Area: Valuation: $555555 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. G (, 5 APN Number: 32609029.75 Occupancy Type: APPLICANT CERTIFICATION 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally, the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date I v. Issued byr' Date:- f ❑ OWNER -BUILDER DECLARATION RE -ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed. If a roof is the following two reasons: - installed without first obtaining an inspection, I agree to remove all new materials for I, as owner of the property, or my employees with wages as their sole compensation, inspection. will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) Signature of Applicant: Date: I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER I 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 HAZARDOUS MATERIALS DISCLOSURE Compensation, as provided for by Section 3700 of the Labor Code, for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain I have and will maintain Worker's Compensation Insurance, as provided for by compliance with tine Cupertino Municipal Code, Chapter 9.12 and the Health & Section 3700 of the Labor Code, for the performance of the work for which this Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air permit is issued, contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued, I shall maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and tine not employ any person in any manner so as to become subject to the Worker's Health & Safety Code, Sections 25505, 25533, and 25534. Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must Owner or authorize rent: Date: �1 1 forthwith comply with such provisions or this permit shall be deemed revoked. _ -- APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct. I agree to comply with all city and county ordinances and state laws relating for which this permit is issued (See. 3097, Civ C.) to building construction, and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, Lender's Address costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply ARCHITECT'S DECLARATION with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional BUILDING DIVISION I PERMIT PERMIT NO. STEAD RD BLDG 6 A-�' TBD — TO BE DETERMINED 071201 OWNER'S NAME: PERMIT ISSUE DATE VS II A CALIFORNIA LIMITED 07/08/2008 PHONDA R'T'T\T SANITARY NO. CONTROL NO. ARCHITECTIFNGINEER: BUILDING PERMIT INFO REMODEL DECK, STAIR RAILS Sc BLDG ELECT PLUMB MECH u p p LICENSED CONTRACT'OR'S DECLARATION p I hereby affirm that I am licensed under provisions of Chapter 9 (commencing zJ w with Section 7000) of Division 3 of the Business and Professions Code, and my license is H in full force and effect. Z License Class Lic. N S1�t. J. p Date l Contractor ARCHiTEC 'S DECLARATION 1 understand my plans shall be used as public records 4 o ti Licensed Professional y � OWNER -BUILDER DECLARATION <� 1 hereby air,. that I am exempt from the Contractor's License Law for the C20 following reason. (Section 7031.5, Business and Professions Code: Any city or county K W which requires a permit to construct, alter, improve, demolish, or repair any structure ° Z 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 Eyi H $ (commencing with Sccton 7000) of Division 3 of the Business and Professions Cade) or y,that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). ❑ I, 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 and Professions Code: The Contractor's License Law docs not apply to an owner of property who builds or improves thereon, and who does such work himself or through his awn 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 thep ect (Sec. 7044, Business and Professions Code:) The Contractors Ll - cease law d of apply to an owner of property who builds or improves thereon, and who contracts s projects with a contractor(s) licensed pursuant to the Contractors License w. ❑ I am e m t n r S B& P C C for this reason Owner v Date `'K 'C6 CE 'S COMPENSATION DECLARATION I hereby ,,VIS of perjury one of the following declarations: ❑ I have and will maintain a Certificate of Consent to self -insure for Worker's 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 Worker's 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's Ca pensaLion Insurance carrier and Policy number are - Card Cw Policy No.: —1 C RTIFICATEO EXEMPTIONFROMWORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is foranc hundred dollars ($100) or less.) I certify that in the performance of the work for which this permit Is issued, l shall not employ any person in any manner so as to become subject to the Workers' Compensadon Laws of California. Dale Applicant 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 Oforthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCr10N LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of LY' the work for which this permit is issued (Sec. 3097, Civ. C.) W A L.endces Name Z Lender's Address C.) O 1 certify that 1 have read this application and state that the above information is iy Fcorrect. I agree to comply with all city and county ordinances and state laws relating to V building convection, and hereby authorize representatives of this city to enter upon the W about-menu ed property for inspection purposes (We) to save, indemnify and keep harmless the City of Cupertino against liabiliuea, Ju cnts, costs and expenses which may in anyway accrue against said City V in co que c of the granting of this permit. APP CA RSTANDS AND WILL COMPLY WITH ALL NON -POINT SOU E U A NS. •0 Signature oConuaclor Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building Occupant store or handle hazardous material as defined by the Cupertino Munici aI Code, Chapter 9.12, and the Health and Safely Code, Section 25532(a)? ❑Yes o Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants asdefined by the Bay Area Air Quality Management District? ❑Yes No I hAtereadthehazardousmaterialsrequirementsunderChapter6.95oftheCalifor- niaHcal Safety Code, Sections 25505,25533 and 25534. 1 understand that If the building docs nal ly haw a tenant, that it is my responsibility to notify the occupant of the roqu�e1W NyhV must be met prior to issuance of a CertifhcatrSof,Occygan% A Owner Ft. Floor Area Required Inspections J 6 Issued by: Re -roofs Type of Roof Valuation Occupancy Type Date c2h 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'n" or better