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CITY OF CUPERTINO
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RACTOt MOW# J N
BUILDING DIVISION PERMIT
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BUID20�UV ING RRDiI++ESS:
HOMESTEAD_RD BLDG #
WEST BUILDERS, INC.
PERMIT NO.
07120123
'S ME:
PERMIT ISSUE DATE
VILLA SERRA APTS A CA LTD
1608 4TH ST.STE 120
09/26/2008
PHOM1EtA n funs
SANITARY NO. CONTROL No.
(510) 525-9378
ARCHITECTIENGINEER:
BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
lob Description
1 herby affirm Nal l am lammed under pmvuiom of CMPter 9 (mmmeneing
with Sactkr7M).f DiAmm3afde Bud.Nc1 ofcsmn,cood aM mylicum in
D
in full fare std cfact. ^ �
Li==mx Lk.#
Desk Comrxkr
TIECTS DECLARATION
8/25/08 SEE #07120212 FOR SUBS. ��
s{J h
G �r
1 undcrsund my plan shall be used u public recortls
�D�/�/ /�AJ/
�r/ (�L!/t ,EiK— / ✓ �f�
Licensed professional
OWNER -BUILDER DECLARATION
I hereby Nirm Out i am exmpt from the Contractors License Law far On,
following maven. (Section 704 1.5, Business and Profession Code: Any city or county
which requites a permit to cnnsuuct. Aw. improve, demolish. Or mpuir any slmcdre
! prior od its issuance. auu requiros the applicant for such Permit m ftk a signed statement
" IN in licensed pmwaw. On provisiwu of the Cmaracmrs Uccle Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 70DO) of Division 3 of the Business add professions Code) or
$555555
h used he is eaumw Ih=m(men and the beau for the alleged rsempdon Any violation of
Section 70.11-5 by any applicant for a permit subjects the applicant to a coil penalty s�
q� Number
Occupancy P Y Type
not mart Nut fiw hundred dollan(I300),
32909029
I, u owner of Ile a mY uamumdes wish cages the'vwk msnpetls
dm stray,
r 7011. Business
will do Newark wa Ne shumums inns
awO
Required Inspecilons
lo'sLiceed,
One .1
and u Cane The naaclors License Iso dost not apply lf ,t awned
_
who is
was nauh work dmselfor through his
property who bullas is i w
Property
d lost N N imn,and
owne WIsuch int No ded fmzafdus
issem wtinnstiou:
o1caroBerrE
.thets,proHaed
Over,
builder the drilling or ovcmml4old withinnun yearofcanpleforIrksowlet-
suildm will Nan Ile Wnacn of proring Out Int did rot build m improve for purpose of
akJ.
1, u owner of Ile property, am achum cly conducting with licensed ronbuars to
construct the project (Sec. 7044, Business and Profeviom Cede:) The Coauxmra U.
Cees Law does not apply to an owners, of proprny who builds or Improv themon, me
whocw=etersuchpmjcmwithaon=Wr(s)lic=nedptuananta Ibe Contractors
Lict. Law.
urasempsundm See ,BAPCrathiamawa
Data
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarsdon:
"
❑ 1 ha.c and will menuin aCerifiaeof Covent iso self-inaurt Int Wort=ls Compem
Olson, as provided for by Section 3700 of the Labor Code. fm On Performance of ON
work for which this permit is ismed.
❑ 1 haw: and will maintain Workers Compensation Insurance, a required by some
37W of that Latour Code, fro the performance of the work for which this Permit th hound.
'
My Workers Compensation froodallce a//��rtier and Polity nommen art:
�a
Carrier. �J1lNM/_ Policy No.: I IA O0O� lI
CERTmCAI 11 EDF jMON MOM WORKERS' �
COMPENSATION INSURANCE
(Tbia xNon rcW mtbecanpleed ifft permit lsfoonc hanthW dollars (1100)
or less)
1 «nify OU in the imformalce of the work fa which this pannft is issued, I Nall on,
employ any person in any summer as m become subject to On Worker' Compemuuon
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If. after making this Cenificsm of Exemption, you should
become subject to the W wbcr's Compensation provisions of de Labor Cade, you most
forthwiW comply with such provision or Nu permit shall he Ounces Icvokcd.
I
j CONSTRUCTION LENDING AGENCY
1 hereby aline ON Here I.. onmstruction lending agency for de perfmmance of
On wort for which this Permit is issued (Sec. 3097, Civ. C.)
Le&?a Name
lenders Address
I Cooly that I harc read Ws application and fee Nu the Nue, iNom tile. in
cortex. I agree In comply with all city rod cowry oulinames Orta mule tan rcIndng b
building onnuroction, and hereby mutation mPmsant.mm of this city to enser upon the
above-numdaned property for inspection purposes
(We) agla In ase, indemnify and keep harmless Irk City of Cupertino against
rtsatedespensu which may in any way acne agtlnt said City
liab&EINS.
incanung of Nu pmniL
APSTANDS AND WILL COMPLY W TH ALL NON
Issued by:
-POINT
SO
Date
Re -roofs
Date
ZARDOr
HAZARDOUS MATERIALS DISCLOSURE
Type Of Roof
Will deoCuperta future dulling handle
.Chaptuoma
HaAond Safety fined by de Cupertino Mpal Code. Chapter 9.13, and the Halts and Safety
Soedon sss3z(a)+
.
❑ Tn
All roofs shall be inspected prior to any roofing material being installed.
Will thea applicant or future building aeca nt Lw
Pv f W equipment or device which
If a roof is installed without first obtainingan inspection, I agree to remove
P
end hvsNnna air conuminwts III ned by Uro Bay Area Air Quality Managements
all new materials for inspection.
District?
❑ Yn u
IhevGGGGGG ad the hvardwamamrials rtquirernewunderCNpkr G93 aftheCslifor-
ntaHal" et ase,Sava,25505.25573 and 0331. I understand that lfde budding
da=snce '"a 011 !'Nam, ON Illmyneumujhilbymmail de.upNlofte
cru
nequhse hit l bcmespdorlodsusnccofa Ccrufleaseaf caps .
Signature of Applicant Date
All roof coverings to be Class 'R" or better
Owner orm0m.nc ,gent cele
CITY OF CUPEKYINU
BUILDING DIVISION PEPJvHT
PERMIT NO.
BUILDING ADDRESS:
20900 HOMESTEAD RD BLDGJIW A—" TBD — TO BE DETERMINED 071201'A_
OWNER'S NAME: PERMIT ISSUE DATE
VS II A CALIFORNIA LIMITED 07/08/2008
SANITARY NO. CONTROL NO.
PHONE21 R rPW
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: REMODEL DECK, STAIR RAILS & BLDG ELECT PLUMB MECH
u a p LICENSED CONTRACTOR'S DECLARATION
ul P I hereby affirm that I am licensed under previsions of Chapter 9 (commencing
w with Section 70W) of Division 3 of the Business and PtitiMions Code, and my license is
y in full force and effect
j C Z License L�•
F, p Date — Contractor t
ARCHrIECPS DECLARATION
I understand my plans shall be used as public records
5
L w ,n Licensed Professional
OWNER -BUILDER DECLARATION
n I hereby affirm that I am exempt from the Contractor's License Law for the
Zq O 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 far such permit to file a signed statement
x C that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
t- $ (commencing with Section 7000) of Division 3 of the Business and Professions Codc) 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).
0z
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W ~
Q
UO
U
H �
Ula
❑ 1, 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 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 Contractor's 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.
❑ 1 am exempt under Sec. , B & P C for this reason
OwnerDale
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 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.
My Workers Compensation Insurance carrier and Policy number are: �d
Carrier. CeJ V1 Policy No.: "'�
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Dissection need not becompleted it the permit is for one hundred dollars ($100)
or less.)
1 certify that in the performance of the work for which this permit is issued. I shall not
employ any person in any mannerso as to become subject to the Workers' Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT., If, after making this Certificate of Exemption, you should
become subject to the Workers Compensation previsions of the Labor Code, you 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
the work for which this permit is issued (Sec. 3097, Civ. C.)
Lender's Name
Landers 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 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
liabilities, judgments, costs and expenses which may in any way accrue against said City
in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
SOURCE REGULATIONS.
Signature of Applicant/Contractor Date
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupantstorc or handle hayardous material
as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safely
Code, Section 25532(a)?
❑ Yes ❑ No
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
District?
❑ Yes ❑ No
I have mad the hazardous materials requirements under Chapter 6.95 of the califor-
nia Health & Safety Code, Sections 25505, 25533 and 25534.1 understand that if the building
does not currently haw a tenant, that it is my responsibility to notify the occupant or the
requirements which must be mel prior to issuance of a Certificate of Occupancy.
Owner or authorized agent Date
Sq. Ft. Floor
Valuation
Occupancy
Required Inspections
15
Issued by:
Re -roofs
Type of Roof
Ply
U
1
Date J7r
_44
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 "j. " or better