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07120152 HEVISION 1 CITY OF CUPERTINO BUILDING PERMIT DATE BUILDING ADDRESS: 20800 HOMESTEAD RD BLDG 3 A-B CONTRACTOR:WEST BUILDERS,INC. PERMIT NO:07120152 OWNER'S NAME: VILLA SERRA APTS A CA LTD PARTN 1608 4TH ST STE 120 DATE ISSUED:09/26/2008 ( ER'S PHONE: 6509313457 BERKELEY,CA 94710 PHONE NO:(510)525-9378 ❑ LICENSED CONTRACTOR'S DECLARATION r- r BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class h Lic.# er3 Z7 3, `"` MECH RESIDENTIAL COMMERCIAL Contractor WW5%)3L 491:14) Date I hereby affirm that I am licensed under the provisio s o Chapter 9 JOB DESCRIPTION:NEW APT BLDG,BLDG 3 A-B,2300 SQ-DOES NOT (commencing with Section 7000)of Division 3 of the Business&Professions INCLUDE Code and that mylicenseis in full force and effect. E 9/330/090/09 R ECH/PLUMBING.EVSN BLDG 1-4 FRAMING(SEE#07120165 FOR t "tom 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 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$555555 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number:32609056.3AB Occupancy Type: correct.1 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, PERMIT EXPIRES IF WORK IS NOT STARTED costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. Signature ? Date , g / � Issued by y�_�. -` Date: S /!.-to L v OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is I,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection. Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date: construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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 performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Safety Code,Section 25532(a)should I store or handle hazardous material. permit is issued. Additionally,should I use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534. become subject to the Worker's Compensation provisions of the Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Ow,;. i gent: Date: /Q APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of work's to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.) upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name ir,h'mnify and keep harmless the City of Cupertino against liabilities,judgments, and expenses which may accrue against said City in consequence of the Lender's Address g._...Ling of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal C de,Section ARCHITECT'S DECLARATION 9.18. 11r Signature Date / I understand my plans shall be used as public records. Licensed Professional CITY OF CUPERTINO � �� T ��'°% �' �'""` v°I` `"' BUILDING DIVISION PERMIT . .„COeN<TRA QRIN'FORMATIOIV PERMIT NO. Bu1Lq�b�c,AplytLEsFiOMESTEAD RD BLDG 3 A-B WEST BUILDERS, INC. 07120152 IILA'S tNSAUMVE: PERMIT ISSUE DATE VILLA SERRA APTS A CA LTD 1608 4TH ST STE 120 _09/26/2008 PHONE:A n font SANITARY NO. CONTROL NO. (510) 525-9378 ARCHITECT/ENGINEER: BURRING PERMIT INFO 'BLDG ELECT PLUMB • MECH 0 0 C 0 30o LICENSED CONTRACTOR'S DECLARATION [mF I hereby affirm that I em licensed under provisions of Chapter 9(commencing Job Description `Zwith Section 7000)of Division 3 of the Business and Professions Code,and my license is NEW APT BLDG, BLDG 3 A-B, 2300 SQ n-cN in full force and effect. $a-5gt_C D License Class Lic.0 8/25 SEE 07120212 FOR SUBS, Dam Zv Contractor ````\! ��`t �� ee "C/ARCHr1ECTS DECLARATION < I undersand my plans Mall he used as public records o t Licensed Professional OWNER-BUILDER DECLARATION 0I I!tetchy,(firm that I ant exempt from the Contractor'sssionsCoLicense Law for the 0 o following reason.(Section 7031.5.Business and Professions Code:Any city or county 5s m M which regales a permit to construct.alter improve,demolish,or repair any structure • zY priortoits issuance,also requires the applicant •for such permitto •file a signed statement £ < that hes licensed pennant m the provisions of the Contractors License Law(Chapter 9 Sq.Ft, Floor Area Valuation £FD (commencing with Section 7000)of Division of the Business and Professions Code)or $555555 Ye R ie that ( at he exempt thoefrom and the basis for dm alleged exemption.Any violation of Section 7031-5 by any applicant for a permit subjects the applicant to a civil penalty of — ,,py�yumber Occupancy Type an live more thve hundred dollars MOO). 32609056 Ai5" P y YP D L 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 sal:(Sec.7044,Businrss • and Professions Code:The ContactorLicense s Law does not apply to an owner of Required Inspections property who builds or improves thereon,and who does such work himself or through his own employux,provided thai such impmsem:Ms not not intended[trolleyed for sale B, 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.). • • D I.u owner of the property am exclusively contracting with Earned contractors to constmct the project(See.7044.Business and Professions Code:)The Contractor's Li. cense Law does not apply In an owner of property who Wilds or improves thereon.and. who contacts for such projects with a contractor(s)licensed pursuant to the Contractors sense Law. I am exempt under Sen ,B&P C for this reason wrec Date WORKER'S COMPENSATION DECLARATION I hereby alum,under penalty of perjury one of the following declarations • D I have and will maintain•Certificate of Consent to self-Insure for Workers Compen- ' melon.as provided for by Section 3703 of the Labor Code,for the performance of the work for which this permit is issued. D 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 5 Workerins Workers ka PCoot9eroadoo urance carrier and Policy number ase: ,g^T� • Carder. — Policy No: a lZ'S ✓\ O CERTIFICATEOF EMP1ION FROM WORKERS' COMPENSATION INSURANCE mats section need not be completed title permit is for one hundred dollars(SIM) or leu) • I certify thot 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 . 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 mus ,,- Z forthwith comply with such provisions or this permit shall he deemed rooked. Z y CONSTRUCTION LENDING AGENCY [rI hereby affirm that there s a construction lending agency for the performance of Cd r7 the work for which this permit Is issued(Sec.3091,Civ.C.) W E Lenders Name Orr 7 Z Lenders Address • • U 0 1 certify that I have read this application and state that the above information is W - corm I a - m comply with all city and county ordinances and state laws relating to ' -ro rV' building •• tion.ad hereby authorire representatives of this city to mer upon the • above-m sed property for inspection purposes. H 4 agree to save,indemnify and keep harmless the City of Cupertino against to liabiliti • menu.emuand expenses which may In any way accrue against said City —� 411 U.Z in co • the granting of this permit. / ^ APP I• • •ERSTANDS AND WILL COMPLY WITH ALL ON-POINT Issued by: �J �,�_if// Date Z6 fid SOU C 'Ea LA•ONS. 9 ? 'OV. Re-roofs SignaOF tu . .pli. ' onvactor Dale HAZARDOUS MATERIALSDISCLOSURE Type of Roof I the applicant or future building a Chapter 9 or handleHelthhazardous material77/ defined by theCupeNno Muni u L Code. 9.13,and the Health and Safety Ce,seetim 23332(a)7 All roofs shall be inspected prior to any roofing material being installed. D Yes If a roof is installed without first obtainingan inspection,I agree to remove Will s applicant or future ding occupant sac equipment or devices which P g eDmtrict?hazardous air contaminants defined by the Bay Ana Air Quality Management all new materials for inspection. ❑Yes No I have m the hnardous materials requirements under Chapter 6.95ofthe Califor- nsHealth& yto. .Smios25503.25533 lad 25334.1undcmad that ifthe building does not cu 0 tenant,that it is my responsibility to notify the mupant of the Ifs w ` ren;. missuan¢nr.eenir ol�apyhy,- Signature of Applicant Date own manth em �1 L`/ f/n�Ll✓(Dote' All roof coverings to be Class'4'or better