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BUILDING DIVISION PERMI
CONTRACTORINF'ORMA.TI01V,
BUILDING ADDRESS:
7.0900 HOMESTEAD RD BLDG WARW
TBD — TO BE DETERMINED
PERMIT NO.
07120157
NER'S NAME:
PERMIT ISSUE DATE
VS II A CALIFORNIA LIMITED
07/08/2008
PHONRI 121ITf
SANITARY NO, CONTROL NO.
ARCHITECTIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
lob Description
L hereby afford died I .m limmee under provisions of Chalets 9 (commencing
--_ _ _�_
wide s«timr 7(%kl)nr Divismn5orthc Badness adP pssionseode,.nd my fcenmt,
in full force and effect. 2
l.am IY. t
Dae_ / SLfd�_Con T
t,7 / /lA0 A*,60/140/ .�, _ S , //
/v�/ / //�L
f
ARCHTfERSDECLDECLARATION
1 understand ns nd my plane shall he utd As public rtcorm
-
Licmmed Mcfessionel
OWNER -BUILDER DECLARATION
1 bcmby affirm that I am commit front de Contrmmrs Leon= Law for de
! following deme. (Sutimn 71151.5, Business and Pmfessmm Code: Any city or ..my
: which requiter a permit to construct, alter, impmw, dcmolim. or mpair any structure
! prior to its issuance. Alan requires to applicant for ach permit to file a signed summer,
that he is Hemmed purwant to doeprovision¢ of the Contiattoh Lmmen lAW(Clupter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 7000) of Disvdon 5 of the, Business and Profusions Code) or
-
: Beat An is exempt therefrom and the buds for dee alleged exemption. Any violation of
APN Number
Occupancy e
P Y, �'P
Section 7051.5 by airy Applicant, for a permit subjects the applicant to a civil family of
no, mom man (SM..e hundred dollars ($.
0 1. As owner of the property, or my employees with wages as their sale cempensedon.
e ns
Required Inspections
9 P
intendedm"`dforsale(Sm.7a'a
re6 moR .'B"e�
will do the, work. rdm`m"'u an owner or
And Professions Code: The Centimeters Licence, Law duce not appy m
property who builds or improves thercon,and whodmauch work himselfor through hu
own employees, provided that Adobe improvement, an, not intended moRere ! measle IL
howews, the building or improsement Is told within one year of completion, the owrmr-
builder will have the burden of proving that he did nut build or impmw for purpose of
sae.).
0 I, As owner of the property, am exclutivdy contracting with liamed contractors m
comtruc, the project (Sec. 7044. Busums and Palmsiont Code:) The Contractor's U.
cense law does no, appy to An owner of property who builds or improve thereon. And.
who contracts for Such projects with a coltn%bl(s) homm d pmevam ut dee Contractor's
LICenY Law.
❑ I Arm exempt under Sec ,B&P C for this name
ner Date
WORKER'S COMPENSATION DECLARATION
1 hereby afNm under Penalty of Pcrjmy oro of the foltewing dect,ntions:
❑ I haw and will nmamma Cr:ndfate.G.deer to wlf-insurefmWmaersCompcn-
mean, u provided for by Section 5700 of Be Labor Code. for the performance of the
wmk for which this permit is iauad,
0 1 ban and will maintain Woraul Compenuuon Insurance, a required by Section
5700 of the Uttar Code, for thm performance of the work (rwhich this Fermi, is issued
'
MY Workers Cmmpensatimn Immrance ander end Policy num art: M�
Cartier. _ ��'CLj'�- CeA'N Policy No.: W
FlCATE OF PTION FROM WORKERS'
COMPENSATION INSURANCE
(ILisactim need rot be completed if me permit Is future hundred deBAn (SIM)
mrmaa.)
1 artily the' in this perfomramo of the work Ins which this permit u issued. I shall nm
.
employ my canon in my manner m a At bmcmmC subject to the Wartmf OunpmrWlW
IAws of L'alifomii Date
Applicant
NOTICE TO APPLICANT: If, after making this Corollate of Exemption, you should
become SubfR( to the, Wmfamre Cmepeoadon pmviLom of Ne Labor Codi, you mdtl
fmMwith comply with such Provism a or this permit shat W deemed mvmked.
CONSTRUCTION LENDING AGENCY
1 hereby aft— the there is A communed. lending agenry for the performanceof
the work for which this permit t, named (Sec. 5097, Civ. C)
LAndces Name
Lenders Accent
1 certify that 1 haw mad this application and cam m.t me Mn.ittroreatimn is
cormcn I agree In comply wide All city and county ordinances W Lute laws relating to
Wilding commcuen, and hereby sermons reprosuadves of this cit, to cost upon the
shove-menumnedproperty forinspectionwhich
indemnify
(We) agree to an. And keep hamlet' ft City of Cupertino agarol
ta.t comgran and upete A
which they in my way amus ageimtsdd Cry
incoieeaum= of
in monsequena of thm granting mf thio Fermi,
pe
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
,
Issued by:%Date
SOURCE REGULATIONS.
Re -roofs
Signature al AppliaHAZADam
HAZARDOUS ALS DlsaosuRE
Type of Roof
Will de a Wilding
t m forum Wilding cecupatnom m handle maeris
Hardmus
C.pa
u darned by the Cupertino Municipal Cede. Chapter 9.12, v0 dee Health end Safety
'de' $menton 2ss52(,)7 ❑Yu ON.
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant ds: equipment or device which
If a roof is installed without first obtaining an inspection, I agree to remove
.mit haammm Air comandimna as defined by the Bay Asa Air Quality Marta, cmert
all new materials for inspection.
District?
0Yu 0 N
1 haw read the haamau muertat, requhemuts under ChApet 6.95 of the Califer-
meHalth&Safety Code.Somom 25505, 25555 and 25534. I undcnund that dLhc building
dom not currently ban A tenant this it it my responsibility At maty tic mceupent of the
mgmoromawhich tete, be mel prim nim. or. Certificate of Occupancy.
Signature of Applicant Date
All roof coverings to be Class'W' or better
Owne,oramhmriseagem D,e
r�
CITY OF CUPERTINO
PERMIT
� Tk
BUILDING DIVISION
_.T
_a s .....
BUILDING ADDRESS:
20900 HOMESTEAD.RD BLDG #
WEST BUILDERS, INC.
PERMIT NO.
071201 2V
OWN 'SM ME:
PERMIT ISSUE DATE
VILLA SERRA APTS A CA LTD
1608 4TH ST.STE 120
09/26/2008
PHONL?T D mrT
SANITARY NO. CONTROL NO.
(510) 525-9378
ARCHITECTIENGINEER:
BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
a o 0 0
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) ofDivision 3 of the Business and Professions Code, and my license is
NEW APT BUILDING # A—B 1,574 SF
in full force and effect
License Lie•M
8/25/08 SEE #07120212 'FOR SUBS.
Data Contractor----
AR]
CHfTECTS DECLATION
I understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's 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
Contractor's License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
that he is licensed pursuant to the provisions of the
7000) Division 3 the Business and Professions Code) or
$555555
(commencing with Section of of
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
32909029 Number
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars (5500).
[11, 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 Cade: The Contactors License Law does not apply a 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 contactors to
construct the project (Sec. 7044, Business and Professions Code:) The Contactors 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 Contractors
License Law.
❑ 1 am exempt under Sec. B & P C for this mason
Owner Date
n .
11Oppp"'
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the fallowing declarations:
C]I have and will maintain a Certificate of Consent to self -insure for Workces Compen-
sation, as provided for by Section 3700 of the Labor Code, for the performance of the
V
work for which this permit is issued.
`, x
❑ 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.
1
.
My Workeees Compensation ^IInsura��nce carrier and Policy number are:
Sf^A.G � T/1M1/ PolicyNo.:714%10004I
Cartier.
'CERTIFICATE OF M1'170N FROM WORKERS'
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 to the Workers' Compensation
Laws of California. Date
n
/ p ri11119
ol/
Applicant
NOTICE TO APPLICANT: If, after making this certificate of Exemption, you should
become subject to the Workers Compensation provisions of the Labor Cade, you must
forthwith comply with such provisions or this permit shall be deemed revoked.
l!
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency far the performance of
the work for which this permit is issued (Sec. 3097, Civ. C.)
1
Lenders Name
9�
I\N
Lenders 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 authodr'a representatives of this city to enter upon the
above-mentioned properly for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cuperflno against
--
liabilities, cots, castsand expenses which may inany way accrue against said City
in conuq ncc the granting of this permit.
AP IC ERS7ANDS AND WILL COMPLY W T'H ALL NON -POINT
Issued by: Date
50 C E L ONS.
G:4
Re -roofs
Type of Roof
Signature t/Contactor DetC
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle haymilous material
as defined by the Cupertino Munic pal Code. Chapter 9.12, and the Health and Safety
Code, seeties 2553z(a)7 1
All roofs shall be inspected prior to any roofing material being installed.
r_1 Yes p/NO
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 harardaus air contaminanZefmncd by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑ Yes u
lhavrficactthe hazardous materials requirements under Chapter 6.95 of the Califor.
niaHealih& cl ode, Sections 25505,25533 and 25534. 1 understand thatifthe building
does no cu d h a lenan4 that it is my responsibility to notif the occupant of the
require nls hl st be met prior to issuance of a Certifmcau of cupan . 4
Signature of Applicant Date
All roof coverings to be Class's.'' or better
Owner or aRenl ate