07120165 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20800 HOMESTEAD RD BLDG 1 A-B CONTRACTOR:WEST .re *r PERMIT NO:07120165
INC. D1 IM inirominommilliPIPOwill.l.1 3, . 1.(.)
'`VNER'S NAME: VILLA SERRA APTS A CA LTD PARTN 1608 4TH ST STE 120 DATE ISSUED:09/26/2008
OWNER'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 Lic.#
MECH r RESIDENTIAL r COMMERCIAL
Contractor Date
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: NEW APT BLDG,BLDG 1 A-B,2300 SQ-DOES NOT
INCLUDE
(commencing with Section 7000)of Division 3 of the Business&Professions ELECT/MECH/PLUMBING.
Code and that my license is in full force and effect. 9/30/09-REV BLDG 1-4 FRAMINGG
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. Sq.Ft Floor Area: Valuation:$555555
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 APN Number:32609056.1AB Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
''gnature Date 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.
❑ OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. I will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Owner or authorized agent: Date:
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 Worker's
Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's 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
ipon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
•
CITY OF CUPERTINO . ,wektiks•ss•ez.?".tz':i t>i2^ '^ -fir'
BUILDING DIVISION PERMIT CONTRACTREI 'ORMj3IION
I G ESS: PERMIT NO.
BUI
w2��8� HOMESTEAD RD BLDG 1 AB WEST BUILDERS, INC. 07120165
ER'S NAME: FERMIT ISSUE DATE
VILLA SERRA APTS A CA LTD 1608 4TH ST STE 120 • 09/26/2008
PHONE:),nnn
rl SANITARY NO. CONTROL NO.
(510) 525-9378
•
ARCHr1ECTENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB , MECH
o I= C C
uoo LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby s1Erm that I am licensed under provisions of Chapter 9(commencing
with 5ation700)nfDivision 3 of the Maim=and Professions Code.amiry license is NEW APT BLDG, BLDG 1 A-B, 2300 SQ
2;or in full force and effect
Epj �¢na �—Conuacw � 8/25/08 SEE #07120212 FOR SUBS.
•
rte`-- `1 ARCHITECTS DECLARATION�ON"�
WU 1 understand my plans shall be used is public records
SQA Licensed Professional
Fs 3 OWNER-BUILDER DECLARATION
ri q I hcrehy affirm that I am exempt from the Contractors License Law for the
p O following reason.(Section 7031.5.Business and Professions Code:Any city or county
$fwhich requires a penult toconstrusanctums alter,improve,demolish,or repair any sanctum
i
¢ 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 Taw(Chapter9 Sq.Ft. Floor Area Valuation
s (commencing with Secton7000)of Division 3oftheBusinmandProfesionsCode)or 555555.
Nu 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 Number Occupancy e
not mom than five hundred dollars(1500). 32609056 P yTyp
Las owner of the property.or my employees with wages as their sole cmnpmwton, .
will do New&and the suumure is not intended or offend forsaie(Sc.7044.Business
and Professions Code:The Connrzmrs License Law does not apply to an owner of Required Inspections
property who builds or improves t ercon,and who does such work himself or through his
ownemployees,provided that such improvements are not intended or offered for ale.If.
however,the building or improvement is sold within one year of completion,the owner-
builder will have 0e burden of proving that Inc did not build or improve for purpose of
a .).
•
I.as owner of the property.am exclusively contracting with licensed contractors to
constrict the project(Sec.7044,Branca and Professions Code:)The Contractor's Li. •
CC=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. •
Iem exempt under Sec ,B&PC for Nis reason
•caner Date •
WORKERS COMPENSATION DECLARATION .
I hereby affirm under penalty of perjury one of the following declarations: •
❑I have and will maintain a Certificate of Conant to self-Insure for WarkersCompeo- '
ation,u 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,u requited by Section
3700 of theLaborCode,for the performance of the work for which this permit is issued '
My Warlktc�nyc�oo�n. on//I�n3ss�urrann�e�cant and Policynumberam: (�,rl •
Carrs • Ct w&// Policy No: `�' 11300 L`
CEEERRRTTTFlCATE OF E FMPTON FROM WORKERS'
COMPENSATION INSURANCE
(This sealed need not be completed if the permit Is(oronc hundred dollar(5100)
or kis)
•
I certify that in the performance of the work for which this permit Is issued.I shall not
employ any person in any manner a as to become subject to the Workers'Compensation '
Laws of California Date
Applicant
NOTICE TO APPLICANT:If.after making Nis Cenificate of Exemption,you should
become subject to the Workers Compensation provisions of the Labor Code,you must
.J O forthwith comply with such provisions or this permit shall he deemed mated.
Zh CONSTRUCTION LENDING AGENCY
[-t I hereby affnm Nat Nem is a constnctim lending agency for the performance of
Cd the work for which this permit Is issued(Sec.3097,Civ.C.)
w 6 Lenders Name
12. Lender'sAddress '
UO I certify dui I have read this application and state that the above information u
57.E.
correct I agree to comply with all city and county ordinances and stale laws relating to ,
.O building c- lion,and hereby athoda representatives of this city to enter upon the •
W above-mend.y property for inspection Purposes
6. (We)rR• to ave,indemnify and keep hamlets tie City of Cupertino against i
y liabitat:ad 4 -.es.costs and expenses which may In any way accrue against said City 44 —1�
Uz inc of, granting of this permit.
s-r APPLI w 'STANDS AND WILL COMPLY WITH 11 LL NON-POINT Issued by: I. 1' - 4! FI Date ' -. 6./-S
SOUR R&U i ,NS
'9(2C/et,p
Signatu of ppiican✓Contraceor Re-roofs ' — / .
HAZARDOUS MATERIALS DISCLOSURE Date
Type of Roof s�
Will the applicant or future building occupant store or handle hazardous material
defined by the Cupertino Munk' I Code.Chapter 9.12,and the Health and Safety
Code. Yes
e
0Yes 32(n)7 All roofs shall be inspected prior to any roofing material being installed.
•
If a roof is installed without first obtaining Peon,an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which g
emit istrihazardous air contaminantsdefined by the Bay Arca Air Quality Management all new materials for inspection.
❑Yes No
nI hat bvdous materials requirements unders]apler6.95ofNeCalifor-
acesnoNks ty .Secnma llitmyresnd75534.1 undemundoccupant
building
does not one Y snot.all it is my responsibility no notify the asupat of the
require nu hk be met prior m issuance of a Certificate fpamy� Signature of Applicant Date
r, (lis/{/
Owner orauth ' nl Date All roof coverings to be Class'%'j."or better