07120199 CITY OF CUPERTINO BUILDING PERMIT # _
BUILDING ADDRESS: 20800 HOMESTEAD RD BLDG 4 A-B CONTRACTOR:WEST BUILDE , PERMIT NO:07120199 3 et-ii,/Q
INC. DATE ais..10111.
"WNER'S NAME: VILLA SERRA APT A CA LTD PARTN 1608 4TH ST STE 120 DATE ISSUED:09/26/2008
,WNER's PHONE: 6509313457 BERKELEY,CA 94710 PHONE NO:(510)525-9378
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB
License Class Lic.# r r r-
MECH RESIDENTIAL COMMERCIAL
Contractor Date
JOB DESCRIPTION: NEW APT BLDG 4 A-B,2,300 SF-DOES NOT INCLUDE
I hereby affirm that I am licensed under the provisions of Chapter 9 ELECT/MECH/PLUMBING.
(commencing with Section 7000)of Division 3 of the Business&Professions 9/30/09 REVSN BLDG 1-4 FRAMING(SEE 07120165 FOR
Code and that my license is in full force and effect.
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:32609056.4 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:
"'nature 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.
0 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 Owner or authorized agent: Date:
permit is issued.
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
ion the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
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 CUPERTINOt *mo i-zx..^•^ v 'n ' 4+"'M' • ^ 'kg T w"�'^' •
g
BUILDING DIVISION PERMIT eoNTRACTORIN.�'ORMATJQN` '
BUI DR
ESS: PERMIT NO.
�$U HOMESTEAD RD BLDG 4 A-B WEST BUILDERS, INC. 07120199
•
RS NAME: PERMIT ISSUE DATE
•
VILLA SERRA APT A CA LTD 1608 4TH ST STE 120 09/26/2008
PHONE.A nmAT SANITARY NO. CONTROL NO.
•
(510) 525-9378
•
•
ARCHITECUENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
C O C C
u o o LICENSED CONTRACTOR'S DECLARATION
;„..1 I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description
- with Section70lD)otDivision 3 of the Business Professions Code ndmyuanse is NEW APT BLDG 4 A-B, 2, 300 SF
rd in full force and effect easast .
iq: Licari Lk.+ �,� 8/25/08 SEE #07120212 FOR SUBS.
g--- Date �1/ Contractor
e�Q ! .__ARCHITECTS DECLARATION
?a U !understand my plans shall be used as public records
S.113
G Licensed Professional
`N3 OWNER-BUILDER DECLARATION
i F I hereby affirm that I am exempt from the Contractor's License Law for the •
0 O following mason.(Section 70313,Business and Pmfessiom Code:Any city or county
2 5- which requires a permit to construct alter,improve.demolish.or repair any stmctum
—iy prior to its issuance.also requires the applicant for such permit to file a signed statement
[-c that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq. Ft.Floor Area Valuation •
(commencing with Section 7000)ofDivision 3 of the Business and Professions Code)or • $555555 •
S 5- that he la 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 N'Number Occupancy Type
not mom than five hundred dollars(S500). . 32609056! P Y yP
• tJ Las 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 Required Inspections
property who builds or improves thereon.and who does such work himself or through his
awn employees,provided Nat such improvements are not intended oroffered 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 Contracted'Li. .
cense Law does not apply to an enter of property who builds or improves thereon,and.
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's
cense Law.
anesemis'under See ,BAPC for this reason
her Date
WORKER'S COMPENSATION DECLARATION
• I hereby affirm under penalty of perjury one of the following declarations:
•
O I haze and will maintain a Certificate of Consent to sel6ksure for Worker's Campem
saslon,as provided for by Section 3700 of the labor Code.for the petfonnanre of the
wort 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 Compensation nnsurance airier and Policy number ass:^ '-tet •
CartierCartier�A't r/ w^ha Polity No.: «Osal_�� g 4
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE •
•
(Tris section need not be completed if the permit is for one hundred dollen(31 W)
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
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
0 Z forthwith comply with such provisions or this pemnit shall be deemed revoked. ' •
'ZV) CONSTRUCTION LENDING AGENCY
H vim•' I hereby affirm that there if a construction lending agency for the performance of
av the work for which this permit is issued(Sec.3097,Civ.C.)
aa Lender's Name
z lender's Address .
t.)o I certify that I have read this application and sate that the above information is
,E
connect I agree to comply with all city nod county ordinances and state lawn relating to
.O building conavuction,and hereby mthorire representatives of this city to enter upon the
above-mentioned property for inspection purposes.
F a (W..agree to save.indemnify and keep harmlea the City of Cupertino against i
v.n V1 liabilities, a's..°tots,costs and expenses which may In any way acetic against mid City Wfitiella
U Z in c' -• ;cc• the granting of this permit. Ai
'•' SOP' IC i '' I-ERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: i
�
i ONS. Ctto k t/ Date / Uj
Z-
S
Re-roofs
Signature Contractor / .
AZARDOUS MATERIALSDISCLOSURE Date
Type of Roof C/y
Will the applicant or future building occupant nom or handle hazardous material
fined by the Cupertino Muni' 1 Code.Chapter 9.12.and the Health and Safety
.Section 25532(a)7
DYes Na All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection,ection,I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit harardom air contaminants aydeBhed by the Bay Area Air Quality Management all new materials for inspection. •
Diwict7
❑ ca u
IA the ha2Nous materials requirements under Chapter 6.95 of the Califor-
nia I • S Code,Sections 255(15.25533 and 25534.1undeaand thaifte building
• not f} dy ve a Ica that It is my responsibility to notify the t of the
req mI` j� wbemet pnormiaaamrnracntr�ar �� Signature of Applicant Date
Ownero .uu red agent { Date' All roof coverings to be Class'W'or better