07120167CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20800 HOMESTEAD RD BLDG 2 A-B
CONTRACTOR: WEST BUILDERS, `
O: 7120167
INC.
OWNER'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 DEGLARATION
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.#
r-
MECH RESIDENTIAL COMMERCIAL
Contractor Date
B DESCRIPTION: NEW APT BLDG, BLDG 2 A-B, 2300 SQ-DOES NOT
I hereby affirm that I am licensed under the provisions of Chapter 9
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 FRAMING (FEE,SEE 07120165)
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
APN Number: 32609056.2AB
Occupancy Type:
Section 3700 of the Labor Code, for the performance of the work for which this
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
180 DAYS FROM LAST CALLED INSPECTION.
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 accrue against said City in consequence of the
Issued b Date:
y'
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9,18.
RE -ROOFS:
Signature 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
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 & 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
CONSTRUCTION LENDING AGENCY
Compensation laws of California. If, after making this certificate of exemption, I
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
upon 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
rY OF CUPEKfINU
BUILDING DIVISION PERMIT
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RD BLDG 2 A-B I WEST BUILDERS, INC.
OWNER'S NAME:
VILLA SERRA APTS A CA LTD
ARCHrMCr/ENGINEER:
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions or Chapter 9 (commencing
with Section 7000) orDivision 3 of the Business d Prof ions Code my license is
on full force and ffe�pl.lhhlbc
93 g st,.
License CILie. if —
DateContractor
CTS DECLARATION
I unders d used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt Crum the Contractors License Law for the
following mason. (Section 7031.5. Business and Professions Code: Any city or county
which requires a permit to conswc4 alter, improve, demolish, or repair any structure
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 Contractors License Law (Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of
not more than rive hundred dollars ($500).
❑ 1, as owner ocompensation,
f the property, or my employees with wages as their sole compeation,
will do the work, and the structure Is not intended or offered farsale (Sec.7044, Business
and Professions Code: The Contractor's License Law does not apply to an owner of
property who builds or improves thereon, and who does such work himself or through his
own employers, provided that such improvements are not intended or offered for We. If,
however, the building or improvement is sold within one year of completion, the owner -
builder will have the burden of proving that M did not build or improve for purpose of
sale.).
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044. Business and Professions Code:) The Contractues L-
eone Law does not apply to an owner of property who builds or improves thereon, and
who contracts for such projects with a conlractor{s) licensed pursuant to the Contract es
License Law.
❑ I am exempt under Sea B & P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a Certificate of Consent to self -insure for Workers Compen-
sation, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
❑ I have and will maintain Worker's Compensation Insurance, as required by Section
3700 of the Labor Code, for the performance of the work for which this permit is issued.
My Worker$ �yamRensalio insq uranx canner and Polo: —7 a`reDO A'I I
Cartier. �-`.'„_`.'41-',0�_ Policy No.: i (y
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSA7ON INSURANCE
(This section need not be completed if the permit is forane hundred dollars ($100)
or Icss)
1 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. Data
Applicant
NOTICE TO APPLICANT: If, alter making this Certificate of Exemption, you should
become subject to the worker's Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a consuucdnn lending agency for the performance of
the work for which this permit is issued (Sea 3097, Civ. C.)
Lender's Name
L ander's Address
I certify that 1 have read this application and state that the above information is
corect I agree to comply with all city and county ordinances and state laws relating to
building construction, and hereby authorim representatives of this city to enter upon the
above -men ' red property for inspection purposes
(We gree to save, indemnify and keep harmless the City of Cupertino against
liabilities,] g cots, costs and expenses which may in any way accrue against said City
in copqc o, c granting of this permit,
APPURSTANDS AND WILL COMPLY Wi ALL N-POINT
SOUGU A ONS.
2_ oa
Signp icant/ ntraclor Date
ARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Munic' t Cade, Chapter 9.12, and the Health and Safety
Code, Section 25532(a)?
❑ Yes Na
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants defined by the Bay Area Air Quality Managcmcm
District?
C] Yes No
Ihavem the hazardous materialsrequiremensunder Chapter 6.95ofthe Califar-
niaHeailh&S yC,Sections25505,25533and 25534.1understand that orthobuilding
dots nal curtcn ha tenan4 drat It is my responsibility to notify the the
requiremen w h t met prior to issuance of a Ccrtifnc Occu3�p.antor
----. n—
1608 4TH ST STE 120
(510) 525-9378
NEW APT BLDG, BLDG-2
8/25/08 SEE #07120212
PERMIT NO.
07120167
PERM T ISSUE DATE
09/26/2008
SANITARY NO. CONTROL NO.
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Job Description
A-B, 2300 SQ
FOR SUBS.
Sq. Ft. Floor Area I $ 5 5 5 5 5 5 valuation
32609056
Required Inspections
Issued by:
Re -roofs
Type of Roof
Date 7 - 2_6/- 4
,_�
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'n" or better