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CITY OF CUPERTINO
BUILDING DIVISION PERMIT''!'
BUILDING ADDRESS:
PERMIT NO.
HOMESTEAD & N STELLING RD
WEST BUILDERS, INC.
07120212
OWNER'S NAME:
PERMIT ISSUE DATE
VILLA SERRA APTS A CA LTD
1608 4TH ST STE 120
09/30/2008
pl{O fMs D m T
SANrTARY NO. CONTROL NO.
(510) 525-9378
ARCHrIECI7ENGINEER
BUILDING PERMIT INFO
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LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) ofDivWon 3 ofthe Business and Professions Code. and my license is
NEW APT BUILDINGS—DOES NOT INCLUDE E/M/P' S (10800
in full force and etre¢L
License Class Lic•K
& 10900 HOMESTEAD, 10870 N STELLING RD) — THIS
Date tractor
ARCHITECT'S DECLARATION
PERMIT FOR PLAN CK PURPOSES ONLY. FEES TO BE PD
I understand my plans shall be used as public records
ON
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Convectors License Law for the
following mason. (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 is issuance, also requires the applicant for such permit to file a signed statement
licensed to the the Contractors License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
that he is pursuant provisions of
2 0 0 0 0 0 o
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he is exempt therefrom and site basis for the alleged exemption. Any violation of
32609056
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a Civil penalty ofNumber
not more than five hundred dollars (S300).
.'`
0 L as owner of the property, or my employees with wages as their sole a mpenaadon,
Required Inspections
wW do the work. and the structure is not intended or offered for sale (See. 7044, Business
and Professions Code: The contractors License Law toes not apply to an owner of
property wbo builds or improves themon, and who does such work himself or through his
we 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 rat build or improve for purpose of
sale.).
0 L as owner of the property, am exclusively conuacdng with licensed contractors to
construct the project (Sec. 7044, Business and Professions Code:) The Contractors Li-
cense Law does not apply to an owner of property wbo builds or improves themon, and ,
who contracts for such projects with a contrector(s) Ikeased pursuant to the Contncars
License Law.
0 1 am exempt under Sec B & P C for this won
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
0 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.
0 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.
My Workers Compensation Insurance carrier and Policy number are:
Carrier. Polity No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSA71ON INSURANCE
(nds section need not be completed if the permit Is forone hundred dollars ($100)
.
or less)
I certify that In the performance of the work for which this permit is issued. I shall nes
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 Workers Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed mvokeA.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
the work for which this permit Is issued (Sex. 3097, Civ, C)
LendersName
[.enders Address
I certify that 1 have red this application and state that the above information is
corms I agree to comply with ail city and county ordinances and state laws misting to
building construction, and hereby authorix representatives of this city to enter upon the
above-mentioned property for inspection purports
(We) agree to save, indemnify and keep harmless the City of Cupertino against
liabilities, judgments, costs and expenses which may in any way accrue against said City
�
in IL
APPPLICANT UNDERSTANDS uence of the granting of AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE RE.GULATTONS.
Re -roofs
Type of Roof
Signature of Applicant/Contractor Date
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety
Code, Section zss3z(a)?
All roofs shall be inspected prior to any roofing material being installed.
❑Yes J-] 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 hazardous air contaminants as defined by the Bay Arca Air Quality Management
all new materials for inspection.
District?
0Yes ONo
1 have read the harardcus materials requimments under Chapter 6.95 of ton Califor-
rria Health & Safety Code, Sections 25505, 25533 and 25534.1 urdcrsumd that if the building
does not cunentiy have a teanL that it is my responsibility to notify the occupant of the
requirements which mew b: met prior to issuance of a Certificate of Oce.
Signature of Applicant Date
All roof coverings to be Class %" or better
Dare
Owner or authorized agent
.
Building Department
CITY OF CUPERTINO
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
TELEPHONE: (408) 777-3228 • FAX: (408) 777-3333
OFFICIAL NOTIFICATION OF NEW/ADDRESS CHANGE
TO: All Agencies
FROM: City of Cupertino
DATE: October 30, 2009
RE: New/Change of Address APN #326-09-056 & 326-09-029
Please note the following address changes: 20900 Homestead Road (formerly The Grove)
has changed its building numbers from 1 thru 11 to buildings 70 thru 80. 20800
Homestead Road, and 10870 N Stelling Road have not changed from the letter dated
October 01, 2009. The addresses are as follows:
20800 Homestead Road Bldgs 1 thru 32 and Bldgs 59 thru 69
20900 Homestead Road Bldgs 70 thru 80 (changed from bldgs 1-11)
10870 N Stelling Road Bldgs 33 thru 58
See the attached spreadsheets and site map for the updated building and unit numbers.
The project name has changed from The Grove and Villa Serra Apartments to The
Markham. Please update your records accordingly.
The new addresses will take effect immediately. If you have any questions, please call me
at (408) 777-3246.
Sincerely,
Susan Winslow
Administrative Clerk