04030111 CITY OF CUPERTINO -
BUILDING DIVISION PERMIT .CONTRACTOR I(NFORMATIQN'a�. — '
BUILDING ADDRESS: CENTEX HOMES - ' - PERMITNfb4030111 -
11513 MURANO CIR LOT 33
`1ER'S NAME: PERMrT ISSUE DATA
CENTEX HOMES 2527 CAMINO RAMON 4100 12/08/2004
ONE: SANITARY NO. CONTROL NO.
(925) 415-1600
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LOo LICENSED CONTRACTOR'S DECLARATION JobDescri tion
u 1 lis cby affirm that 1 am de
licensed under provisions of Chapter 9(commencing P
`x with Scmue.]ll(10)of DiA.,. of do,Busineasen ro{ siav Co e.and we is
mdefomeande SFDWL-3 STORY (PLAN 2)
S h? Lkcnse CI Lie.X
'ARCHITECT'S Dctor TION LIVING 1753/GARAGE 477 SQ FT
'�es< 1 understand my plans shall hused ed as public records
DyU
3 ta Licensed Professional
�ct5 OWNER-BUILDER DECLARATION /� rn -
F I hereby alarm that I am exempt from the Contracted License Law for the - a/!J"
OC O following mason.(Section]031.5.Business and ProruSov Code:Any city or county P /`1
1,m which requires a permit to constmct,alter,improve,demolish,or¢pair any structure
'c—h prior u its issuace,also tcquiv the applicant for such permit ro fie a signed stammem
thathei¢liccnud pursumuo the provision of dm Conmcwd License law(ChaPur9 Sq.Ft. Floor Area V 00286
In,
exemiNSation]OW)of beeirs n3 the
Profcas vi Code)mf _ (', -,-/
that he u exempt W:lefrom and the baso fa the alleged exemption.Any violation of h 6� _
Section 7031.5 by any applicant fa a Permit subjects the applicant to a civil penalty of APN Number C%>,!j �06culTaddylType
not moa man Bw hundred dollars(M). 36619076 . 00
owner of me pmpeny,m my.
y employees with wage as they sect compensation, L
1mthework Codthe swCrom unms Li roRemA for hot apSa.]014,Bust,of -
pr Professions builds
The Conveners and
law doh not himseto an owner ter - ' Required Inspections '-��ic, �,t;��"�.;
ownenywbo Wilds provided
smhies mn. menudoessuenwohoroff aNrough his L
however.fth,Ding or
win arc not ear ilfdoroRud for ak.lr,
howler,me building or improvement is rob within one)car or mprove for
the owner-
builder will have 1W burden of proving that he did not build or improv for puryote of
akJ.
I,is owner of the propcny.am exclusively contracting with licensed conoacmrs to
consumer the project(Sec.7014.Business and Professions Cade:)The Conoacmis Li-
ttnse law does not apply w an owner of property who Wilds or improv thermal,and.
who contracts Tor such projects with acomracmr(s)licensed pursuant to the Conuactch's _ ..
Lkeu Law.
I am exempt under Sec. .B&P C for this reason _
cr Date
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury ooe of the following dalantions: _
0 l have and will mtlnuinaCcAOcauefCoventtowlfi umfmrWor sC=Wn-
ation,as provided for by Section 37W of the Labor Cade,for the performance of the
work for whim this permit is Issued. -
❑1 have and will maintain Workers Compensation Womouna,u requited by Section -_ ,-
3700ef me labor Code,for the performance of the work forwhich this permit is issued..
My Work tmmadonlu h=iumdPmlicynumbcram: (��_ /ate
Carrier. Policy No.:
CERTIFICATE F EXEMPTION FROM WORMS'
COMPENSATION INSURANCE
(This section need not bo completed lime Permit is forone hundred dollars(5100)
or less.)
I cerdPo tha in the pc ultimo e,of the work for which this Permit is issued.l still not
employ any person in any marencrsa as m WCmme subject tmhe Wmecos Compcnation
Laws of California.Doc
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
he<o nc subject to the Worker's Compensation provisions of the Labor Code,you must
.J z forthwith comply with such Provision or this Permit snail W dmmN revealed.
zO CONTBUC ION LENDING AGENCY
[-+ I hereby affirm that thea is a mnsVuction lending agency for the performance of
C' the work for which mu pemtit is issued(Sec.3 ,Civ.C.)
OW. Q Lendmrs Name
z Landcr's Address
U Q 1 crtiry,mal 1 have read this application and state that the above iefonnaiun is
LL `i
corms I agree m comply with all city and county ordinances ana d sure laws relating an �'���-----
DWildvw
Willing coction,and hereby Walmnre mrhv anutiof this city enter upon use
r U .have-memmmcd property for inspection purposes
L•+py (We)agree to ave,indemnify and kap harmless the City of Cupents.against
L,I liabilities,judgmcnu,coats and eaN.which may in any way act.against said City
t.1 z in consequence of the granting of this Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
S ULATI S, r -
Re-roofs
Signmuremf Applic- omxctor Detc
RDOUS MATERIALS DISCLOSURE Type of Roof
Will Lee applicant or future Wilding occupant store or handle havvdov material
as dc0ncd by the Cupertino M. Code,Chapter 9.12,and the Health and Safety
e.
Section 2ss32(a)? All roofs shall be inspected prior to any roofing material being installed.
res
Will me applicant or mm emodin team .rat as e m If a roof is installed without first obtaining an inspection,I agree to remove
rip s P q preens or deemcs voices g P
emit h..dov ale comami nr Good by the Bay Arra Air Quality Management all new materials for inspection.
District?
❑Yes
No
1 have mad du hvardnusmaunalstequirtments underehaptar 6.95 of the Califor-
meHealth&Safmy Codc,Sections 25505.25533 and 25534.1 understand thaifthe Wiling
does not curmndy haze a telae,ma it is my rhpo nihilhy as notify the occupant of do
re sw'ch mus met wlauanc nificaaaroc� p ignature of Applicant Date
L(I'vnese, at oath All roof coverings to be Class "B"or better (/