04080131 CITY OF CUPERTINO -
BUILDING DIVISION PERMIT � CONT'�R&&OR-M.101 VIA TON R
777
BUILDING ADDRESS: - CENTEX HOMES PEEMIT NG04080131
-NEWS NAME: PERMIT ISSUE DATE
CENTE
ONE: SANITARY 0. 0 OLNO.
ARCHIM47T/ENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMH MECH
0 0 0 0
LOO LICENSED CONTRACTOR'S DECLARATION
'r1 u 1 hereby affma tbel I em limosed under pmvtsions of Chapter 9(rommcncing Job Description
with section 7000)Of Diviaion3ofdic Husinnssand Professions Code,and myllccnm is
D�ZLumlmmeandatmcr. REVISION--PORCH DETAILS (PLAN 4)
LlcenxC a Lk.n
c°^Imewr NO NEW PERMIT ISSUED/ ORIG. #04030084
ARCHITECTS DECLARA i
1 undco tam)my plans shall W used ns public mcn
W.
n
iG i- Licensed PoAmraonel
�S OWNER-BUILDER DECLARATION
.�<Y 1 hereby affre that 1 am exempt from the Contractor's License Law for the
F.O O following mason.(Section 71131.5,Business and Professions Coda:Any city Or mum,
which requires a permit to consumer.rimr,improve,demolish,or repair any stmcmm G`
?< prior m its issuance,also requires the applicant forsuch Permit to File a signed statement
thatheislicensed putavanliothe provisconsofulContmcmfsLicenselaw(Chaptcr9 Sq.Ft.Floor Area Valuati99115
B (commencing with Section 7")of Division 3 of NC Business and Professions Clark)at
that he is exempt dmmfrom and the basis far the alleged exemption.Any A.I.wn of
Secdon 7031.5 by any applicant for a permit subjects the applicant m a civil penalty of APN Number Occupancy Type
not ream than five hundred dollars(sew). 36619076 . 00
Ej I,as owner ofthe property,or my employees with wages Is their solecourn maation,
will do the work,and theswctom is not intended uroffered Russia(Sec.7044,Business
and Professions Code:The Connector's License Law does net apply to an Owner of Required Inspections
property who Wilds or improves duccon.and who does such work Wassailer through his
Man employees,provided Otto such improvemen0 wool intended Or offered for ask.IL
however,the building or improvement is said within one year of complmw.The owner.
bkldlr will have the burden of proving Nat he did not build or haprew fm porion,of
se
L owner of the property,am exclusively contracting with licensed convectors to
cooawd the project(Sec.7044,Business and Pmf°ssimts Code:)The Curiosities Li-
came law does not apply to an owner of umpeny who builds or Winans thereon,and
who contracts for such projects with a contractor(s)licensed pursuant o the Convactmes
License Law.
❑tem exam ntl Sec .B&PClgmis an70
wren Date I
WORKER'S C MPENSATION DECLARATION
I hereby off..under pane Kof perjury ore of dm following declarations:
I honored will maintain a COnifc.m of Consent to ref-Imam for WorkeM1 Compen-
sation,a provided for by Section 37M of me Labor Code,for the peAormance of the
work for which mis Permit is issued.
❑I have and will maintain Worker's Compensation Insurance,at required by Section
37M of me labor Cook.for the performance of die work for which this permit is issued.
My Worker's Compensation Insuranm camor and Polity number wac
Carkc Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This rection recd not bcemandned if the permit Is farooe handled dollars($1(0)
or Ma.)
I certify that in the purficrmenco,Of the work for which this Permit is issued,I shall not
employ any person in any manner an as to become subject to the Workers'Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions Of the labor Cock,you must
.JO forthwith comply with such pmvisions or this permit shall he deemed revoked.
try CONSTRUCTION LENDING AGENCY
[—i I hereby offum that there iso construction lendingagemcy,far me Performance of
g
this work fur which this Permit is issued(Sec.3097.Civ.C.)
WA Lender's Name
M
gLz Lender's Address
U Q I mnlfy mat 1 have mad this application and sane that the above information is
IT. F correct.1 agree to comply with all city and county ordinances and state laws minting to
O V building contraction,and hereby audience mpremnmlvesofthis city to enter upon me
[27ahov°-mnt
eioned property for inspection purposes.
(We)agree to Ove,inticmnify and keep humlcss the City of Cupertino against
„y y Ilebllides,judgments,calls and expenma which may in any way accrue against said City
U 7 in consequence Of the germing of this permit. O
�7 APANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date V
50 CE A NS.
(,CO Re-roofs
Si of Applic.w%Zwtmhm, Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant slum or handle haysrdaus material
0 defined by the CupertinoEcru
ipal Code.Chapter 9.12,and the Health and Safety
0" Will
25532(.)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes No
0Will die applicant orbuilding Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit harardour air cantaminats defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes Nu
I have mad the no...d his tequimmenw under Chapter 6.95 of the Califor.
.in Hreltb&Safety Code,Stt6ons 25305.25533 end 25534.1 undcrsmnd that if the building
docs not c ham aril. it is my responsibility to cooly me Occupant of the
require ts iah at m a crianaafacerdfren yeyd7. C Signature of Applicant Date
Owner or authonmd Agent C `�' JtD/� All roof coverings to be Class "B" or better