04030107 CITY OF CUPERTINO a '^'' 'x• '
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION - -'-'- ' " • '-
BUILDING ADDRESS: CENTEX HOMES - PERMIT"4030107-
-- '
F1151
ER'S NAME: PERMrt L4UE DATE
CENTEX HOMES 2527
ONE:,
SANffARY N0. CONTROL NO.
925) 415-1600 '
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
u00 LICENSED CONTRACTOR'S DECLARATION IbDOSCTI tinct
C I hereby affirm that 1 am licensed under proOp
visions of Chapter 9(commencing -
b with Section]O(I(q of Diwjaion Sof dm 'nessand PmfcssiumC m yliccnu is
„
in
mBforeeand et. �Poz SFDWL-3 STORY (PLAN- 2)
°v�z Liccase s _Lke.P
i�'c Dam CmIraeror LIVING 1753/GARAGE-477 SQb IFT - - -- ----- --
qq uys RCHTTECTS DECLARATION -
�i a< 1 undeausal my Plans shell W used as public mcomis
30 Licensed Professional
OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am ucmpl from the Contractor's License law(or the - -� ` -- - - -- — — --- -
O O (allowing mason.(Sadun](D M,Business and Professional Coal CAny city or county
m
which requires a pcsmit m canal alter,improm.JemolL h,or¢pais any small � _ �al
riy prior to its issuammc,also requires the applicant for such permit to File a signed normal O
E�o that he ishttnud pursuant In led provisions(if the contruwrs License law(cnaptery Sq.Ft. Floor Area V' �Q fl•Ly V41il 86
sa
(commencing with Section 7")of Division 3 of the Business and Professions Cods) - Cl' VV
$ that he u exampa therefrom and the basis for the alleged exemption.My violation of �y fir rr
Sell 7031.5 by Any April for a permit subjects the epplican1.a civil penalty of APNNumber v4�"!!j. Occupancy Type
;Core than Rm hundred dollars(ssoB). 36619076 . 00 !/ t fir
I,as owner Utah. .Nay.or my employees with wags as Heir sok coni'marl k
w 1 da the work and de struchan isnot intended in off rcd fmsale(Sec.7045.Business
and Portentous Cade:The Coatiocmrs a«ase Law docs nm apply in m owner ar Required Inspections - f
propeny who builds orimproves thereon,and who daessuch work himulfor through his -
ownemployces,provided thiumchimprommentsarenminumdrA oraRemd formic.M
however.the building or improvement is said within am year of eempletion.Ne owner- -
Wilder will have the Wrden of proving that W did not Wild or improve for purpo,of
.In I
❑1,a owner of the propeny,am eaclmively contracting with licensed comments to
comttuct the project flint.]Dda.Business and Professional Code:)The Contractor's Li-
small Law does not apply inanowner o(pperty who Wilds or improves thereon,and.
who contracts for such projects wit a contractor(s)licensed pursuant in the Control
Licence,Law.
❑lameaernptunil Sec. .B&PCforthismasan - - -
er Date
WORKER'S COMPENSATION DECLARATION -
Iherebyifftren under Pantry of perjury one of the following declarations: -
IhamandwillmainuinaCcniGateof Consent to sel6imure for Wall Compcn- "-'- — - -
ration,as provided for by Section 37W of the labor Code.for the performance of Ne
work for which this permit is issued.
❑1 have and will maintain Worker's Catnp mqi Insuraa l as sal by Section37W of the tabor Code.for am Nationance of the work for which this permit is issued. --- ---' --- - _
My Work SZnminpe'maLaashh.IInnn on came,and Policy mortician,
Carrier. e ' 0 Poli'Na.:6Q f!
CERTIFICATE FE%EMMON FROM WORKERS'
COMPENSATION INSURANCE
(This section need not hecumplcted if the permit is forone hundred Uranus($100) ..-or less.)
1 tens!•that in the performance of the.,it for which this Permit is issued.I shall not - .--�
employ any person in any manner so as to become subject to the Workers''Compemation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT.If.after making this Certificate of Exemption.you should - -
bttome suhjeet to the Worker's COMN=(lOft previsions Of the labor Coda,you most
2 ra lh comply with such provisions or this Nmni t shall W deemed rented.
z'O CONSTRUCTION LENDING AGENCY
(--i I hereby&Main that there is a comtruction lending agency for the performame of
a the work fur which Nu permit is issued(Sec.Ma.Civ.C.)
Lenders Name
G Lander's Address
U O 1 c oily that 1 ham read Nix application aM sum Nat the aWve information is
Ftartest.I agree to comply with all city and county UNim ncer and sum laws relating to
U building construction.and hereby mularl mpresenutives of this city to enter upon the
} Ln above-mentioned property for inspection purpows.
OL (We)agree m save,indemnify and keep harmless flu:City of Captain.against
liabilities.judgments,costs and expenses which may in any way accmc against said City
U z iAnPePP9CANT of the gaining of
UNDERSTANDSthis AND Permit.ANDWITH ALL NON-POINT I ued by: Date %UA
C EG //-
Re-roofs
Si emrc of pplicanVCp me or Dete
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will de applicant or future (ding ace partemm or handle hvardous material
-defined by IM CupertinU pal C.
Chapter 9.13,and the Health and Safety
See
2ss3x(a)' All roofs shall be inspected prior to any roofing material being installed.
❑Yes
Will the applicant or fuwm building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
c._mit havardnus air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
District?
❑Yes ❑
I have maJ the bvasdnus mamdals requiamcnm unJcr Chapter 6.95 olthc Caldor
nia Health&Safcty Code,Scc6ons255U5,25533and25534Aundersmndthatifam Wilding _ -
Joos not cameo I have a team 4 the o u my mspomihiIdy notily ted acuPant of Jtc
m W riarmi mcear e -ttaltary.� gnatureofApplic t Date /
0 nerorauthorircdagent ��Date All roof coverings to be Class "B" or better C.