04030086 CITY OF CUPERTINO °i�"a'r =3-sF+`w" '� ` �.�""``� ";` 3` '
BUILDING DIVISION PERMIT 6CONTRACTOR INFORMA ON
BUILDING ADDRESS: PERMIT NO.
CENTEX HOMES 04030086
AM PERMIT ISSUE DATE
E: 2527 eAMINO F_i!dtDN #100 SANITARY OL NO.
a "
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG �_ ELECT-_, .PLUMB MF.CH
LOo LICENSED CONTRACTOR'S DECLARATION - Job.Description .
til I harebY affirm that 1 am]torsed Wader provisions of Chapter 9(commencing `
�<E withSenian 7")9(D' ion3oftW Business and Professions CodeJst�mYliccnu is
in roll tome ens rffiF is d .)L/)
,'y,? umnae Cl li can n SFDWL-3 STORY (PLAN '3)
�— Date Contncmr
ARCHITECTS DECLARATION LIVING 1809/GARAGE 430 SQ. FT'. ', � -
1 understand my plans ana[]he used as Public records '-
CyU
3 u Licensed Professional
OWNER-BUILDER DECLARATION
Comar GN
n o 1 hereby Maso affirm Net 1 1. exempt from IPr GantraclCo License taw far the
O O following moon.Permit
t ](13 LS,Business and Professions Code:Any city m county
which its requires a Permit W consume,elWc,improve,demMsh,m e a sig any awtlent l/
prior in Slissused also requires dtevishan mffoe suchpermitmflessigned atatemem
S., thmWucial, mpursuammthcpmviviomOftheeB.Siocasivimruclaw(Cluptcr9 Sq.FL Floor Area Valuation
��G (commcntln6 withScmion TOW)nf DivuionJnf the Businev and P,tfcssine,COWo)u, '
y
and he is eumpt therefrom and We basis far We a]Icged cxcmption.Any violation of
Section 7031.5 by any applicant for a permit subjects We applicant a civil penalty of APN Number Occup Cy ype
not mom Nan five hundred dollars(M).
❑I,as owner of me property,or my employees with wage,as their sole compensation.
will do We work and We Structure is not adorned oroReed f...M(Sac.]Daa,eusinua 3661907600 Required Inspections
and Professions Code:The ComncWrs License .
Law does not apply to an owner or q p
property who builds or improves Woman and who does s uch work himse]f or through his
awn employes,provided mat such improvements are not intended aroReeed forsale It.
however,We Wilding of improvement is Sold within ane Year of completion,the owner-
Wilder will have the burden of proving mat he did not Wild or improve for purpose of
sale.).
I.as Owner of tW propcny,am exclusively contracting with licensed contractors to
construct he project(Sec.7W,Business and Professions Cade:)M Contracmr'a Li. .
mane,Law law donot apply to an owner of property who Wilds or improves Woman,and
who contracts for such projects with a contractor(s)licensed pursuant the Contractors -
License Law.
1 ton exempt under Sec .B R P C for this naso.
Owner Dale
WORKER'S COMPENSATION DECLARATION
1 hereby aRrm under penalty of perjury arc of We following Workstations:
have and will maintain aCenifiesre of Consent to se]binsum for Workers Compere
.tion as provided for by Section JTBO of We labor Code,far We performance of me - -
work for which this permit is acted.
❑I have and will..in.Worker's Compensation Insu .a rrquimd by Schon
37M of We Labor Code,for We perfomunco of We work for which this permit is issued.
My Work ompensation surence Omer and Policy nutpbe
Cartier. Policy No.: ` J(
CERTIFlC TEOF NFROM WORKERS' '
COMPENSATION INSURANCE
(rossection need notWcompkeWdiftW pcmilislarom hundred do]lars(SIBIq _
or less.)
1 mr i),Wa in the performance of am work to,which this Permit u issued.1 Slash not
employ anypeemn in Say manner u as W become Subject o dW Worke,i Comperssation .
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making Was Certificate of Faemption,you Should
become subjttt m me Workers Compensation previsions of the tartar Cook.you most
.JO forthwith comply with such previsions or this Permit shall W deemed mated.
Z CONSTRUCTION LENDING AGENCY
[-. I hcrcby.famd mat Wert u a consuuctinn lcnding agmcy for the Terfurmance of -
CL me walk far which this permit u issued(Sec.3097,Civ.C.)
W Q Lenders Name
0.Z Lender's Address
U 0 1 certify met I have rod this application and se,¢that We above information la /
L2.;: correct 1 agree he comply with all city and county ordinances and se,M laws relating m
DU building construction.and hereby authorise mprmmltaivrs of this city to corer upon We
r W above-mentioned property for inspection purposes.
(We)agree m Save,indemnify and keep harmless We City of Cupertino against
F' N liabilities,judgmcnu,costs and carpenters which may in any way accrue againstaaid City
U Z in comeyuence of We granting of this Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT ssued by: Date
SOU EGULATIONS,
Re-roofs
S' vert of Applicant/ nRDO Dem
}AZAROOUS MATERIALS DISCLOSURE Type of Roof
Will We app ream or ruwm huilding accupant Smrc or handle havardous material
as defined by We Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code.Semon 25532(.)? All roofs shall be inspected prior to any roofing material being installed.
0 Yea
Will the applicant or m m buildin6 "arm'
tau equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove -
t baamdous air conuminanu defined by the Bay Area Air Quality Management all new materials for inspection.
thiel?
❑Yea ErAn
In ave mad the Waardaus materials mquimmenu under Chapter 6.95 of the Califor-
niaH.Ith,r Safety Codc,Eauorun%5.25533md25534.1und mute ifIM Wilding
n t urrca,) have a tenant.out it u my re,poruihi]ity W wary We omupam of oc
4th ilm me orWi 0 cmdfie,teofOCm c Signature of Applicant Date
Owner or]kthorin agent Date All roof coverings to be Class"B" or better