04090238 CITY OF CUPERTINO :" _ ..=:xYBUILDING DIVISION PERNIITCON'L1�C"°rRh,T.M''.,0, A"1;ION�
V.
BUILDING ADDRESS: _ CENTEX HOMES PERMIT'9040.90238
7316 RA11113OW DR LOT IS
R'S NAME: PERMIT ISSUE DATE '
CENTEX HOMES
PHONE: - SANITARY NO. CONTROL NO.
(925) 41S-1600
ARCHITECTtENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
uoo LICENSED CONTRACTOR'S DECLARATION JOb DOSCTI hOn
1 hereby affirm Net I am licensemen
d under provisions of Chapter 9(commencing Job
withSect1.7").Ohe um 3ofthe Buairmuand Prof.Wnm Code,and mylicense ie
infull ra=and effect. REVISION--GARAGE/OFFICE FOR MODEL HOME
,p License Class Lic.g
Date Conracror NO NEW PERMIT ISSUED/ORIG. #04030087
ARCHITECTS DECLARATION
¢ Iundcraundmyplans'hill the used!aspublic nmems REVISION--#04070135
G Licensed Profeuional C
OWNER-BUILDER DECLARATION
I 1 hereby mirm Net I am exempt from the Conlmaor's License Law far the �\
p 0 following moon.(Section 7031.5,Business and Profeenuu Cade:Any city or county r
$ which".I.•permit m emsuuct.alter,improve,demnluh,nr repair arty nrueooc - v
F Z't^ Ador ns its iuuence.abu mgviru the applicanrfor such permit ro Ele uignedststement
< Net he illi=nseJpurmmunNcprovisiouoflheConuacmr'sIJ=uclaw(Chap¢r9 Sq.Ft. Floor Area Valuation
GF�O
,at
bt exempt rectian70ro)of basisfrof alleged
l Bmimssantlm.AnyaIt Con.or
S $ Net k b campy tltertfrom and or bub for be cts Me Gumption.Any violation of
not ren 7031.5 Manfiyundredunr( permit subjects Ne applicant 10•civil Penalty of APN Number Occupancy Type
not more Nan fiw hundred dalton(SSW). - p y -+p
❑I,as owner of the property,or my employees with wages as th.irmlecompensation,
will do the work end dte mucture is notintended or offered intrinsic(Sec.7044,Business Jbbl�)U 6U
and Pmfuaiou Cade:The Commoner Li=ve Law does not apply m an owner or Required Inspections
propeny w ho but Ids or improves thereon,end who does•tach work himsel f or through his
ownemployox.provided that such improwerents are not intended moBe=d for We.It,
however.Ne building or improvement Is mid within ane year of completion,Ne owner.
builder will more Ne Morden of proving that he did not build or impure fm purpose of
uleJ.
1.as owner of the progeny.em exclusively contracting with licensed contractors to
c truct dte project(Sec.70",Business and Profmsiou Cede:)TM Conmctor'a Li-
ccue law does.ai apply roan own,of property who builds or improves thereon.and
who contracts fm such projects with a contracror(s)licensed pursuant to the Comr.croes
Lice ue Law.
❑lames un pal ,BBT for thin
D,
RKER'S OMPENSATION DELLA
I hereby aRrre under pemlty of perjury one of Melfsl 0,Malua0ou:
I have and will maintain a Cenifreate of Consent to self-Insure fm Worker's Compen.
anion,u provided for by Section 37W of the labor Code,for dm parrormance of the
work for which this Permit is Issued.
❑1 have and will maintain Worker's Compensation Insurer=,as required by Secdon
37W or Ne labor Codc,for Ne performarta of the work fm which this permit is issued.
My Workefa Compensation Insurance cania and Polity number see:
Cartier. 9 Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE t
(This sectim need not be completed lithe permit Isforone hundred dollars(SIM)
or leas.)
1 certify Nat in the performance of the work for which this permit is issued,l shell not
employ any person in my manner m as m bcmme subject o Ne WoMori Compensation
Laws of Calif xo i•.Date
Applicant
NOTICE TO APPLICANT;IL after making this Certificate of Exemption,you should
become subject in Ne Worker's Comp nsation pmvisiom or Ne Labor Code,you must
Z forthwith comply with such provisions w this permit shall W decreed mwkcd.
z51 CONSTRUCTION LENDING AGENCY
[-+ I hereby affirm Nat Nene is a construction lending agency ror Me Performance of
the work fur which Nie permit is issued(Se:.3W7,Ci,C.)
CL,
Landers Name
.7 Z Lenders Address
U0 I certify that I haw read this application and sure that rhe•how information ie
F comet.I agr=to comply with all city and county aNin•n=s and state laws misting u, -
DU building Construction,and hereby authome wpneaentsdws of this city to enter upon We
f3I •hove-mentioned Property for inspection purposes.
W (We)agree to=eve,indemnify and kap hamlets the City of Cupertino against
to liabilities.judgments,costs and expenses which may In my way a=cme against said City
U 7 in consequence of the grant" of this permit.
F7 APPLICA N DS AND WILL COMPLY WITH AL ON-POINT Issued by: Date
SOURC EG y��
/ Re-roofs
.-tune of ApplicareVContramr Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof,
Will the applicant ser rumm building oceupanumm or handle habou dour material
dented by the Cupenino Municipal Code,Chapter 9.12,and the Health and Safety
Section 25532(=)? _/ All roofs shall be inspected prior to any roofing material being installed.
U Yes vg Nu .
Will Ne applicant or future building accupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit havardou air comeminmtsyt defined by Ne Bay Am Air Quality Management all new materials for inspection.
District? .MT/ly-r
Yu
1 have mad Ne huaNam.=data mquimmems under Chapter 6.95 Croon Califor.
niarlealth&S ode, dms23505,25533end25534.1undc wdNatif Nc building
does not c ndy he ban at is my responsibility m notify e.pmt of the
require. isle east ' pd WmodemoflCcrtirmin an= Signature of Applicant Date
caner ar,.thari>aa rat Date All roof coverings to be Class"B"or better