04030106 CITY OF CUPERTINO RM
. .. '' �T!g+ �ygar 1��Ta��nsya,�«� �i�BUILDING - PERMIT - CONTRACTOR INFORMATION mai - -
BUI LDING ADDRESS: - CENTEX HOMES PERMIT Nt4030166 - -
11500 BIANCHIN N LOT 31
ER'S NAME: - PERMIT ISSUE DATE
CENTEX HOMES 2527 CAMINO RAMON 2004
ONE: SANITARY NO. CONTROL NO"
(925) 415-1600
ARCHITECT/ENGINEER: - BUILDING PERMIT INFO
- BLDG ELECT PLUMB MECH
Lop - LICENSED CONTRACTOR'S DECLARATION
y V I hereby aRrm that 1 am licensed under provisions of CMp¢f 9 pe mencing Job Description "
< with Snor
ion]000 7.,U4
vison3o(tm Businessand .fns" n. cense is
mullfrree,nd f � SFDWL-3 STORY (PLAN 2)
Spm Liccnm Clara a _Lie.M'
Date Contactor LIVING 1753/GARAGE 477 SQ FT'
ARCHITECTS DECLARATION
?W� I undersand my plans shall W used as public records
3 W Licensed Pnlfosslanal - �
`03 - OWNER-BUILDER DECLARATION
i4 I Wrchy oRrm Nat 1 am exempt from the Contactors Limne Law for the
00 following reason(Section RD 1.5;Business and Profmiuns Code:Any city or county /a,
.y m which require a permit to consumer,aimp improve,demolish,m repair any someone /I;q 11 ,/' "-
FI< prior to its issuancalso requirethe heapplicantforsuchpermittoItasignedsuent I / $1&60286
Nat al is licensed pursuant to the provisions Of Comracmr's Limnse la (Chapter
Law Cha ter9 Sq Ft.Floor Area �� �J ry'" / V
%FG (commencing with Section 70M)of Division 3 of de Business and Professions Co@)or
i $ that he u exempt therefnmt and We buss for Ile alleged exemption.Any violation of
Semen 7031.3by,m applicant fors permit subjects Ne.pplicamu.a civil penalty or APN Number i0ecupallcyrType
no than Ii hamdrtcidolrsrs($500). 36619076 . 00 '
uowncr of to propmy,army employee with wageutheir sole compenuton. I) ��� - -""- -"Ind,
ens the swaum is not intended or snared forsdc(Sa.]B4a,Buorless
and Profession Com:The Contactors Limuse law ams nor apply m•o owner or Required Inspections
property who builds or improve thereon,end who dousmh work himself or through his
own employee,provided that such improvcmcnta are not intended or offered for sale.If,
however.she building or improvement is mid within one year of completion.the owner- -- -
builder will have the burden of proving that he did not Wild or improve far purpose of -
sale").
❑1,As owner of the property,am exclusively contracting with licensed mntaaors to
contract the project(Sec.7044,Business and Profession Cade:)The Contractors U.
corse law docs not apply to an owner of property who Wilds or improves Ihemon,and -
whomournersformenprojeerswithacontraaor(s)thanked pursuant to the Cormaelora -- -• --" — -- -'
License law.
❑Iamexemptunde Sec. .B&PCbmdd.reuon - "-
er Dam -
WORKER'SCOMPENSATIONDECLARATION
t 1 hemby affirm under penally of perjury one of the following declaration:
I hove and will maintain a Ccnificao{of Consent o self-inurt for Wormers Cumpon --
moon,As provided for by Section 37W of Ne IaWr Code.for the performance of the
work for which Nis permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,u requited by Section
My ofthclaWrpasoadimltnpunmcanaaftWwork
My Wo-yafaCpmpensadan lnsynnz carrier and Policynumber,ef-
Cartic:—�ihGCCbRII ICATSO Policy O V
CERTIFICATEOF COMPENSATION
EXEMPTION MOM WORKERS'
COMPENSATIONINSURANCE
(Thissecum need not W complcmd if tW Permit is froom hundred dollars(SIM)
Us leas.)
1 certify that in the performance of the work for which this Permil'u issued,I shall not
employ any Pers. any manner so as to become subject to the Workers'Compensation
Laws of Califamia in
Applicant
NOTICE TO APPLICANT:If,afar making this Cenifcate of Exemption.you should
Weome subject to Ne Worker's Compensation previsions of the Labor Code,you must
.JO faMwiin comply with such provisions of Una Nonitmall he deemed revoked.
Z CONSTRUCTION LENDING AG ENCY
1-..�.. I hereby Affimt that there is a cons nnemn leading Agency for the Perrurmame of
'3S
the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lenders Namc - V /-
6, Lender's Address
U C) I anify that I have mad this application and sue that the above information is
LL F coRttL I a&=to comply with all city and county ordinances and Sum laws relating to
0U building convection.and hereby authartc repreenutives of this city to enter upon lW
r above mentioned property for impaction purposes.
e)aree to save,
and
mnify
H y liabilitiess,judgmens.costs andcexpenses which manin my way accrue,against mid Cty
U in consequence of Ne grading of this Permit.
^ APPLICANT UNDERSTANDS AND WILL COUELY.WITH ALL NOWPOINT ued by: Date
SOURCE RE ULATION -
-y Re-roofs
nature of A,Iic.Vc vacua, Date
H ARDOUS MATERIAL$DISCLOSURE Type Of Roof
Will the applicant ser future Wilding occupant atom or handle hvallou material
As defined by the Cupertino Municipal Code,Chapter 9.11,and the Health And Safety
c.Section 15531(a)? All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or fuvilUing mcupanl um cyuipmcm or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit hazardous air tronuminana as defned by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yea
1 have read the hamudous mamnalereyuimrmmrs under Chapu06.95 of the Califor
.is Humph&Safny Cmc,Sections 25505,25533 abut 23534.1 undcrsaol IhatifNc building
does not currently have a tenant.Nat a u my braponibiloy to notify the areup.(of she
myuirtmc whicM1 tent W ma pri9Jr issuanre or 'B te of acuP /Signature of cant Date j
Owner or mthomaUa �" Date All roof coverings to be Class "B" or betterV/