04030067 L11ILDING
1 BUI of c DI DIV] onNc ERMIT ONTRACTOR INFORMA ION Y
:: ,,?,ADDRESS: CENTER HOMES P�`"IIT"04030067 "ANCHINI LN LOT 28
ER'S NAME: - PERMIT ISSUE DATE
CENTEX HOMES 2527 CAMINO RAMQN 4106 19 /08/2004
SANITARY NO. CONTROL NO,
(925) 415-1600
ARCHITEC iENGINEER: - BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
w 1 hereby affirm that I am licensed under phonsiom of Chapter 9(aeneing Job Description
"
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W wi0tion70(IB)ofDiOMon3ofthcud
Bnmss Prfcssium Codaan licctscis -- - -
_Z5 mm
`o°`+ imm�r°mea^def - SFDWL-3 STORY (1992 SQ. FT. LIVING SPACE) - -
���cW o^ GI - c gD nr GARAGE 430 SQ. FT. (PLAN 5)
Sia RCHITECTSDECLARATION REVISION--404080014
m< 1 understand my plans atoll W used As public records
JyU
;ot, Licensed Professional
OWNER-BUILDER DECLARATION
1 hereby.w1firm(Sec Nat 1 1. exempt from the Contractor's License taw for M
Z p o following reason.(Second](131.5.Bmincss and Prfcssiuns Code:Any city or county
K m_ which requires a Permit to conswct,alter,improve,demolish,or repair any structure
prior to its unuance,also requires the applicant for such permit to file a Signed statement /� n f
�s< that be is licensed pursuant to the provisions of the Comments License Law(Chapter 9 Sq.Ft.Floor Area q / ,�, Valuation
(commencing with Section 70W)of Division 3 of the BturroMand Professions Chile)in 11 I
W 5$ that he is eam mpt therefroand the basis for the alleged exemption.Any violation of - - ` 11✓ l:_ i$224700-
Section 7031.5byanyapplicantfor ape.it subjects theapplicutwacivilpcmltyof APN Number A-, I "- Occupancy Type
not ore Nan Bae hundred dollar(SSM).
1,uowner
ow
puginy,or my employees with wages u ihirsole compenation,
11 do We work,and the..In.isnot inteadW or offered Image(Sec.7014.Bush. u '
and Profesdom Code:The Cone$came Law does twat apply 1^an ower of Requii'ed�'Inspections�JUS
pMopemploy=,ho ilptroo&mdthat such promsdximpmscmenu are not inte�edhimscilm,thro.gh hisoroRartA for We. f, - `�\i�r�1�7
however,the building or impmvement is sold within one you ofcomplcuon,the owner- v�/ft/-• �-�\
builder will have Ne burden of proving that he did not Wild of improve for purpose of
❑h as owner of the propeny,am exclusively contacting with licensed convectors to
construct the project(Sec.70414,Business and Professions Cade:)The Contractor's Li-
cense Law duct not apply 1°an owner of property,who Wilds or Improves IW2°n,and .. • . --.,. -
whocontractsforsuehprojectswithacommcwr(s)licensed pursuant in We Convectors - -• - - -- -_ _
License U
0 l am exempt under See. B d:P C for this..on
er Data
WORKER'S COMPENSATION DECLARATION _
1 hereby affirm under actuality of perjury one of de following declmauom:
0lhamand will mainuinaCervRate of Comemmself-insure fm Wprkers Compen- '- _ '" — "'-"- - - _--- �-
,u provided for by Section 37M of We LAW,Code,for the pcdorm.of the
work for which this permit is issued. -
❑1 have and will maintain Workch Compensation Insurance,a required by Section
311 of the labor Crude.for the performane,of We work for which this permit is issued.
CMayrtWieor.rkcr�� �pnidn Ins nee carrier Pon cy Noy
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section and not h completed if the permit is for one hundred dollars(SIM)
M lass.)
1 certify that in the per(otmma of the work for which this permit is issued,l shall not
employ any person in any manner so As w become subject to th Workots'Compemavon
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
bceomc Subject in th Worker's Compensation pavilions of the talar CMB,you mum
�z
forthwith comply with such provisions or this permit shall W deemed rtrokcd.
Z N CONSTRUCTION LENDING AGENCY 1 _
PI W mhy affirm that thrtis a construction lending agency for We perfermanec of
a the work for which this potion is issued(Sec.3097,Civ.CJ
Q lender's Nurse - - - -
.7 z Lender's Address
U 0 1 certify Nat 1 havc read this application and stat,WILL the above information is
e.t" cortett I agree or comply with all city and county on inanecs and auto laws mlating to
0U building construction.and hereby authorim minMaermuncs of this city to enter upon We
aWvc-mentioned prieny for impaction Inflames.
(We).,me to ave.indemnify and kap harmless the City of Cupertino against
F' fajl
liabilities Judgments.costs and expenscs which may in any way accsuc against said City j
U z in consequence of the granting of this permit. /
^ APPLICANT UNDERSTANDS AND WILL CO PLY WITH ALL NON-POINT Issued by: Date
E LATIONS.
Re-roofs
Signuum of App tcanV nvamor •Dow
AZARDOUS MATERIALS DISCLOSURE Type of Roof
Will We applicant or future Wilding occupant store or handle hurshlous material
as defined by the Cupertino unmi al Che.Chapter 9,13,and the Health and Safety
e,S do 5533(.)7 o All roofs shall be inspected prior to any roofing material being installed.
Will t e appfiesmor future building occupant use equipment ordevices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hannuous air emotion im an¢as ,Fred by the Bay Arca Air Quality Management all new materials for inspection.
Di
No
1 have read the branches materialsrtquimments under Chapter 6,95 of the Cantor.
ria Health&SanclyCM,.Scctiem255B5,25533xnd3553d,1undcrstvWthis iftW Wilding
Gg currently haat a tenant that n u mY rtapomi " m nuafy the occupant of th
n wwismusthmet romwedu fisc tate of Ocu ry — /ignature Of App ' an[ D
G
aumotiz sent ore All roof coverings to be Class"B"or better