04030061 . CITY OF CUPEWrINO _ . . s 3x:< +x asdrA% -.�. �:• t^ 5. — - -
BUILDING DIVISION PERMIT
iiwyCONTRACTORINFORMATION
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BUILDING ADDRESS: CENTEX HOMES PERMITN'64030061 -- - - '
11517 BIANCHINT LOT 26 IER'S NAME: PERMIT ISSUE DATE
CENTEX HOMES 2527 CAMINO
ONE: SANITARY NO. CONTROL N0.
(925) 415-1600
ARCHRECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
v00 LICENSED CONTRACTOR'S DECLARATION Job Description _
mC I hereby affirm that 1 am licere cd under pmvW f Chmpmr 9 mri eyeing
iW with Section 701 I'Divixign] fthc Busincas of �e,end n.yl' se is -
„« inrnumm<anaerr /`f,�i SFDWL-2 STORY (1510 SQ. FT.LIVING SPACE)
j _ Liccnsc L4.N GARAGE 435 S Q FT (PLAN 1)
I � Dam AR ITELTS DECLARATION
4_< 1 understand my plans haBWused aspublic mounds REVISION- -#04080010
Sou
;oy Licensed Professional .. -
g OWNER-BUILDER DECLARATION I� p
.<P 1 hereby affirm Nal 1 am exempt form the Contractors License Law for the �`1\,l' p
n 0 following mason.(SmOm 703 1.5,Business and Precisions Code:Any city nr countyrN
K m which mquirci a permit in construct.slier,improve,demolish,or mpair any svucrum 1.� I
m-m poor m its issuance,also ouplisea the mplicam for such Permit to file a signed statement
'i< that hoislicensudpursuant toNcpmvWomnfshe Cpmrmhr'sLimmeLaw(Chapter 9 Sq.Ft. Floor Area ]/ Vahiatibn
s-ts0 (commencing with Section 7000)of Division]orOo Business and Porm rcomor Cods)
i that be u exempt therefrom and the basis for the alleged exemption.Any violation of 9nnn$17 3 141
Section 7031.5 by any applicant for a Permit subjects the applicant o acivil penalty of APN NumberOccupancy Type
not more Nan five hundred dollars($500). ryJC1 I
I,as owner of the n
❑ prose y,mmy OEin udo,.U,guug.(s.ecompewineas 'I r 1• s t
will pr tho work and theswnum is not intended proRemd forsak(See.7044,Business 6 o r, i
and Porfrssiom Code:The ContracmYa License Law most ort apply m sn owner of � Required Inspections L� \s,�} •' • -
propenywhobuildsorimprovutimrmn,and whodmssmnwort himself or through his 4 `�J
uvncroployees.pmvided Nmsuchimpromements enol immmded oro@redforsale,It, -
however.the building at improvement is sold within arm year of completion.the owmr-
b Ids will toss the burden of pmving dot M did not Wild or impmxs far pupose of
u4 .
I,u comer of the propsny,am exclusively contracting with limned morrrecmrs so
ortswct the pmjen(Sec.7004.Business and Professions Code:)M Conracmrs Li-
center
cense law dors not apply m an ownu of property who Wilds or improves thereon,and
who contracts for such pmjecu with a contncm-0s)licensed pursuant mthe Contractors - -
I.ummo Law.
❑ Ian exempt under See. .B&P C for this..,.on .," . .
cr Dam _
WORKER'SCOMPENSATIONDECLARATION -
I hereby sfTm under penalty of perjury,ane of the following declarations:
l has and will maintain aCeniGmmof Ccumentmulf-insum fm Workers Compen- ^ ' - "•"
cation,as provided for by Section 3700 of she Labor Code.for the performance of Oc
work for which this permit is issued. - -- - -
❑1 have and will maintain Workers Compensation Insuunce,as required by Section - -• -
3700orthe boy Code for thepeK rmsnee of the work for which this permit is issued. - - ` . .
My W cr mpena Don sat tics carrier and Policy ggryuuu ��ycccyyygggeee 6
Cartier Polity No. me L✓-�
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section med not W completed if ttc permit is(seen hundred dollars($100)
or lm)
I citify that in the performance pf be work for which this Penni,is issued.I shall not _
,.ploy any person in any manner so as is become subject,.site Wmkera'Compewtim -
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should
Wearies aubject W the Workers COmPLRLtIan provision or the Lmm Code,you no.
.,O foMwidt comply with such provisions or this pernitahall W domed revoked.
Z'" CONSTRUCTION LENDING AGENCY
(-i I hereby affirm that then is a construction lending agency for dm performance of
D: Ne work fur which this permit is issued(Sec.3097,Cil CJ
W Q Lender's Name
D lender's Add.
U 0 1 certify that I have read this application and sum that ted show information is
W t" cornea I agree to comply with all city and county collimators and sum laws relating to
U building construction.and hereby authoore mpmammtoccs of this city to enter upon the
fS] above-mentioned property Tor iospecdon pmposs.
6. (We).,me m save,indemnify and keep harmless the City of Cupertino against
rA liabilities,judgments costs and expcmcs which may in any way accrue against said City
U Z in consequence or the Simi ng of this Permit.
^ APPLICANT UNDERSTANDS AND.WILL COMGPLY-Wt ALL NON-POINT
I ued by: - 4taAw Date
S llR R 0 ATI I/4�i�E�' /
Re-roofs
Signature of ApplianUCa ocmr Dem
HA ARDOUS MATERIALS DISCLOSURE Type of Roof
Will Nc applicant Lir forum Wilding mcupam emm or handle haurd0us mamtial
as defined by she Cupenino Muni ipal Code.Chapter 9.12,and the Health and Safety
c,Section 255320)? All roofs shall be inspected prior to an roofing material being
❑Yes D p p y g g installed.
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
no,hazardous air sontaminams crined by the Bay Arca Air Quality Management all new materials for inspection.
District?
❑Yrs No
I have read the hvardrns materials mquimmcnu under Chapmr695 of the Califor-
maHealth&Safety Code,SeNmts 25505,25533 and 75534.1 undencoud that ifthe Wilding
does not currently have a teen,that it u my mspmuibility m notify the sampan,of dm
myui nrcn WmerrwissD aaacertiRc. altars yk gnatureofAppli ant Date 1
2-Oe All roof coverings to be Class "B"or better V
Owner Lir authommil agent Date