04030108 CITY OF CUPERTINO .. _ _
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION --
BUILDING ADDRESS: CENTEX-HOMES - PERMIT N004O3O1O8
11520 BIANCHINI LN LOT 27
E0.2 NAME: l'ERhVf tmmDATE
CENTEX HOMES 2527 CAMINO
SANITARY NO. - CONTROL NO.
ONE: -
(925) 415-1600
ARCHITECT/ENGINEER: - BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LO Zp LICENSED CONTRACTOR'S DECLARATION _
I toreby affhsm Nal l am licensed under provisions of Chapter 9(commencing lob Description
with Seadm 7").(Divisigh Sof Ban. Prof o.0 liccnmis
in mummeande SFDWL-3 STORY (PLAN .2)
S"„t Z Licen ass Lic.M
Da�Camrannr LIVING 1753/GARAGE 477 SQ FTF(r\ _ _
ARCHITECT'S DECLARATION r1 h\\ y - -
a 1 understood my plans shall Ire used as public amords V Y'I J ft I(. "t����
0 i D r'. ,
;ut;
Licensed Pmfessianal
`m5 OWNER-BUILDER DECLARATION
1 hereby affrm that 1 am exempt from Ne Contractor's License Law for the
p o following moson.(Section 7(n 1.5,Business and Profercons Code:Any city Or county n�
ism which requims a permit to eonsuuet.alto,improve,demolish,an repair any swcture Ir�'D VUd -
v-'^ priorto its issuance,aboampui.,tia.pplicart imauch permutes filcasigned stokmcru
1-Z< Met he is licensed pursuanHa the provisionsarthe Contractor's License taw(Chapter9 _ Sq.Ft. Floor AreaiVa"ft286
(commencing with Section 7000)of Division 3 of the Business and Professions Code)or V /s'7 lI /��
3$ Out,he u emmpt therefrom and the basis far Ne alleged exempd.a.Any violation of `�t t'���.l �
Section 7031.5 by tory applicant for a permit subjects the applicant to a civil penalty of APN Number 066ahc
P Y_1yPe
oat mom than Bw hundred dollars(5300). 36619076 . 00
L as. 0;,:
of the proputy,m my croployces with wages u their sole comper adon,
'Udo Ne work an0 theswcturt is not intended oroRertd ferrate(Sa.7000,Bgircu
and Pmfrssions Cade:The Conuaclara License law does nal apply Or in owner of - - ..._ - Required Inspections - ._ -•' .
property who builds orimproves thereon.and who doessuch work himalfor thmugh his
own employees,provided that such improvements are not informed or o@red for ale.If. -
however.the building or improvement is said within one year of completion,the owner. - -_
builder will have the burden of proving that he did not build or improve for purpose of
ask.).
❑1,Or none,m Ne propeny,am axclusively minsecting with licensed ranmactars to -
construct the pmjcct(Sec.7006,Business and Professions Code:)The Conwcfer's Li-
doom Law does not apply to an awner of property,who builds or improves demon,and ......
who contracts for such projects with a conuacmr(s)licensed pursuant to the Conuaetots - - - - --- - --
License law.
❑1 am exempt under Sec .B&P C for this reason
er Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty or perjury mm of dm following decimations: -
IhaeeaadwillmainiamaCertifgmofConsenl.self-insure for Worker'.Compen- -
s ion,is provided for by Section 3700 of the labor Code,for the performance of Ne —Y
work for which this permit is issued.
❑1 he.and will maintain Wohcts Compcnsalion Immener.as babirod by Section -
)700 of the labor Code.far the perfarmanceaf dte work for which Nu pemhit is issued.
MyW�Wprkiee((sss C��am��p�eh,w�tion/Insynrfce carrier and Policy nmb�er amort:
Carrier(�r-^� Policy No.:(�✓�- V LF -
CERTIFICATE OF EXEMPTION FROM W ORKERS
COMPENSATION INSURANCE
(Thu section need noE W completed lithe permit is formic hundred dollars(SI00) -..
ter less.)
I cent(that in Ne performance of the work for which this permit is issued.I shall not _
cmployany person in any mannerso as to become subject to the Wmlmor Compensation _
Laws of California.Data
Applicant
NOTICE TO APPLICANT:Ir,after making this Cenificam of Exemption.you should
become subject to the Worker's Compensation previsions of the Labor Code,you most
�Z foMwith comply wife such Provisions or this permit shall W domed rooked.
ZO CONSTRUCTION LENDING AGENCY -
[-.Z I hereby aRrm do Here iso comuuctinn lendlngageney in,the perfarmanee of
> the work for which this permit is issued(See.3097,Civ.CJ
W Q L mdcr's
D. foer's Addrera
U Z
U0 I ttnee that 1 have read this City
and coup and scalea that the above sus totalling is
Lk.U
correct,1 agree to comply with all city and county ordinances of and sante laws relating to
0(, movengcmionelltproend hereby auNan prcpmsenutivrs of this oily tocnmrupon the
G shave-(W)a agree
to saw,for inspection purposes.
(We)gree to ase,indemnify and keep hay in m the City of mCupenstm against
U Z incoitiq,judgmentsecostsand expenses
penniich may In any way aecmc against aid City
C)z t.
APPl.CANTCof UNDERSTANDS Agranting of ND WILL COMPLY WITH ALL NOWPOINT Issued by:
SOU RE LATIONS. -- - -
Z' Re-roofs
Si tum of Applicam)CO heli Data
H ARDOUS MATERIALS DISCLOSURE Type of Roof
Will The applicant ser fust.building oceupanntore ar handle haneahaus material
az defined by the Cupeninm Monic'n]Cade,Chapter 9.12,end the Health and Safety
c,Section 25533(.)? All roofs shall be inspected prior to any roofing material being installed.
❑Y Nu
Will the applicant m Tum building Occupant um equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit Im.oh us air conuminants u defined by me Be,Arca Air Quality Management all new materials for inspection. -
Dnuict7
0Ycs Nu
1 have read the hvardnw materials rtquirtmens unnkr Chapter 69S of the Califor-
maHralfh&SafetyCode.SectiMMMS.M533 and 75530.1 understand the ifthc Wilding n
dans not currently have a repent Naz it is my mversibdity m notify the occupant of the
re uim cans which must be met prior w Oran aCr.rc.w for, pre'r ignature of Applicant Date
owner ser amhoriae gent �� Doom All roof coverings to be Class "B"or better V