04030062 CITY OF CUPERTINO ;
Bu1Lot"c DIVISION PER CONTRACTOR INFORMATI®N
[.U1,DING CENTEX HOMES PE`hdIT"C04030062
11521' BIANCHINI LN LOT 25
VER'S NAME: PERMIT ISSUE DATE
CENTEX HOMES 2527 CAMINO RAMON 10 12/08/2004
ONE:
SANITARY NO. CONTROL NO.
(925) 415-1600
ARCHITECDENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
u_pp LICENSED CONTRACTOR'S DECLARATION
up I hereby affirm man I am li¢nscd ander provisions nr Chapma 9(commencing Job Description
U who Section 7000)of Division Sof the Business and Pmficssinns Coded liccnx is -
p� morn mrteam rrmm ,ya�yr' ,�j SFDWL-3 STORY (1753 .SQ. FT. LIVING SPACE)
O tgZ Liccam Lk.N
=—o Dam Contractor GARAGE 477 SQ-'FT— (PLAN 2) " —'
ARCHITECTS DECLARATION REVISION--#04080012
J
rc� 1 understand my plans shall W used as public rttorth '
oda
LLo G L'xenscd Professional
OWNER-BUILDER OEC.Conor ON
a� 1 mono aRrm on 1 1. exempt from me Conrnan.rs c:Any
Law fou the
Zpo fallowingreason.Permian]1131.5,BusinessandrmR,aioli Ca at Any city orcounty
occuum
which its is u•Permit m cines ase alcor,improve,dcmmHh, file
repair ed ..ram
prior mintiss.d also inquires ase applicant for Such Permit Lfilessignedaummenr
tb< th atoranicevcd Pursuant lothe p Division
nfthe the
an censcLaw(Chapter
Code)
Sq.Ft. Floor Area Valuation
��$ (cat he is Sampo Sectionart and the
basis
3 of me Business and Proficuon.Any
Calc)or $200286
Net he is eumpl therefrom and Ik baso for dire alleged exemption.Any violation of _-
Seniors 7031.5 by u0 applicant fora permit subieclt due applicant m a civil penalty of APN Number Occupancy Type
not mart man five hundred dollars(S500).
❑I,ascaesura of Ne property,or my employees with wages as their sole compensation, 3 6 6 19 C1 -
willdothework-and the...too,isrou'nende,doaaffemd foanale(Sec.704,1,Business Required Inspections - -
and Professions Cade The Contractor's License Law does not apply to owner wner of - q p
property who builds.,improves thereon,and who d.,.h work himself.,through his -
.a employees,provided thmurch improvements nenotimmuded oaonemd for We.It. - � - - - - -
however.the building or impmvement is sold within am year of completion,the nwncn � 'n
;[ham
ilder will have the burden of proving oust M did not build air improve far puapare of j til `. //�,t1
as owner of the property,am exclusively convecting with licamand conuacmas 10 1 " ^r L
.n the pmjecl(Sec.704,1.Basin,.sad Professions Code:)The Contractor's Li.
Law does not apply m an owner or propcny who Wilds or improves thcman,andcontracufor such Projects wire a conuacoa(s)lured puasuam to de Conuacmesmse Law, p f^ame.empEunder Scc. .B&PCforthismuon _ l�l`cr Dam � � ' rlWORKER'SCOMPENSATIONDECLARATION1 hereby aRrm under penalty of perjury one of the following dederai.ns:and will maintain a Ccniftum of Consent to cel0insure for Wortrra Compcn- '
nation,w provided for by Section 3700 of the,Labor Codc,for the pefamuMe of the
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insum m.as required by Section --
3700 of the Labor Code for the performance of the work for which this permit is issued.
My Work�er7s wC�om'�peesauLop Insuramzcarivand Policynumberem: /
Cartier, Policy No.:W —o
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
rrhis section need not he completed if the penalk u foram hundred dollats(SIM) _
ver lis.)
I ccnlW that in me performance of the work for which this permit is issued.I shall not ., ..
employ any)comm in any mannerso as to became subject to tM Workers'Compensation
Laws of Caliromia.Dam .-
Applicant -
NCoCE TO APPLICANT:IL after making this Certificate of Escreption,you should
become subject 1.the Worker's Compensation provisions of the Labor Cade.you must -
�Z roMwith comply with such provisions or this Permit shall IS,dmcmem mvokea.
Z O
CONSTRUCTION LENDING AGENCY
[-. I hereby affirm that mere is a conviction lending agency for the Perfortnana of
a the work fur which Nhs permit is issued(gee.3037.Civ.C.)
lA 0 Lenders
a I<nderi AM Addrrsa
U C I cenify Nat I have read this application and some that the above information is
it, f" corm.1 agree to comply with all city and county ordinances and sure laws mating to
0U building coats.cuon,and hereby mountain,mpnesmanims of this city to enter upon the
rW shove-mentioned property for inspection purposes.
(We)agree I.sam,indemnify and keep hlethe City of Cupcnino against
F N asmm liabilities, costs and expenes which may in any way accoe against said City
U in consequence of the Starting of this permit.
^ APPLICANT UNDERSTANDS AND WI COMPLY WITH ALL NON-POINT Is d by: Date _ a
SOUGH[ U).A�'IOt �p� ��- G
� �/I a e-roofs
S' -.lure of APPlmsrucon of Date
HAZA OUS MATERIALS DISCLOSURE Type of Roof
Will Ne applicant or future Wilding occupant sore or handle hanrdon national
as defined by me C='ia Muni 1 Code,Chapter 9.11,and the Health and Safety
r.
Section lss3l(a>7 All roofs shall be inspected prior to any roofing material being installed.
❑Yea Na
Will the applicant or future building occupant=equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
MIL harardnu,air mnum amu defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes �I Nu
I have read the havasdnus materials requiremem,under Chapter 6.95 ofthe Califo�
ria HcaW&gafctyCa@,Sttuon 85U3.155J3 and 25s34.lundcrsund thetifthc Willing l/ !J -/yam
dors nor curtunly has.a¢nuns.mar it is my rt ihility m nodlY de acupant nr d¢
wh Bs arm
iss a caodbi 7 Signature pplicant -Date )
Owner or aamorizmd a nl Dam All roof coverings to be Class "B" or better (�