04030065 `. CITY OF CUPERTINO —
Bu1LD1Nc Division ]wAACTOR�INF
ORMATION
PERMIT HCO1�
BUILDING ADDRESS: _ CENTEX 'HOMES PERM""N'64030065
1523 BI
`VER'$NAME: PERMIT ISSUE DATE
CENTEX HOMES 2527 CAMINO
ONE: SANITARY NO. CONTROL NO.
(925) 415-1600
ARCMIIECTIENGINEER: ,
BUILDING PERMIT INFO
- - - BLDG ELECT PLUMB MECH
0 0 0 0
uOp LICENSED CONTRACTOR'S DECLARATION _ Job D(:SCr7pLlOn -
0 C I hereby affirm that 1 am licensed under pmHar.motsnr CMpmr 9(co mcncing -
b wich Seclian JIXM1)af D'visi 3 Buri. of 'o and i rue is
^or'n in fullfo¢eandene O'`/" SFDWL-3 STORY PLAN 3.
j z Licca s Lk.g
Z�'o Do. _ Conlr.cwr LIVING 1809/GARAGE 430
H21Iundkitundmy ansshalMuscdazpuhlicrecomiON REIVSION--#04080012
JyU
of LkcnuJ Pmfcssinnel
g OWNER-BUILDER DECLARATION
Communes
.,
+� 1 hcmby chin.on 11. exempt from the Ca ions;Cook:
:Any c Taw for the
x
cc following.assn.(Section]1D L5,Business and Proksdu.Cale:Any oily ler county -
K m�+ which"at.a Permit to emtsuan,abut improve,demolish,m.pair any+wetum -
_iy prior In its issuance,also mquims the applicam for such Permit to rile a signed statement a -
ss< that heis licensed purnenttoheprovinces oftheConnector,License Law(Chapter 9 Sq.Ft. Floor Area (/� /qr Valuation
�~$ (commencing with 5 Lion 700(d of Division 3 of the Business and Professions Coot)Or - !h/f/�r /l n ^ $210700
a. Jut k is exempt Iherthom W the buts far the alleged eaempum.Any violation of UU 1 Pi r
Section 7031.5 by any applicant for a permit subjects the applicant in a civil penalty of APN Number '
'�/ ` Occupancy Type
not ma.Nen five hundred dollars($500). ,rl s. )/
L u owner oftie Pnperty,w my employes with wages az their sok compensation, / _
• willdo the workd w.and the sauctuce is not intended offend forsale(Sce.]OU.Business 5662:9076 . tj
and Prolamin ro Cox:The Contracmes License law it=ant apply m an ander of - " - Required Inspec ns
,.,my who Wilda or improma thereon,andwhmdcassuch work himxelfor through hi+ __ - --
.a employccs,provided that such improwmemt..or intended oruRcnd ratable.if,
however.the building or improvement is said within one year of completion,the owner-
builder will thaw tie human of proving that he did not build or improve for purpose of
•;who
as Owner of the progeny.am exclusively convening with licensed ronirutors to _ \J
vuct the protect(Sec.70aa,Business and Professions Code:)The Connectors Li-
e law does not apply in in Owner of property who Wilds or improm timate,and .. .
contractsfm such projects with a comanstar(U licensed purwa,w the Conaaamrsnse Laam exempt uder Sea .B&PC for thisDauWORKER'S COMPENSATION DECLARATION
1 beuby aRtm under penalty of perjury mate of ILe fallowing coo antiov:hamandwillmaintainaCcnificate of CnnsenOo half-..sum for Workers Camper- �'_" -' ... •. �. .
sation,u provided for by Section 3700 Of the labor Code,for the mires ace of the
work for which this Permit is issued.
1 have and will maintain Worker's Compensation Insurance,as uyuired by Section
3700 of the labor Code.for the pc if ante of Ne work far which this permit is issued.
My W hn'.i pion lnsu ce eamier and Policy numher an ` /3 s
Came Policy No.:
CERTIFICATEOP %EMMON FROM WORKERS'
COMPENSATION INSURANCE
(Thisunion deed not Wcomplcad if the Permit is foronc hundred dollars(SIM)
or Icss)
1 canny the,in to performance of the work for which his permit is issued.l shall notemploy any Person in any mender an as to hecome subject to the Workers'Compensation
Laws of California.Dam
Applicanl
NOTICE TO APPLICANT:If,after making this Cmulma.or Exemption,you should - - — -
become iuhjcct to on Warner's Comperwtion provisions of the Ichor Cade,you must
.J z forthwith comply with such prnvisimu Or this Permit shall he reamed nwked.
ZO CONSTRUCTION LENDING AGENCY
[-.� I hereby affirm Nat there is a construction lending agency for the Performance of
12 to work for which this permit 0 issued(Sec.Merl.Civ.C) _
ls7 0Lender's Name
e. Lcnderi Address
U O 1 certify Nat I lure read this application and mule that the show information Is
La. P coves.I agree in comply widr all city and county pNimncn and sum laws misting to
0 U building communion,and hereby motion repruantames of this city in enter upon the
W shout-mentioned property for inspection purposes.
6. (We)agree to nw,indemnify and keep heron etra the City of Cupertino against
h
liabilities judgments.costs and"porous which may in any way scene against mid City
U z s Permit.
in conseqof the gorrung uence
A1ND WILL COMPLY WITH ALL NON-POINT ISS by: Date .
R A 1 7-
/� e-roofs
Signature O(APPlicaml n our Dale i
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Wit)the applicant or future building accupanumm orhandk hvardous material
az defined by the Cupertino Alyn]*Code,Chapter 9.13,and the Health and Safety
c.Scetion 355320)? J( All roofs shall be inspected prior to any roofing material being installed.
C Yes
Will the applicant or future building occupant d e equipment or dcvicca which If a roof is installed without first obtaining an inspection,I agree to remove
it hazardous air commrm nu defined by the Bay Area Air Quality Management all new materials for inspection.
Mork,?
Dy. Nu
1 have mad the hararJoos trounr lsrequi.meats uMcr Chaplerb.95 of the Califor
ria Health&Sarmycox,Se%Ou25505,35533 and J553a.l understand Nat ifthe Wilding
docs not c�h�
haveat it is m maponihili w y the occupant mf the I
remort ance,of. 'ma fOccupayy� ' nature of plicant Date
Owner tar Date All roof coverings to be Class "B"or better U