04030085 CITY OF CUPERTINO
BUILDING DIVISION PEN'TR
RMIT COACTOR'INF0RMATIONN
BUILDING ADDRESS: CENTEX HOMES PERMrr",.4030085 -' -
11527 BIANCHINI LN LQT 21
ER'S NAME: PERMIT ISSUE DATE
CENTEX HOMES 2527 CAMINO PMQN 4100 12 /08 /2004
ONE:
SANITARY NO. CONTROL NO.
N .
(925) 415-1600
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG - ELECT PLUMBMECH
0 0 0 0
�Oo LICENSED CONTRACTOR'S DECLARATION —Job Description
us 1 Wreby affirm Nat I km licensed under provlaions of Chapter 9(commend
ZT wid Scctmcia7 0uf IvisiAn3o Business artlP cyi ns lice - --
SginfinseC;!nder�� SFDWL-3 STORY (PLAN 3)
u`en /(J��e.a LIVING 1809/GARAGE 430 SQ. FT-.
ni-Z Dau +��+���--���[[ ``(( Canlydnar
ARG ITECTS DECLMtATION
>? 1 understand my pla shall named
mud as public memrds
DyU
m t; Licensed ProfcasimnH -
`o� - OWNER-BUILDER DECLARATION _ _ � _ --
Wrcby affirm that I am exempt from the Convactofs License Law for the _ —Ali �- )
/�— —--------— --
p o following mason.(Section 703 L5,Business and Rofcssium Code:Any city or enemy r ��
x m which requires a permit u,construct,alter,improve,demolish,or repair any structure
prioriniu issuance.also raqulme the applicant forsuch Permit o file a signed comment -
-��'< d„thei:RcensedpumsamtothePmvislonsnfMeConvocuf.UcenselawChapter9 Sq.Ft..Floor Area. / ,.'Valuation
as r o (commencing with Section 7000)of Division 3 of the Business and professions Code)to fin y�21 O 7 O O
y $ Nal he is exempt Ibe¢from and the basis for the alleged exemption.Any violation of
Section]031.5 by any applicant for a permit subjects de applicant m a civil penally of APN Number r f7 ceupa2ncy1 Type
not mom Nan n hundred dollars(5500).
I,ma wof the Z ,
' ❑ PmR'+ty•amy employres wish wegeaaz Heir sok compensation. .,
wBldnthew,L,.dncamnumianotimmndedwoff.mdfored.Sec.vBaa.Bmurears RequiredIns actions
and Professions Code:The Conuactor's License Law docs not apply to an owner ofP d I I - -- -
propertywhobuildsorimprovestharmon,and whodoes suchwork himselforthmugh his + —
own employees.provided thalsuch imprommenta id a not im and,d croRered forsam.If.
hnwenr.Ne building or improvement is cold within one Warofeompleion.theowner-
builder will have du burden of proving that he did not Wild or improve for purpose of -
sale.)
I,as wxr of de property em exclusively cmomatinP with licensed c mersomm m -
ones de project(Sec.7614,Business and Professions Code:)The Convacmrs U. .. _.. .. ...
came law does.m.,ply to m mou of psep,ny who Wilds mr impmva sW reon,and. - -
whoconlractsfor such projects with a convacmr(s)licensed pursuant in Ne Convectors ----- •-- --- _.-__-.
License Law.
❑ 1 am esempt under Sec. .B&P C for this on
Data
WORKER'S COMPENSATION DECLARATION -
Iherebyaffirm under penalty of perjury one of de following da_Wations:. -
mn,as and will for b in Section
37W of Me Latour
Code for for Wm,mmu ce cif Me —
woimn,az hick this
for by 5s Wo 3'100 of Ne IaWr Code,for the performance of the
work for which Nies permit is Word.
❑1 have and will maintain Wmrkcri Compensation Insurance,az required by Secdon - — - -- - --__.
3700ofthelabm Code.fortheperformarlceofthewarorwhich Ou,n ilisissued. - - --- -`- . ._.
MyW �n missssaffia�i str7ntt rimier and Policy nmud%KrrW: `f,� a
Cam z C-!-2 Poli,N..:(�.�!
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section need not becompl,tediruW Permit is forma,hundred dnllars($100) --- - - -
or lass.)
I emJfv that in the performance of the work for which this permit 0 issued.I shall not .... .
Lmpkyanyperany manaruazmhecomc subjecuo the Wmrliri Compcnsadon
lawn of California.mia.Data -_
Applicant
NOTICE TO APPLICANT:IL after making this previsions
nu Of Exemption,you should - -- - -forthwith
subject y the workers Cmm s or Mis pmrisiunl of do talar Code,you most
.Jz forthwith comply with such Previsions or dies permita1,a11WdccmW rented.
'Z OCONSTRUCTION LENDING AGENCY
[•� I Wrehy affirm that them is a construction lending agency forthc Performance of
C4 th,work for which this permit is issued(Sec.301 Civ.C.)
1 A lenders Ndmc
=z Lender's Addmu
U O 1 certify dal 1 have mad this application and sue dal de above information is
D. F' conte,.1 agree a comply with all city and county mNinuues and sure laws relating to
0U Wilding conswnion.and hereby aulhorix repmesenutivei mf this city m enter upon de
above mentioned Pmpcny,for Inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
liabilities.judgments.costs and eapcnus which may in any way entatic against mid City
U Z in eomed uencc of the gaming of this Permit.
^ APPLICANT UNDERSTANDS AND WILL COMPL ALL NON-POINT Issue by: Date
G ONS
roofs
Signature of Applicku Con tom Data
H RDOUS MATERIALS DISCLOSURE Type of Roof
Will Ile applicant or forum Wilding occupant sore or handle hrous materiel
as defined by the Cupenino unicipal Code.Chapter 9.12,and the Health and Safety
c,Section 255321(a All roofs shall be inspected prior to any roofing material being installed.
❑Y
will do applicant or tomo building occupant tau equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hunacdnus air cnnuminanu defined by de Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes
In vereal the hasamdom materiels requirements under ChePur G95 o4bildi.,
nix Heald&Sa(ny Code,Sections 25X15,25533 and 25534.1 undersand Nat ifC{nO Caly M1YnBICnNI,dallli5mym9pm0 nnllly 11M[uC, ' ntenr 4ignatureofAppl ant Date
Owner of authmmcd agent All roof coverings to be Class"B"or better La