Loading...
04030109 CITY OF CUPERTINO . ➢-'�"� *' ' '* "' -" >s x§ - " BUILDING DIVISION .:. PERMIT "CONTRAC'&TOR INFORMATIO N ; BUILDING ADDRESS: PERMIT NO. CENTEX HOMES 04030109 AM PERMIT ISSUE DATE 14 252=7 IVO E: SANITARY OLNO._ ARCHITECDPNGINEER: / BUILDING PERMIT INFO BLDG kELECT PLUMB MECH LOK LICENSED CONTRACI)R'S DECLARATION a� er 6 1 bereby affirm that 1 sm becosed under pmvisimu or Chapter 9(commencing , Job Description v✓.�///CVp�_`. ^Z i� wire s«tion 7alu)arpiwaon 3or du aurins..arta Proressimmcodc. mans is ` V - — mall mace.nae to G ' Sqb inanaC Lk:d �e SFDWL-3 STORY . (PLAN '2) ' s°y Das��c-C-attos--RAnDN LIVING 1753/GARAGE 477 SQ <F_TC ,Q ..?C©aS _• . " . I understand my plans dull he used u public records ��ff �yO 3LiccnStt Pssionel D `l s'u.ct�3 mfcOWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from dm ContactorLa Contactors License w for the o0 following mason.(Sauun 7W 1.5,Business and Professions Codc:Any city or County - V x m which requires a permit to construct,alter,improvedemolish,or repair any swemre nom'^ prior m its issuance.also requires rW applicant for such permit to file a signed statement ,�< thatheislicensed plminiuothepmvisiovofthe Continuum's UCc. aw(Chapter 9 Sq. Ft.Floor Area Vaution �Fo (commencing with Section 71100)of Division 3 of use Business and Profexa teas CMO)tar 2.00286 C. $ that he is exempt tracmfrom and Ne basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subject;Ute affirmed to a civil penalty of APN Number Occupancy Type not mom Nan live hundred dollar($500). ❑I,as owner of the pmperty,or my employees with wage as duck We compensation, 3 ,." will do the work.and themrsetwe is not intended ar offered mrsale(Sec.7614.Business - and Professions Chide:The Com runs License Law does not apply Ip an owner or Required Inspections property who builds orimpraves thereon,and whodoessuch work himulforNrough his -- own employes,provided that such improvemcnm are not intended croRcad for We.If. however,the building or improvement is sold within one year of completion.the owner- builder will have tM burden of roaring that he did nm build or improve for propose of sale.). 1,as owner of do,property,am exclusively contracting with licensed Commcmrs to Construct the project(Sec.7044,Business and Profetdom CMe:)The Convector's U. COnu law dors not apply to an owner of property who Wilds or improver thereon,and. who contracts for such projects with a contnctor(s)licensed pursuant in the Comnctot s Liana law. ❑ 1 sm exempt under Sec. .B A,P C for this..on Owner Data WORKER'S COMPENSATION DECLARATION 0uon, I hereby affirm under Knotty of perjury one of the following declarations: 'arc end will maintain a Ceru0am of Comcnt m ul6lOsure for Warkce,Compcn- as provided for by Section 37W or the Ia Wr Code.for the performance of the work for which this roomit is issued. ❑I have and will maintain Workers Compensation Imurana,u required by Section - J700of the labor Code,for the perfarmaux of Ne wart for which this pe,mit is issued. - _ ' My Wormpetn�adoo Insuranacartierand Polirynklism, Canier:Y�/7g.��/ Policy No.f^'�l {� CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This account need not Wcomplcted iflM permit is forone hundrtddollan IXB or less.) I certify Nat in the performance of the work for which his permit is issued.I shall nut employ anyperson in any annar u u to Wcomc subject to the Workers'Compewdon Law s of Caliromia.Da¢ Applicant NOTICE TO APPLICANT:IL after making this Cenifica¢of Exemption,you should become subject to the Worker's Compensation provisions of the Labor CMe,you must - Z forthwith comply with such provisions or this permit snail he deemed rooked. ZO CONSTRUCTION LENDING AGENCY '[•+ I hereby affirm that there is a Construction lending agency for the Performance of _ x > the work for which this permit is issued(Sec.3037,CO.C.) U]Q Iandces Name Landers Address U O 1 certify that I have read this applicaion and sum thin the above or.on.run is U. F correct.1 agree to comply with all city and county ordinances and stem laws relating to 0U Wilding construction,and hereby authorve rtp¢lcrutives of this city to enter upon the W above-mcntionM property for inspection proposes (We)agree to save,indemnify and keep harmless Ne City of Cupertino against F" ,i liubilidef,judgments,costs and expenses which may in any way accrue against said City U z APDL COof the of this rearmil. ANTUNDERSTANDS AND WILL COMPLY WITHssued SNON- by: /9Date Re-roofs Signature of Applic nROmrr Dam AZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant ror mforum Wilding occupant store or hurdle h Health anmaterial as dcfinM by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety Code,Section 25531(.)7 All roofs shall be inspected prior to any roofing material being installed. O Yes Nu Will the applicant or future Wilding Occupant use,equipment or dances which If a roof is installed without first obtaining an inspection,I agree to remove t hazardous air contaminants n de0ncd by the Bay Ama Air Quality Management all new materials for inspection. vuvicti ❑Yca Nu I have mad the hararel.materials mquitcnums mntc,Chapmr6.95 of Ne C.1her. niaHcaIth&SarctyCMc.Sccdon125N)5.25533md25534.1un&orsu uiftM Wilding does nm currently have a¢rant Nat it is my responsibility m mtdfy the oecupant of the rtquim a must W irm"dar isranaa Eamofa Signature of Applicant Date Owner tar amiono'e ager ram All roof coverings to be Class"B"or better