04030105 CITY OF CUPERTINO . . -- -- ...._ , s -a -�d.trv: :' ? '�'$ 6w:' '-' - - - - --. . ..
Bun.DiNCDtv]SION PERMIT COI4, R -TOR NFORMATI®N - .
BmLDINGADDRESS: CENTEX HOMES PERMITN004030105 `•
BIANCHINT LN LnT 22
H
VER'S NAME: PERMIT ISSUE DATE --
CENTEX HOMES 2527 CAMINO RAMQN 4100 12 /08 /2004
ONE:
SANITARY NO. CONTROL N0.
(925) 415-1600
ARCHTT ,`ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
y0o LICENSED CONTRACTOR'S DECLARATION 7obDescri Description
UZ C 1 hereby affirm War 1 licensed under pmvisioaz of Chapter 9 mamoripm' g P
n<e wr0 section 70(IU)a Diviai die BusinessuWP r a de myylc962 is
< moll, ode --� SFDWL-3 (PLAN 2).
"g Diner a Convaemr LIVING 1753/GARAGE 477 SQ
Qq AR ITEC"rS DECLARATION _-
'�2''� I undersand my plain shell W recd as public rtmrds
DyU
;0G Licensed Professional
3 OWNER-BUILDERexemptDon,ConTION _
I brachy.(Sere on 1 1. exempt from tc ConlnstCode:Any c taw for the
x sp whichfollow
cores a Permit
9c13L5,Business land sae,de iuos h.or Any city or county
y$ which its requires a permit rx cnnswa6 alcor,improve,demolish,ri e a sig any structure
prior it its issuance,p also m to the IW applicant for such permit mice signed statement
YI'm (commis Rented pSectioumW pmvisioru of me Contractor'sLicensePromLaw dom Code)or ... - Sq.F[. Floor Area V O@P286
r.G (commencing nMIsexempt
Sml1o0 700 0)the
DivLs'snn 3 of she al Buseged ext and ate.Any
Ction of
i�$ War k u exempt Ihmefmm and IW but,for the alleged caernptian.AnY violation of
Section 7031.5 by arty,applicant for a permit subject,the applicant to a Civil Penalty of AIN Number Occupancy Type
not mom than BK hundmd dollars(S5Bo). 36619076 . 00 /;n
❑I,uawmr of We propcny,mmy employees wire wagesazlWir sole cnmpcnraJon, .� f1 1., v '
will do to work.and um.cr m isnot intended in offered false.(Sec.7W.Business
and Professions Code:The Contractors Li..Law doe not apply x a owner of Required Inspections and
Wildsmimpoes mcreon,andwho doessuchwork himailmthrough his
own emplayccs.provided that such improvements art aminmMed at offered for sale.if, �C -
however.me building or improvement is sold within one yev ofcompledon,the owner. y'Y•�/-�/H - - - - "-
;ban
ill have Jin burden of pmving mot he did not Wild or improve for Propose of
l' n �F6/dd//qqA
wner of the property,am exclusively contracting with licensed continuous m
construct me project(Sea 7094.Business and Professions Cade,:)The Contractor's Lt
w does not apply m an owner of property who Wilds or improv Jmmon,and
acts for such pmjccu with a central licensed pursuant ro me Contractors
Licenseaw.
Law.
lunder Sec. .B d:PCfor this restart
Date
WORKERS COMPENSATION DECLARATION
thereby M.under penalty of perjury oat of me following declaralwax
and will mamiliin a Certificate of Conscnt to selr-insure,for Warner's Compen- -. -- - -- -
sation,as Provided for by Section 37M of the Labor Code,for to Performance:of the
work far which this Permit is issued. -
1 have and will maintain Workers Compensation Insurance,u required by Section
MyCWeaf Ne VWrNe Cine? Porel1,for which this Permit isissued.
War mesa o era a and Polrry n mbar
X32
CERTIFICATE OF EXEMPTION FRO WORKERS'
COMPENSATION INSURANCE
(ITu section need eras W completed iftW lermir is for ane hondmildo11ars410)) _
or less.)
1 certify mut in the performance of me work for which this mmail is issued,1 shall notemploy any Nixon in any marner an as to tiecome subject to Olt Workers'Comritrisafion -
Laws of California.Dow -
Applicant _NOTICE TO APPLICANT:If,after making this Cenifcam of Exemption,you should -
Imcome subject to the Worker's Compensation previsions of the,Labor Cork,you most
.J,Z faMwltn comply wit such previsions or this Permit shut W deemed looked.
zCONSTRILUION LENDING AGENCY -
[-.� I hereby aRrm mat mere iaa conswction]codingagency or me performane of _
15 M me de rfor which this permit is issued(Sm.3041,Civ.C.)
W A
Lenderss Name
LL Lender's Address
U C) I certify mat 1 have read this application and sum out the above information is
U, F contact.1 agree to comply with all city and county ordinances and sum laws relating to
0U Wilding construction.and hereby authonre mpresenmtivu of this city m enter upon she
>�Wabve
o -mentionW ose
property for impaction purps
CL (We,)agxc to saw,indemnify and kap harmless the City or cup,
against
FN liabilities,judgments,casts and expeosos which may in any way same against and City
U z AFPCqucncc or DEife RSTANDSrafting of IAND WILL COMPLY WI L NO�INT by: - Date f _
S E NS.
'4—roofs
amrt of ApplicanJCanuacmr Dam
HAZARD 9 S MATERIALS DISCLOSURE Type of Roof
Will me applicant of fu(lrrt building occupant slam or handle haamdous material
az defined by the Cupertino Municipal Code,.Chapter 9.12.and the Health and Safmy
e,Section 255320)1 All roofs shall be inspected prior to an roofer material being installed.
❑Yes P P Y g g
Wit,the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
I havardnos air conuminants defined by the Bay Area Air Quality Management all new materials for inspection.
vin?
❑Yes
1 hew read the nazaral mr,onamnals requirements underChapmr6.95 of the Califor-
malicalm&SafctyCWc.Scuicaus 25505,25533 am125534.1 undcssuvb that ifmc Wilding
dot, I curxrid,naw a tenant,dist u u my res, i roLIN the acupanl of me
w ts n m1 me misavanc ace - amarOcany , Signature of App}'cant - Date
_YAC
.Ownermautorivedag I Dam All roof coverings to be Class "B"or better