04030076 CITYOFCUPERTINO
BUILDING D)v)sfoN PERMIT 1CONTRACTORd4NFORMATION �. -
BmLDiNcnooRFss: - CENTEX HOMES PER""b4030076
11533 BIANCHINI LOT 21
ER'S NAME: PERMIT ISSUE DATE
CENTEX HOMES 2527 CAMINO
ONE:
SANITARY NO. CONTROL NO,
(925) 415-1600 _
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
uoo LICENSED CONTRACTOR'S DECLARATION Job DOSCi3ptlOn '
u C 1 hemby of m Nal I am limned under provisions of Chaptcr 9(cam mein&
n�i wiNScmion7IXX))of Division3of NC Busincssand of ions mile is
inrmlmmeanae 7rSj SFDWL-2 STORY (PLAN 1)
p ? Liccnm L'c.N
_�❑ Dam - can DEC LIVING 1510/GARAGE'-4-35--SQ-FT=
AR ffNT DECLARATION _
I understand my plana xhall M uxJ as public records
JyU
Licensed Professional -
` 5 OWNER-BUILDER DECLARATION
I 1 hcrchy a(Sec on 1 1. exempt from dm Conuum Code:
LiA.,l Law far the — - - -- -- '
00
fallowing moon.permit
t 7(DLS, ,,Our.
and Pmfessiodi Cole:Any city or county
Kau` winch 34 islu a n.also m Uirat the pp W impmsn.uch Permit O or repair any tatemene
nt
u�'^ priwmits issuance.also mquimstbupplicmtfor such pcnnitmfilc aaigncd statement
��< that he is licensed pursuant the previsions of the Convector's License Law _.. . .Sq.FL Floor Area .. Vgi�tp[Jgr141
tt
in (eom mucin,with Section70(sh of Division 3 nfthe Business and Pmfusions Com)or -
in that he u among,Nmefrem and On boor for the Mlcgcd exemption.Any violation of
Section 7031.5 by arty applicant for a pesmitashin3s Ne applicantm a civil pcvllyof APN Number Occupancy Type
not marc than five hundred d.11an(5500).., "
I,as owner of Nemm to Wt woes u their sale coin n:atitan, 36619076 . 00
tproperty. Yet in Yew' B pe ...
will do the work,and the he Com(s not intended oroRexo Inlair not apply Toad,Business
and Pmfwh ons Code:The Conhenums .it who Law does not apply lf an owner or Required Inspections - -
pmperly mplo ,pmvidcdpat thimpmmmcno ensuch olimm�r oroffendforughhis -
ownemr,ocwipingeriNaMWMCmiswld iunowtinaofm po on.forsal=- __ - ------ '--- -- '
.. however,Nc buil the arimpmwroving satIm did one year of unpro of rNe owrcr- , q - - - — — - -
builder will haw the burticn of proving Nat k tlitl not build or imPmw for purpose of
ale;..rommiridtom
progeny,am ucluxivclyc.nlsmting with lianudc.nuanoa tothe project(Sec.7614,Business and Perfuuons Cod,:)no Canuacmr's Liw docs not apply to ' owner of prepmey who builds or improwa Demon.and _ swtnclafor such pmjec3 with a comeactor(s)liartscd pursuant to the Conuacmr'sLauampt undo Sec .B&PC for Nis DamWORKERS COMPENSATION DECLARATION hereby affirm under penalty of perjury oro of the following declarations:
n and will maintain a ccrurcm of Continuo elf-imam for Workers Cheapen-" - ' -- " --
sation,as provided for by SCNan 3700 of the Labor Code,for the pcdo...of Ne
work for which this permit is issued. -
❑1 haw and will maintain Worker's Compensation In! quimd by Soction
]700 of Nc labor Cod c,b Ne perf eine of NewotXbr.W=' mos permit is issued. �T. . ..
My WarkCfs�ynpen ti a canim and Policy
Carver. /1/ Polity No.: y/ '
CERTIFICATE OF EKEMP 1ON FROM WORKERS'
COMPENSATION INSURANCE
(This union aced not bccompleted if the permit is for one hundred dollars(Slap
or less.)
1 certify Out in me perfovnance of Ne wart for which this Permit Or issued.l Nall not
employ any person in any ma em,ao az m became subject o the Workin'Comilememon
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption.you should - -
noncom subject CO the Worker's Compensation previsions of the Labor Code,you must
.,z forthwith comply with such Provisions or Nis permit shall be deemed invoked,
z
CONSTRUCTION LENDING AGENCY
(-..N. I hereby aRnm Out there is a construction lending agency Pot the performma of -
p$?
On work for which this permit is issued(Scc.3(r9I.Ci¢C.)
W C) LertdcfName
z La d ks Address
V Q I certify in,,I have mad this application arm sole that the about information is
Uy P coned 1 agree no comply with all city and county ordinances and state laws relating to
0U building construction.and hcmby auNorlx tepmxntatiws of this city in enter upon Nc
r W shove-mentioned property for impccuon purposes.
(We).,me to save,indemnify end keep harmless de City.(Caption.against
tib liabilitiesjudgments,costs and cxpcmes which may in my way see=against Said City
U in emisiorimmc of the granting of this Permit.
�•' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT I ued by:9 Date .(
SOLIREE ON . �
Re-roofs /
Signature of ApplicmUConu) Dem
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will y t applicant or(Muni building occupant emrc ,handle Health anmaterial
az defined by Nc Cupertino Municipal Code.Chapter 9.13,and the Health and Safety
sdilftim.Section 35533(a)?1
Yes JBrfu_/ All roofs shall be inspected prior to any roofing material being installed.
❑
Id. Will she applicant or fumrt building..pan,umcquipmmt ordevines which If a roof is installed without first obtaining an inspection,I agree to remove
havardnus air contaminants u defined by the Bay Arca Air Quality Management all new materials for inspection.
it'? 1
❑Yes �Nsa—
I Laine reed the hmaNtrus materials rtquimtrcnts under ChaPterdYS of Jre Glilar
ullh&Safety Cade,Sections 255(15.25533 and 25534.1 under9md dutifthe building
n hart aamt.Nati 's my reap. b nmify the oaupantm t n us et issuane c� tnamofOc =Y P ignatureof plicant Date
er or authnrir.ed age Date All roof coverings to be Class"B"or better