04120099 CITY OF CUPERTINO i
BUILDING DIVISION PERMIT . CO NT&O-TWINFORMATION �.
BUILDING ADDRESS: PERMIT N00 4 12 0 0 9 9
11503 MURANO CIR
OWNER'S NAME: PERMIT ISSUE DATE
CENTEX HOMES 12 /17/2004
ONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG EIPCT PLUMB MECH
0 0 0 0
u00 LICENSED CONTRACTOR'S DECLARATION JobDescri tion
C I hem Y.(slam that 1 am liceucd under proviaieu of Chapter 9(wmmencing P
t/ with Section IX10 (Division Sof Ne BusircssaM PmfcsWsru Code.antl mylice�ia
� 1e`eOse n " Lim.x TEMPORARY POWER PERMIT
S
Le?— Date -
ARCH I'IECI'S ECLA
,8 I understand my pans 16.11 he uud upuMie !
D1U
`LL� Liccned Rofcssrowl
05 OWNER-BUILDER DECLARATION
C \
I I hereby affirm Oat I am exempt from the Contnctofs License Law for the —
S e O following reason.(Section](131.5.Business and Professions Cole:Any City ar county
m
which requires a permit to en.,alter,improve.dconfish,or repair any structure
,fZy pilar N its issuance.also nerIums the applicant rorsuch Permit to file a signed stamment
mm< that he isImensclFursuan,tothe provisions,ofthe Centmctor'sUcnsclaw(Chapter 9 Sq.Ft. Floor Area - uation
efnF� (commencing with Swuon]gp)mf Divuion3of Ne Businessand Pry@axions Ged,)Ur
$ Nat he is exempt Osterman std the basis for the alleged exemption.Any violation of
Section]031.5 by airy applicant fora permit subjects the applicanuo a civil penalty of
not mom Nan five hundred dollars(5500). Occupancy Type
❑Lasawneroftheproperty,ormyemploycea with waguut6 kmiecompenuuon.
will do Ne won,end the Structure is not intended of offered forsok(Sec.70",Business
and Protections Code:The Conn.cmrs License law daces not apply m an Owner of - Required Inspections
property who builds m im proves thereon,and who docs such work himsel f or through his
awn employees,provided Nat such improvements are not inmMedoroffemd fors.k.If.
however.the have
the
ar impronmenng that
wi did
of Mid of bomowfin the pose of - -'
builds will hon dm burden of proving that he did not dJld or improve far propose of -
eak.L
nI of the property,.m ceeluxivcly cenuuting with locaed...0 rt to -
constrtmt the project(Sec.70/d.Business and Profwions Code:)The Canuacter's Li- .. ..
cane law don not apply in an owner of property who builds or improws thauon.and - - -
whoContracsforsuchprojectswithaconlaxtpr(s)licensed puissant to the Contractor's - ---
Let..
0 1 am u rept un ,B&P C far this mason
WORKERS COA(1PPTSATIOND N -.-.._ •� �,
Ihereby option under penalty of perjury one o e following declensions:
(bare and will meinmine Cerufiwmat CouemmulGintum for Workers Compcn- __ ,._-.
union,as provided for by Section 3700 of the labor Code.for the performance of Ne
work for which this permit is issued.
O 1 haw and will maintain Worker's Compensation Insurance,as myuimd by Section -
3701)Ofthe labor Corm,fm the performanceofthe work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number are:
Cartier: Policy No.: _
CERTIFICATE OF EXEM MON FROM WORKERS'
COMPENSATION INSURANCE
(Thu eCtion need not becomplemd if the permit is forane hundred dollars(5100)
or lois.)
I certify,that in the performance of the work for which this permit is honer.I shall not _
employ any person in any manner.m az to become subject to the Worker Compcnsadon
Laws of Ci ifamia.Dam _ ---- --
Applicant
NOTICE TO APPLICANT:IL alter making this Certificate of Eemption,you should
beeome$.him to the Weaker'.Campcuaumn provisions of the lion,Cock,yen mus
.J O forthwith comply with each porwouou or this Permit shall he deemed revolved.'Z..J7 CONSTRUCTION LENDING AGENCY
,�+ I hereby affirm Nat them is a construction lending agency for the performvmc of
E
Oc work for which this permit is issued(Sc.3037,Civ,C.)
SQ Lender's Mune
z Lender's Address
V
U C) 1 comfy that 1 have read this application and sum that the show information is
Iy H Correct.I agree to comply with all city and county ordinances and sum laws misting in
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building construction,and hereby auNonp reunwins of this city to cover upon the
ah
r 4 on-menuooed property far inspection purpopose.
(We)agree to save,indemnify and keep hamJess the City of Cupertino against
Urn in Coitia,judgmcnu cosy and o
f this
may in any way urnmagairstsaid
City ///t/Y'/
U z mcoturyucti Nos Nis permit. Issued b / / '
^' APP CANANDS AND WILL COMPLY WITH ALL NON-POINT
SOU CERY' Date
7 14Y Hal. �� e-roofs /
n o (racsor Dam
RDOUS MAT AIS DISCLOSURE Type of Roof
Will r futum Wi ng Occupant some or M I v Nous mammal
defined bo Mumci I Cede.Chapter 9.12.and Health and Safety
ode,Section 25532(¢)? All roofs shall be inspected prior to any roofing material being installed.
p Yw
Will the apPliam or forum E IJIf a roof is installed without first obtaining an inspection,ection,I agree to remove
iof Occupe" ue cyuipment or device.which
,mit natatorial air cmnuminans u cfired by the Bay Area Air Quality Management all new materials for inspection.
Donict'
❑Yes
1 have read the hsurdous traknau mquimmens i nderChmpmr 6.95 of die Califor-
six Health&SafclYCOde.Ssuoes 25505,25533 am125334.l Maxasand this ifdu Wilding
Jou t curtcn0y w a mn.nk Nan it u my responsibility m pouf pant of the
m4 ' ntswni a.tb merpdo .9ameair em makerOco Signature of Applicant Date
Da
wric,
red. t ate All roof coverings to be Class"B"or better
or amhomed.gem
x Community Development
10300 Torre Avenue
{ --f Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEI�TINO
Building Department
JOB ADDRESS: PERMIT#
�2D/�qQlJ ()41 2-oo 9
OWNER'S N1 PHONE # —/ d
GENERAL CONTRACTOR: ate_ FAX # 1.11r--14001
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the followin information
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
j,L/1 Electrical 0G(�
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass/ Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/(2ntractor Signature Date
1
CITY OF CUPERTINO % G1
TEMP POWER �GJ Jo�o9 I
�CUPERTINO PERMIT APPLICATION FORM
APN# � / d � T Da/
Building Address:
!/
Owner's ame:
Contr or: Phone: License #:
Contact: Phone: Cupertino Business Licehse#:
B ding Permit Inf :
Elect ❑
Job Description:
Residential ❑ C mmerc al
i
Cost of Project:
Qt . �
App Fee ID Fee Description Fee Group
BTEMP Temporary Power ELECTRICAL
EPERMITFEE Elect. Permit Issuance ELECTRICAL
BUSLIC Business License BUILDING
?-�'7