04030100 CITY OF CUPERTINO
BUILDING DIVISION PERMIT '=;,CONTRACTOR�IhNF.�ORMATI`ON
BU ILDING ADDRESS: CENTEX HOMES PE "No04030100
508 MURANO CTR TOT 40
OWNER'S NAME: PERMITLSUBDATE
ONE: SANITARY NO. CONTROL NO.
CHITECfIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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LOp
LICENSEDCONTRACTOR'SDECLARATION
w 1 hereby affirm Net I am licensed under provision of Chapter 9(co ai g Job Description
wiN gcctian]IXIO)o(Div/( sionBusinw aMpruionx d� uu �'
in roll farce and oneEt. D(i /G�
-� Lien � cnt�amnr SFDWL-3 STORY PLAN 5) n
aDole LIVING 1992/GARAGE 430 SQ 'FT '
P ARCHITECTS DECLARATION u 7 r
0W� lundcrsmnd my plain slWlhuudupublic recnms ADD PLLONGRNGR FEES „ r 1J�
LL t, Licensed Pmrcssioul
5
a.pOWNER-BUILDER DECLARATION 0
.�00 1 ream.nein on 1 am exempt from Nc Confemum;Cock:
:License law for the
ieo which re roas,a Permit 7031.5,Businessand Professions Coda:Any oily or county 4 1 N
6 which requires,a permit hs uiroxi n alter,impmm,dcmolihPerm Permit to
or repair any tamcwm e r
HOE heor Wi uiensnce.aint,dpursuantto sea lhovisioc or forthe Contractor's
onpermi'Liconsc Law
Bammcm
Y9G (commcming it pursuant to of Division
the Comrumr iLimnussio Code)or Sq. F[. Floor Area 1 ; r Valuation,
¢f$ tcom a is axe with Sectionmm(KKhand O basis
3 of the Busalleged
exemption.
Proon.Any
latm,of ,. 2
3— that he u exempt themfmm and the bnsiv for On alleged eumption.Any violation or 4 70 0
Section 7031.3 by any applicant fora Permit objects the applkant in a civil penalty of APN Number Occu
not mina man five hundred do1Ws(5500). parley Type
0 1.as;owner of the property,or my employees with wage as moi sato compensation,
will do the work and me awcture OF not intended or offered imago(Sea 7014,Business
and P.I.O.Code:The Contractors License Law does nos m ns apply an owner of Required Inspections
property who buildsarimpmves dmrron.and who doessech work himselfor through his
own employees,provided met such improvements are not intended ora@red forme If.
however,lie Wilding or impmmo ens umld within mm yeti of completion the meet-
builder will have the burden or proving that he did tins build or improve for purpose of
sale.).
❑1,as owner or the ympeny,am exclusively contracting with licensed conuacmot to
consumes the project(Sec.7064.Business and Profetiou Code:)The Contractor's Li
cause law docs not apply in an owner of properly who Wilda or improm Merton,and,
who contracts for such projects with a eontraemr(s)licensed pursuant in du Camracm,"
Lienee law.
O l am exempt under Sec. ,B&PC ror this moon
Own Date
WORKER'S COMPENSATION DECLARATION
1 hemby arrom under penalty of perjury one or the following declarations:
ham and will maintain a Carificam of Consent m self-insure far Worker's Compen.
n,as provided for by Section 3700 of the labor Coda for the performance of IM
far which this permit B ismcd.
1 have and will maintain Workers Compensation Insurance,as required by Section
3 of me labor Code,for the performmec of the work for which this permit is issued.
My Workers Compensation Insurance carrier and Policy number art:
Carrier. Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Mis section need not W eamplemd if the Permit is rmonc hundred dollars($iW)
or lux)
1 certify Out in the imfmmencc of the work for which this Permit is issued.I shall not
employ any person in any manrmrsuu m become subject to On Worked Cotoroma n
Laws or California.Dam
Applicant
NOTICE TO APPLICANT.If,after making this C(MiGeam of Exemption,you should
become subject to the Workers Compensation provisiou of the IaWr Code,you most
.,O rormwith comply with mch provisions or this permit shall he deemed mated.
Z y CONSTRUCTION LENDING AGENCY
[—� Ihereby affirm that mere is a construction lending agency for lie Performance of
!Ythe work for which this permit is cussed(Scc.3D97.Civ.C.)
GQ lender's Name
Z Lcnderi Address
J Q 1 certify that 1 have mad this application and more that the above inro mitim Is
ly F' enter.I agree to comply with all city and county eminences and state laws mlasing to
Wilding eonson.Won,and hereby au horice repruenutisu of this city to enter upon the
EU
Property for inspection purposes
H C (We)agree to save,indemnify and Foch harmless the City rat Cupertino id City
f/3
liabilities,muroo of OF granting
expenses which may in any way cecina against said City
Z in consequence of Ne graining Of this Permit
w. APPLI NT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT I ued by: Date
C R: U TIONS. �J O
�L�— Re-roofs
Si atumaf AppliuMCa7/r aor Dam
"OARDOUS MATERIALS DISCLOSURE Type of Roof
Will do eppfc44nt ser future Wilding Occupansat=or handle huardous material
u defined by the Cuperm in 1 Code.Chapter 9.12,and the Health and Safety
Code.Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yea u
Will the, .cam or future din occu rat tum equipment If a roof is installed without first obtainingan inspection,I agree to remove
PO Wilding w q it Qu of devices a mm
I harardnus air contamina dednnd by the Bay Area Air Quality Management all new materials for inspection.
den
Dyes ONO
1 have maJ the hvamrms materials requirements under ChaPmrli.95 afthc Gliror-
nuHcahh&SmmyhOW RSections Out
it MY FeSixona .1 W Mvily the
Met
building /
dors not cuncmly hots a mnenL Net it u my mspossihility m noul'y the cecupan of the
m ihmuttb metpdorm ueara nth mora ? Q Signature Date
ownc.oranmo <dasent Da All roof coverings to be Class "B"or better