04030090 CITY OF CUPERTINO
BUILDING DIVISION PERMITCTOR4NF0RMATI0N
BU ILDING ADDRESS: CENTEX HOMES PERMIT"04030090
OW NER'S NAME: PERMIT ISSUE DATE
CENTEX HOMES 2c;27 CAM mn RAMON 41 00
ONE: SANITARY NO. CONTROL NO.
(925) 415-1600
A CHIEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0
LOO LICENSED CONTRACTOR'S DECLARATION
�uC 1 hereby affirm Our 1 am licensed under provisions or Chapter 9(commencing Job Description
�W with Scction]tllp)of DivisienJof gat Businessand Profeatiomeode. rad mylicemcu
pia mmuforceanile octY� SFDWL-3 STORY (PLAN 3)
n Ll License CI a Lic M
o Dow -9'7 LIVING 1809/GARAGE 430 SQ. FT.
art ARCHITECT'S DECLARATION
Jm< Iunderstand myplans shall heused as public memal, ADD PLLONGRNGR FEES
�yU
0.t; Licensed Professional
5
OWNER-BUILDER nexempt
DECLARATIONamelee
Z O F I hcrchy.(Sons Out 1 oro cBusin from On Cssions Co :Anyc Law far the
OO fallowingrcasoa Permit
]IYy L;Businessane va.demoli Code:Any em orcounty
m which requires a permit also re uir s the alter,improve,h permit t or rile a sig any strned ucture
�i
Poor to he its iensedp pursuant
to the prevision or for mchpctor's Geese aw(Chaptern
££ss< Thatmenciing with Section
previsions of dp Contractor's Ltecnussw(C Cods)
Sq.Ft.Floor Area Valuation
yh$ (commencing Section9000)ofDivisionbs3 th all,cd Business and Professions CWy)or
Nat W is exempt tbertfrom and the basis for the alleged caempuon.Any violation of $210700
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of APN Number Occupancy Type
not mom than rive hundred dollars(S500).
P Y YP
O I,ss oww afloat property,or my employees with wages as their We compcntauon,
will do the work,and Ocatructurc is not intended or offered forsale(Sec.7W,Business 3156190 6U
and Prefossiom Code:The Commend'License Law dors not apply to in owner or Required Inspections
property who Wilds at improm Ocreon,and whodoes such work himself-through his
own employers,provided thmsuch improvemcras art nos intended aroffcreg for We.If,
however.the building or improvement is sold within one year of completion,the owner-
builder will have the Widen of proving Nu W did not Wild Or improve far purpose or
sale.). I 9
C]1,as owner of the peeper,am exclusively contracting with licensed contractors to
the 1•=]
construct Project(Sec.]044,Business and Professma
Professions Code:)The Corcmf
r's Li- 1
cense Taw docs mot apply p in owner of property who Wilda or improm thereon,and
who contracts for such projects with a cantnctor(s)licensed pursuant to the Contractor]
License Law,
❑lam exempt under Sec ,B&PCfar this reawn
Owner Data
WORKER'S COMPENSATION DECLARATION / r
I hereby affirm under Penalty of perjury use or the following dedarmonc t r !rr^
have and will maintain a Cer iOwm ofConsenuo self-imum for Worker's Compcm t�
s,as provided fm by Secuan 3700 of Ne LOor Cove,for the Narang.of the
k for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as required by section
37 of NC LaWr Code,for the performancc of the woh for which Nupennit is issued.
My Worker's Comp-mauon Insurance carrier and Policy number ore �r � (
Car(_IFf1=' �C// Miley Na� p� O 3�oV G �U�
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu amion need not W cans land if the permit is future hundred dollars($100)
or loss.)
I sonify Our in Ne performance of the work for which this Permit is issued,1 shall not
employ any parson in any mannerso as to become subject o the Workcri Compcnnauon
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,-flat making this Certificate of Exemption,you should
become subject to the Worker's Comperunim provisions of the Jaber Code,you muss
.J,z faMwith eomPIY with such pmvisiom err Nis Permit shall W deemed revoked.
z O CONSTRUCTION LENDING AGENCY
�-+ I Wrchy affirm Nat there is a construction lending agency for the performance of
the work fur which this permit is issued(Sec.3097,Civ.C.)
0 Lender's Name
D,z L.ender'S Address
U Q 1 certify Nat I love read thea application and stain Nat he aWve information is
W HcorecL 1 agree to comply with all city and county ordinances and Stam laws relating b
0U building convection,and hereby authorim repmsentaumor this city to enter upon the
abere-menudgm Property for inspectionxexpenses
purposes
F y (We)agree to save,indemnify and keep harnless the City of Cupenino against
U zincaities)udgmenta,Sending eapemceadit. may in any way accrue against said City
AePLIC NT of Negrantingof Nu permit
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Is ued fs by: Date
R GULATIO
Re-roofs
6L
&gnmurc of Apphcan tractor Dem
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant score or handle hmardom maunial
as derided by the Cuperand Municipal Code.Chapter 9.12.and OrHealth and Safety
adeWsue,Sectlaea n 255324)?>+ / All roofs shall be inspected prior to any roofing material being installed.
❑Yr�qu
Will tW applicant or future Wading occupant use equipment or dcvia<,which If a roof is installed without first obtaining an inspection,I agree to remove
IL�
havardous air crossed an darned by the Bay Area Air Quality Management all new materials for inspection.
rictP
UYcs /'�No
I have mad the hmardous materials requirements under CWpter6.95 of thc Califor-
ealth&SarctyCads.Sections 25505,25533 and 25534.1 understand thv ifthe Wilding
rpt currently have•tenant Nat it u mY extPomihility ins early gat..,am of the
pcswhichmuubcmclpror iaauanre rapamoraSignature ofApplicant Date
authmimdage o Daly All roof coverings to be Class "B"or better
G