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04030095 CITY OF CUPERTINO �~.�� '�•� '� ^'� BUILDING DIVISION PERMIT YGON'T12A. f11t" WAl110N „ ' BUILDING ADDRESS: PERMIT NO. CENTEX HOMES 04030095 OWNER'S NAME: PERMITLSSUBDATE 7Daw- SANITARY OL NO. CT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH a 0 0 0 LICENSED CONTRACTOR'S DECLARATIONamthmucdunderprovisionsofChapter9(commencingJob Description n]000)of Division 3 ofthe Business and ProfessionsCode.end my licenseeeendeffen. ass Lie.x SFDWL-3 STORY (PLAN 3) Contractor q TSDECL LIVING 1809/GARAGE 430 SQ FT i1 ARCHITECTS be used DECLARATION YY 33 I understand my plans shall he used as public records al CLicensed pmressional OWNER-BUILDER DECLARATION f 1 hereby affirm that 1 am exempt from the ConuecmYs License Law for IM i O O following maxon.(Section 7031.5,Business and Professions Com:Any city or county +�2 which requires a Permit to construct,altar improve,demolish,or repair any stmctum primer its issuance.also requires be applicant reattach Permit to rile a signed moment E< Minna is licensed purmanlro toprovisionsofthc Canuactori License Law chatear9 Sq.Ft.Floor Area Valuation mmmencingwiN Secsion70DO)of Division3afthe Busincaaand Prof"stuns Coda)Or . Nn EM he is exempt NemUom and the base for the alleged exemption.My violation of Section 7051.5 by any applicant for a permit subjects the applicant in a civil penalty of APN Number Occu ane e not more Nan five hundred dollars(95OTL P y P ❑1,asowner of the Pmpmty,or my empioyseswhh wag"u Nehsom compensation, will do the work and Me awcmm is not intended or offered for ask(Sec.7014.Business 3661907600 and Professions Code:The Connector's License Law dace roin . t apply an owner of Required Inspections property who builds or improves thereon.and who does such work himsel f or through his ownemployces,provided that such improvements art not intended unaltered for sale.If. however,the building or improvement is sold within one year of completion,the owncr- builder will have Ne burden of preving that W did not Wild or improve for purpose of i sale.). IZL ❑1,u t Me project of property,.R e u mlvely and cofessions wid:)TOO Cconvacmu m causwer desot (Sec.tooa4.B"mese and ny who Wilds Code:)The es Mumma,LI- 'i=" a' vee cents law docs not apply e ts owner of property who sed p or improves Committees and who contracts for such projects with acommctor(s)Iicensed punsuammlW ConmcmYa �'��I�d t License Law. JVN No ❑lamer pt uncle ac, .B&PCfa Nitre on Aw ��TI �Dy& 1 hereby elfiim under pansOMPEP UAryOMDEhe toRAT;me declaradons: ^' �' ®� have and will maintains CmIlle sof Consent mself-insureforWorker'sCompcn- ton,as provided for by Section 37W of Me labor Code.for Ne performance of Ne for which this permit is iseued. 1 have and will maintain Workels Compensation Insurance,as required by Section 00 of Ne labor Cadp,for the performance of Ne work for which this permit is issued. My Work c�dss.Copm�pinsad�"Insummecamimand Polirynumorare- Cartier.!; ! Policy No,a)E"P ' CERTIFICATE OF EXEMP ION FROM WORKERS' COMPENSATION INSURANCE (rad,section need not W complaint if Ne pe and,Is forces hundred dollar(gins) or less) 1 certify that In Ne performance of Me work for which this permit is issued.1 shall not employ any person in my manner so as to become subject to the Workcoi Compensadon Laws of California.Data Applicant NOTICE TO APPLICANT.If.after making this Ccnificam of Exemption,you should become subject In the Worker's Compensation previsions of Ne Labor Code,you must .J O forthwith comply with such provisions or this permiuhsll k mcmcd revoked. Z 7) CONSTRUCTION LENDING AGENCY tN+ liumb .Mons that More is a construction lending agency for Mc ("' Y 8 .)my Performance of !Yi r�—r Ne work for which this permit is issued(Sec.3097,Civ.CJ k7D Q Lender's theme D z Lender's Address V Q I certify Net 1 have mad this application aM sum that the shove information Is correct I agree to comply with all city and county ordinances and suss laws reading to 0 U building constmction,and hereby outhonre Mproo4nutiv"Of this city to color Open Ne Lt7 move-mentioned Progeny for inspection Pumases LL (We)agree to save,indemnify and keep cornices the City of Cupertino against ti cA liabilities,judgments,costs and expenses which may in any way accosts against said City V Z in consequence of the granting of this Permit ^' APPLICANT UNDERSTANDS AND WILL PLY WITH ALL NON-POINT Issued by: Date SOUR GULATo S. /a Re-roofs tumo'ApPlieany counselor Dau HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will Me applicant or future Wilding mcupantstom or handle hnaAous materiel u defined by the Cupertino Mu mipal Com,Chapter 9.12,and Me Health and Safety Code,s❑Nes zss3z(a)] All roofs shall be inspected prior to any roofing material being installed. Yes No WBI Ma applicant or mrc building accupenl use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove t hazardous air coationants dcfood by Ne Bay Arca Air Quality Management all new materials for inspection. Incl? ❑Yes Nu I have read Nehva ms alorialsmquimmenuunmrchaplor6.95aNmCatifor- nia Hu1N&SafeLyCom,Sectiou255r15,25533 end 75534.1 unmmund MnifNc Wilding does nos cumcndy haw a lonent Nat it a my ormi nsihility to nodl'y Me cecapmt of to rcquimmcnu both met Wt 'or to i" aCcnifcaloor Ocup Ignature of Applicant Date / Owner or authonacd pron Oam All roof coverings to be Class"B"or better v/