04030093 CITY OF CUPERTINO :=.o�wr' k�`�aac *",='=` "' -'•`' ` k'h,
BUILDING DIVISION PERMIT ,CONTRAC"�TOR INFORMATION- :
..'six., u• f.y4„x .-. ttb .
BUILDING ADDRESS: CENTEX HOMES PERMrr"°04030093
OWNER'S NAME: PERMI'r ISSUE OATS.
CENTEX HOME
NE: SANITARY NO. CONTROL NO.
(925) 415-1600
ARCHm3C`r/SNCJNEER
25 415-
ARCHm3C`r/ENGINEER: BUILDING PERMIT INFO
BL ELECT PLUMB MECH
trop LICENSED CONTRACTOR'S DECLARATION O
V I hereby am.Nat I am lisvcd under provisions of Chapur 9(o mmeng Job Description ��
n� widiScedon'700(hol'Divis n 3afthe Busin as end Prafevsium/ e.enQadYliccnm is
0a, in fail fiRdeffect -//—G/J DWL-3 STORY (PLAN 3)
Licenu I Lie.N
_� D, r TSDECL VING 1809/GARAGE 430 SQ P/f
ARCHDECTS DECD TION `'J
j w U I undersand my plana shall be used Bs Public rcwrds GI DO�
6
C 1 Licensed Pnsfcasional
OWNER-BUILDER DECLARATION
K<Y 1 masa .(Sere that 1 1. exempt from du Contras Co License Law far the i
p 0 followwhich
mama.permit
t 71DL5,Bmllon.simprove,
ve,de o li h.or Any oily or county
s
K$r which rsquirss issuance.permit ac cnrtsuuct.aha.improve,hamuli h,nr repair any tatement Z<�•r
yZy Oath i6ensedppursuant
elhovisio o for Such permit to Gleasigned a0wmcnl
< Nal KisliccmedpursuamwNeprtrvisiomofNcConuecmr'WamcLaw(ChaPtm9 Sq. Ft. Floor Area Valuation
-5, (commencing with Section 7")of Division 3 of IM Business and professions Code)or
Basshe u exempt therefrom and the basis for Ne alleged esemption.Any violation of $210700
Semlon 7D31.5 by any applicant far 0 permit subjects the applicant to a civil Penalty of APN Number Occupancy T�
not mom One rave hundred dollen(5500). P y '](�
❑I.nownes ofdu prolseny,mmy employes with wegesu Ncir sole compcnsHdm.
will do the work and destructors is oat intended oroRered(arssle Sec.7044.Business
and Professions Cade:The Connector's License Law does not apply w an Owner of - Required Inspections
propeny w ho bui Ida err im prove Netnon,and who does such work himself ar through his
awn employes,provided Nat such improvements Are not intended araQered forsake IL
movever,Nc building or improvement is sold within am year ofeompledon,Ne owner
builder will have the burden of pmving Nat he did not Wild or Improve for purynse of
sale.).
O I,as owner of the property am exclusively convening with licensed convacwrs in
consumer Ne project(Sec.7044.Entities and Professions Cade:)The Conmeter's U.
cense Law does not apply to an owner of property who builds or improves Nemo,and,
who convects for such projects with a conuactar(s)licersud p osta t in the Canvadoes
License law.
❑I em cxcmpt undo See ,B&PC far Ni wan
Owner Date
p1WORKER'S COMPENSATION DECLARATION
1 hereby affirm under Penally of perjury one of the following declantimoc
have and will mai aCenkfiem,of Consent to self-imube fes WofRer'sCompen-
sauo i.as Provided for by Seedon 3700 of On Inbar Code,for the performance of Me
work for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance,As seyuired by Section
37W of the tsi or Code.for the perfasmanee of the wart for which this permit is issued.
My
cann
r And
CemeWork CERTIFICATEEXEMPTION CyfltOMOWORKERS'
COMPENSATION INSURANCE
(Thi.acctim Med not An Completed LIMA permit is for one hundred audan($1001 -
I..)
1 certify that in the performoce of Ne work for which this Permit is issued,l shall not
employ any person in any manner so as to become subject in the Workers Compenandon
Laws of California.Dau
Applicant
NGrICE TO APPLICANT:IL after making Nis Cenificau of Exemption,you shooW
become subject to Ne Worker's Comp nsumn Provisions of the Labor Code,you mug
.7. z (amhwllh comply with such provis a s or this Jamul shall be deemed invoked.
Econ CONSTRUCTION LENDING AGENCY
[-+ thereby affirm Nat Here is a construction lending agency for the perfmmnncc of
Ne work fur which Nu Memoir is issued Sea.3097,Civ.C.)
Ck1 A Lendcls Nunn
CL
Z)2 Lender's Add.
L) '
)
(„ Q 1--try Nat 1 have teed Nis city
and coon od sou Nat the ebo c informaum i
L4 conch.1 agree m Comply with all city and county aNiA..,and sw we laws mluting to
0U building conavucdan,and hereby auNodm represenwdws of this city to enter upon we
shove-mentioned property for inspection purposes.
F C c,ju agree i.core,indemnify and keep harmless w City of Crum(against
h liabiliti We)g agree
10 casts inti expeindemnify
es ad which may in any a City f Culeinst said City
U Z mcnnubse.ce of the granting of this permit I seed b
APPLICANT UNDERSTANDS AND WILL COMP WITH ALL Noy-POINT y: Date
E REGULATIOL4S.
Signature of Applic O—LOI D
e-roofs
AZ RDOUS MATERIALS DISCLOSURE Type of Roof
Will du applicant or(own ba4ding occupant gain or handle hxzsrdous maurial
es defined by the Cupenina Municil(al Code.Chapter 9.12,and Ne Health and Safety
Cale.QYet 25532(a)? ,� /a All roofs shall be inspected prior to any roofing material being installed.
Will the a Scant or fLoutea ndin aces ant se If a roof is installed without first obtainingan inspection,I agree to remove
OP pet g p cquipmens or devisee which
OIL hazardous air contaminan%n defined by Ne Bay Arca Air Quality Management all new materials for inspection.
Digrin7 `
C]Yes /QNo
Ihave feel Ce ,S.nus me505, 553ls 3.d255rements under Crop udb .ifthe Caldioi
nicea. act entlyyLaws smart.Met its, myrostd25534.1und.aande, NC Wuiltin
dxs t currsndy here a unapt Nm it i.my rsspomihiliryw notify du uPant of N /
tri c huh ma stbcmcpnorwissumc,: ,Mcau m
ancy_i ignareofApplicant Date
�, z a
Gana.M...homed.genj - oaw / All roof coverings to be Class"B"or better