04100001 CITY OF-CUPERTINO ��»aaaA:r : . 'i .;r
BUILDING DIVISION PERF *CONTRACTUR�INFQ ON * .
BUILDING ADDRESS: CENTEX HOMES PERMIT N 04100001
OWNER'S NAME: PERMIT ISSUE DATE
IFE: SANITARY NOC NOL NO.
(92c;) 41F)-16Q0
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
.lip LICENSED CONTRACTOR'S DECLARATION Job Description
1 bereby affirm that 1 am Ilmnsed under Provisions of Chapter 9(commencing
P
with Section 70llo)coivision 3ofO.Business and Pfofcasiona Code,and As,license is _
in full forcu.nd.flect.
License Class Lm.« REVISION--FOOTING EDGE DETAILS
Date Contractor NO NEW PERMIT ISSUED/ ORIG. #04030093
eQ�Q ARCHuITECTS Du ECLARATION
y a I understand my planhell M used public records - - -- --- -
D U
Licensed Porfessionel
3OWNER-BUILDER DECLARATION
lg I hereby
alarm that 1 am exempt.form the Conlmcmis Liecnm Law for the ,...
00 following mason.(Section 7031.5,Business and professions Cod.:Any city of County
k$� which requires,a Permit or eonstmct,abut Improve,demolish,or repair any atrucmfo -
"�y poor to its issuance.also mifund the applicant(orsuch permit to file a signed sulement
�< that he is licensed pursuant m the provisions of the Contractor's License LAW(Cbaper9 Sq.Ft. Floor Area Valuation
$ (commencing with Section 7WO)of Division 3 of Oc Business and Prolosamna Code)Or
Nn he b exempt therefrom and dm basis for the alleged exemption.Any vloladon of
Section 7031.5 by my applicant for a permit subjects the applicant too civil penalty of APN Number Occupancy Type
not mom dun five hundred doll.(5500).
❑Luhe Amdr Ne postmetmmy emplayw withwwguudn,tr ec.camBusman,
will do the wads end Ne he Com isnot intended m Law
dos-1 apply Trials.Business
and Profasians Calc:The Contmctols License Law dots oat apply of an owner of ' O O Required Inspections .. . . .. .. .
propeny who buildsorimproves thereon,and whodoessuchwork himselfor through his
own employees,provided that such impmmmmus are not intended orolfcred for sale.If. ----
however,Ne building or improvement is sold within one you of completion,the most. /a ------ -- - --
builder will have Ne burden of proving that he did not build or Improve for purpaae of \ \
talc.).
m 1.As owner of the property,am exclusively contracting with licensed commeron to
construct the project(Sec.70",Businessand Professions Code:)The Conlnemis Li- i:F�.
cence Law dors not apply N in owner of property who Wilds or improvss thereon,and - -
--
whoconuaclsforsuchprojectswibacontrana(q licensed pursuant to Has ConsWu s ,
License law. - -
❑Iameaemptund x 4 0&PC for Oi .on
t3l.W
y Dam
C S COM ENSATION DECLARATIOW1 hereby alarm under penalty of pejury one of the following declarations:
have and will maintain a Certificate of Consent to sel6lnsure for Workers Compen-n,u provided for by Section 37M of the Labor Code,far the xoInm.n"of the
for which Of,permit is issued.
have and will maintain Workers Compensation Insurance,as m i ited by Section of Ne labor Code,for the perfamunee of Ne work for which this permit is issued.
Workers Compensation Insurance carrier tad Policy number am:
er. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS!
COMPENSATION INSURANCE
(fhb section need no,W completed if the permit isforone hundred dnllars($I00)
I certify that in the perfmmence of the work for which this permit Is issued.I shall not
employ any parson in any muncrm As In Mneme sudbet in the Workeri Compensation
Law.of callfomli Due
Applicant
NOTICE TO APPLICANT:If,after making this Certificate ar Exemption,you should.
become subject to Ne Worker's Compensation provisions of Om IsMr Code,you must
.JO forthwith comply with such prmisinm or this Permit shall he deemed focused.
z CONSTRUCTION LENDING AGENCY
14[••i I hereby affirm that there Is a construction lending agency for the performance of
Ci > Ne work fur which this permit Is issued(Sec.3097,Civ.C.)
Lender's Nun.
= z Lender's Address
J Q I certify dust I have mad this application and state that the above information is
F correct I agree in comply with all city Nd county oNI1WIRa and slam laws mlating to
O U building cowmction,and hereby authorize representatives of this city to enter upon the
W ahove-recnlloncd property for Impaction purposes
(We)agree m saw,indemnify and keep harmless[be City of Cupertino against
fd'q liabilities,judgments.costs and expenses which may in any way action,against said City
617 in consequence of the granting of this Permit. - _ ..
'^• APPLICANT NDER TANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date , -
00
gOURCgE G T g, �0/O//
/ Re-roofs
S cart of AppliaO
HAZARDOUS MATERIALS DISCLOSURE Type Of ROOF
Will the applicant or(Muni building occupant sure mand t e h Health
a d Safety u deBnetl by the Cupertino Municipal Code.CNpmr 9.@,and due HcaIN and Safety
A"Eme.Section M533(a)? All roofs shall be inspected prior to any roofing materia being installed.
❑Yrs No
Will the applicant or ratan,building actinpant use equipment of dwi.r,whichIf a roof is installed without first obtaining an inspection,I agree to remove ...
L hazardous air contaminants As defined by the Bay Area Air Quality Management all new ma al f In 1700.
istrict?
❑Yes 14No
I have mad the Wasidous mamnals requirements under Chapter 6.95 of the Califor. /O / U
nia Healthdr Safety Cole,Smmts15505,25533and2553x.1undcf duatifdm building
does not curmntl aw a tenant Not it b mY fcsponsibility u nmffy the aceup t of due -
myui'.n i etpnm irsan aracenr.a arGl eqC. Signature ofApplieant Date
o maraal onvndagent y/��7' DTA All roof coverings to be Class"B"or better