04030081 CITY OF CUPERTINO , `7 7 ,
ON
BUILDING'DIVISION PERMIT CTRAC'TORINFOT2MATTON ; -
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BUILDING ADDRESS: CENTEX HOMES "r`"4030081
OWNER'S NAME: PERMIT ISSUE DATE
CENTEX HOMES
E; SANITARY NO. CONTROL NO.
(925) 415-1600
ARCHITECT/ GINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
0 0 0 0
uo0 LICENSED CONTRACTOR'S DECLARATION Job Description
ZFF 1 hereby affirm Net 1 am limned under provision of Chapter Y(co mcncm, P
ty with Sceo-701p)oIDivimi Sof Oc Businw Rofuslan Co ,and y encu
��„ immnrnmeande8 "=', _ FDWL-3 STORY (PLAN 4)
DEZ Limnsc Clan Lie.N
Fp Da - cnnlrennr IVING 1836/GARAGE 400 SQ FT
7W ' ARCHITECTS DECLA TIO
l_< une� Jmyplans shallheUsed aspublic records REVISION--#04080127 (PORCH DETAILS)
Ddu
3 ut0 S Licensed Professional
OWNER-BUILDER DECLARATION
aI 1 hereby alTrm that I am eaempt from dire Contractors LJeenm Law for the
O O following mason.(Section 7031.5.Business and Profesiuns Code:Any city or county
m which requires a Permit m enrrvrucl,Weer.improve,demulkah,or repir any structure
prior m its issuance,also requires the applicant for such Permit to Ole a signed statement
thatM is loormd pursuant to she Provisions of the Contractor's Licenm Law(Chapter 9 Sq.Ft.Floor Area Valuation
U,t-O (commencing wish Section 7D00)of Division 3 of the Business and Professions Codi or
$ shat rte is eaempt therefrom and the basis for the alleged exemption.Any violation of $214700
Section 7031.5 by tory applicant to,apc.it subjects she aPPlicmuo a Civil penalty of APN Number Occas ane T
not more thm rive hundred doll.(S500). P Y Type
❑Luowttu of the pmpctty,or my employee with waguatheir sole compena0en. 4611111,
will do the work and neswctum is nmintarWed m offered formic(Sec.7W,Bummust
and Professions Codc:The Contractors License taw does not apply to an owner of Required Inspect
property who bas ilds or improvss thereon,and who does such work himsel f or through his
own employee,Provided Nat men improvements am main¢Med oroRcred f ersale.IL
however.she building or improvement is mid within one year of completion,she owner71*
-
Wilder will have the burden of proving that he did not Wild or improve for purpose ofr /
tttt
gale.), d
❑1,u owner of she property.am exclusively contracting wish licensed contractors to
contract the project(Sec.7044,Business and Profession Code:)The Contractors U. �® i 0pk
come law dors not apply to an Cremes of property who laulds or improves thereon,and av/
who contracts for such projects with a canuactor(s)licensed pursuant m the Contractors
License law. A
❑ Ism exempt under Sac. .B&PCfor this mean ) a.•s
Owner Date i;12
WORKER'S COMPENSATION DECLARATION
I hereby alarm under penalty of perjury one of the following declarations:
1 have and will maintain a Certificate of Consent to asir.m u e for WorkertCorttpen-
smon,u provided fm by Scelidn 3700 of the labor Code.for the performance of tlr
work for which Nis permit is issued.
❑1 have and will maintain Workers Compcnation Insurance,as required by Section
3700 of the labor Code,for the performance of the work for which this Permit a issued.
My wa�lwa omppsit�i ur br n range ri r a 4 R�ii num �: s
CERTIFICATE FE EMPnONFROM WORKERS' �� ��
COMPENSATION INSURANCE
(This section tred not becompleredRthe permit imforombundmd dollars(Slip)
Or less.)
1 certify thea in Ne Performance of Ne work for which this permit u issued.I shall not
employ any permn in any manner m n to become subject torte Worked Compensation
Laws of Califamia.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject m she Worker's Compctuation provisions of the Labor Code,you most
.J O foMwin comply win such provision or this pones Mall be decreed revnkcd.
Z� CONSTRUCTION LENDING AGENCY
�-+ I herehyaRtm Our there I,,Construction lendingageney for she perfurmanaeuf
Cthe work for which this permit is issued(Sce.3097,Civ.C.)
a Q Lenders Name
.Z)z Lender's Address
V Q 1 ecmify,shat I have read this application and shote oat the shove information is
Ds F' Correct,1 agree to Comply wish 01 city and county on inardes and shote laws mlating to
0O building construction,and hereby authorin opesenhotiwa of this City to enter upn the
H Gahovcmenu med property for inspection Purposes
(We)agree to an,indemnify and keep hamtiess the City of Cupendo against
fA Ilabithmajudgmenho,comiadcxpertsu which may in anywayaccmc agWutandCity
[�,Z in consequence of the Standing of this permit. pppQQQyyy /
^ APPLICANT UNDERSTANDS AND WIL��ITH ALL NO POINT Issas d by: Date
50}1$CE RE ULA,1'1�S. �!i
': C4 , e-roofs
.Signaum of ApplicusnAa meLor Date 1
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will theapplicam or future building uccupantstore or handle hsvardous material
as defined by the Columnar,Must pal Code.Chapter 9.Iz,and rte Fiuln and Surety
cr,de. 0YC'zss3z(a>7 Z.
All roofs shall be inspected prior to any roofing material being installed.
❑YC'
If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future b 'Iding Occupant um equipment or device which g P g
it haaardnn air contaminants fined by the Bay Area Air Quality Management all new materials for inspection.
DlglrlCl7
OYCs Nu
I have mnd the bvudnusmaterialsreyuiremcnts untkr Chapter 6.95ofthe Califor.
mallein&SafetyCedc,Sections 25505.25533 and 75534.1 understand net ifthe building C..-� /j )��� •�/� j //[��
does not Currently haw a tenant,that it is my responsibility to and tM omuP t of the
y '
xmm�txmetpr,ryauee ;ce etea �7 � ISignatureofApplicant Date
Owncrm aunori'red actor Date All roof coverings to be Class "B"or better