04030118 IC
TY OF CUPERTINO ��' m=^z +g m*W.BUILDING DIVISION PERMIT CONTRACTOR�INFORMATION 'DING ADDRESS: CENTEX HOMES """04030118
r)90 MURANO ( TR LOT 4c;
EWS NAME: PERMIT ISSUE DATE
CENTEX HOMES
ONE: SANITARY NO. CONTROL NO,
(925) 415-1600
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
u00 LICENSED CONTRACTOR'S DECLARATION O O O
I Wmby affirm that 1 am liamtl under provisioru or Chapter 9(romm uscing Job Description
i with Scaion 7M) I'D' talo 3ofthc Buaincsaand Profcuions din* is
"" in fall fort as SFDWL-3 STORY (PLAN 2) /®fig
Lkem r D IW s]L ®
;�� Dam Conti ter LIVING 1753/GARAGE 477 SQ F
ARCHfTECI'S DECLARATION
?w U 1 undervand my plans Mall W used u public records
3 3 Licenced Pru(ennioctal ' lI
OWNER-BUILDER DECLARATION 2006
<I I hereby affirm Nal I am exempt from the Convectors License Law for the w
i c O rollowing noma.($adun IID 1.5,,euros and professions Code:Any city of county
+�m which require a remelt to canswct,alter,improve,demolish,or repair any srmcma
F Z e prior to its issuance.also requires the applicant for such perm,to file a signed statement
ESC that hoislicensed pursuant to line provisions ofuse,Conuxtoriu<
lnseLaw(Chapmr9 Sq. Ft. Floor Area
ss~S (commencing with Section?000)of Division 3 of Nn Bass.and Professions Code)ar
Nta
at he is exempt therefrom d the buts for the alleged ascription,Any violation of
section 7031.5 by airy applicant for a permit subjects tW applicant an a civil scrally of APN Number Occupancy Type
not mom Nan five hundred kilWa($500). P Y YP
❑I,uo rofthepmpeny,mmyempl°yaawirewageumeiraolecompemfion. 36619076 . 00
will do the work and the structure is not unasked or offered forsale(Sec.7044,Businrss
and Professions Code:The Contractori m LiceLaw does not apply to an owner of Required Inspections
property who Wildsorimprows aleroon.and whodmM
ssuch work himalfarlugh his
own employer,provided dm such improvements are not intended oroRead forsah:.If.
however,the building or improvement is sold within mm year of completion,the owner.
Wilder will have the burden of proving that he did Out Wild or milestone for purpose of
tale.).
❑1,as rower of the property,am eaduively contracting with Resonated convectors to
no.=I the projem(Sec.70a4,Business and Pacessiou Code:)The Convectors Li.
cause Law docs not apply 0 an owner of property who Wilds or improves demon.and
who contracts for such projects with a eomnactor(s)licensed pursuant to the Committees
License law.
❑1 am exempt antler Sen ,B&P C far this on
er Data
WORKER'S COMPENSATION DECLARATION -
I hereby affirm under pevhy of perjury ane of the following declarations: .
1 haw and will maintain a Certificate of Consent to self-insure fm Worices Compen.
.tion,u provided for by Section 3?00 of the labor Code,for the performance of the
war for which this permit is based.
are and will mountain Worker's Campcuation Iruurvta,as required by Section
3WM.f me labor Code,for the perfarmana.f rhe woh for which this permit is issued.
My Wo mrensaho�In(y�w.nce carrim and Polity number arc:
Came o/�J[/ / PolicyNo.:l�� / a+�
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section toed nor W comPlowd if the reit Is furore hundred dollars(giro)
or lass.)
I ccmfv that in the Performance of also work for which this permit is issued,)shall not
employ any person in any manner so an to Wmme subject o the WorkesComperuzdon
Laws or California.Data
Applicant
NOTICE TO APPLICANT:IT,after making this Ccnificale of Esemption,you should
become subject to the Wo,keri Compensation provisions of the labor Code,you mum
,7O foMw;th comply with such provisions or this permit shall W deemed nwoked.
zCONSTRUCTION LENDING AGENCY
[-e I hereby affirm that them is a construction lending agency for the Performance of
the walk for which this permh is ssu
issued(Sec.3097,Civ.C.)
1 lenders Name
=z Lender's Address
U C) I ar ify that 1 have red this application and sum Nat the above jar..U.u
Ir. P correct.l agree to comply withall city and county oodinanees and sure laws relating to
0 V building construction.and hereby authorim mpruenudves of this city to enter upon tW
G aWve-mentionedpmrcnr for Inspection which may
(We)agree to saw,indemnify and keep harmlrss ale City of CupcNno agaiut
liabH f/1 inCilitiesue"Cjudgments.do grusand expmmocrit. may in errwayaccmc against said City
U z in consegmnce of lac granting of this vetoer. Issued by: Date
^ APPLIC UNDERSTANDS AND WILL COMPLY TH ALL NON-POINT
CE L NS.
Signaturcof ApplicanlCan Data a-COOTS
HAZA OUS MATERIALS DISCLOSURE Type of Roof
Will Nc applicant or future Wilding aetipad atom ar handle hazardous material
u da.jd by the Cupertino Municipal Cade,Chapter 9.12,and the Health and Safely
c.Sec Yes 25532(x)? `\ '' All roofs shall be inspected prior to any roofing material being installed.
Yes Ig61u
Will thea applicant or future wadi. Occupant use If a roof is installed without first obtaining an inspection,I agree to remove
pP g P 'equip or devices which g
telt hazardous air contaminants u daloed by the Bay Area Air Quality Management' all new materials for inspection.
DIah;CI?
❑Yes No
I have revJ the W sonlausmmerialsrequircerenu under Cttapter 6.95 of the Calirm-
niaHcalth&Salcey Code,S d.25505.25533and25531.1undcnsundtha,fthc building \-
does not currently haw a errant,that II u my resp esibility to may the aeupant or the
is cast which mum tic met wive arre,tear Signature of Applicant Date
Owner or authorived ag2f All roof coverings to be Class"B"or better