04030082 CITY OF CUPERTINO T�,�T-
BUILDING DIVISION .._ PFi MIT ��CON�CRA.CT��R, IN�'ORM�TION,
BUILDING ADDRESS: CENTEX HOMES 1E11ITNtb4030082
20592 MURANO CIR LOT 10
OWNER'S NAME: PERMIT ISSUE DATE
CENTEX HOMES
WN E:
SANITARY NO. CONTROL NO.
(925) 415-1600
ARCHITEC MNGINEER: BUILDING PERMIT INFO
BLDG ELER PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'SDECLARATION JbDescription
V m Nes I hereby affirm 1 amcause,licensedcause,Provisions or ehapmr om
9(cmeno
cing
genion]OW)of Dir an Sof NC Buvnus Pr9f nit a dm
in fullfo eandc0e ! pg:`� n SFDWL-3 STORY (PLAN 4)
3i2z Co.
^� Data ntrmtor VING 1836/GARAGE 400 SQ FT
RcxrlRcrs DEc Ano+
�< l understand my plansshall be used upublie records REVISION- -#04080129 (PORCH DETAILS)
cw
o Locoed Pndcssiansl
3
OWNER-BUILDER DECLARATION
i0 1 hereby affirm Nat 1 1. exempt from the Compmro ad :Any C ty o for the
D O which
mason.(Section 71DLd,mL Business and Ptofwimn Code:Any city or coumy
.2V which myuircs n e.also rte cmrms the alta[nt for such
demolish,ri e a sig ed structuuncture
°2'^ priorminissuartapursuat to the the
sof for such permitsoicento Law(Chapter
,s< that heielicensed with
pursuantmlheofDivisionfNeCommaor'sndProllLaw(Chapa:r9 Sq. Ft. Floor Area Valuation
QHS (cat he is exempth Setefrom and
the
basis
r h al Business and Professions Cndc)or
.-
that he k exempt therefrom and the buns for the alleged exemption.Any violation ofAt%;E4 7 0 0'
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Numberqr,y. p cy Type
not mote than fin hundred dollars(5500).
❑I,u owner of the property,or my employcu with wegu u their sok eompenution,
willdothewartendtheswnumisnotimmnd moffuedforsak(Sec.7044,Bu nese
and Professions Code:The Contractors License Law does Mt apply to an owner of Req 1
property who builds or improves thereon,andwho dmessuch workhimselfor through his -
manemploycss.provided that such improvements are not intended or offered for sale.If.
however,the building or improvement is sold within one year of completion,the owner- {p�.
Wilder will have the bumm of proving that he did not build or improve for purpose of b+ 4A
sae).
❑1,as Owner of the progeny,am exclusively contracting with licensed convectors to Szz_�
Contract the project(Sec.7044.Business and Profusions Code:)The Convenor's Li-
ewe Law docs not apply to an owner of property who builds or improw,r Nemon,and,
who convaces for such pmjecas with a coetranor(s)licensed pursuant to de Convectors
License Law,
❑lam exempt under see. .B k P C for this mama
owner Dale
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
I haw and will maintain a Certificate of Consent no self-insure for Worker's Compen-
aauon.as provided for by Section 3700 of the Labor Code.for the peffonnana of the
work for which this permit is issued.
❑1 bew and will M.W.Workers Compensation Insurance,as requitod by section
3700 of the Labor Code,for Nc performance of the work for which this permit is issued. '
My Work Compe smion lnsumnce ea cr and Policy number�ma.
Carrier Z. �✓ Policy No.:�Vv
CERTIFICATE OF XEMPTION FROM WORKERS'
COMPENSATION INSURANCE ..
[this section need not he completad if the permit Is Intone hundred dollars($1110)
or less)
I comfy that in the performance of the work for which this permit is issued.I shell not
employ any person in any mmnerm u to become subject to the Workers,COmpeuaetion
Laws of Calif..,..Data
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
became subject to the Workers Compensation provisions of dm Islmr Code,you most
.,z forthwith comply with such provisions or this permit shall be rimmed revoked.
z O CONSTRUCTION LENDING AGENCY
[—� I hereby affirm Nat Vert iso construction lendingagenc,for the performanauf
1a 5: the work for which this permit is issued(Sec.3097,Civ.C.)
1 Q Lender's Name
Z Icnderi Address
U p 1 Minify that 1 have read this application and state that Nc above information or
is�0(, cprtncL 1 cora to comply with ill airy and county nmdmonfininex,;of and state laws r urn.O e
(]V mov ingeonsnuctionand hereby wlhon p rcprescnutivu of this city to enter upon the
ahovc-mcnudgm progeny for inspection
which may
H arposeL
y (We)agree to arc.indemnify and keep harmless the City of Cupertino against
rg
liabilities,judgments, and of thisuwhich may in anyway eccmc against send City
U Z in nNDERSTANDS this WILL Issued by: Date
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NO -POINT
i RC REGULATIONS.
//�iC� '22
Signof ApplianUCn t� Data Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant of future building occupant stem or handle havardous material
as defined by the Cupenirw Mu 'pal Code,Chapter 9.13,and the Healdt and Safety
emle,seniors 7ss3x(a)] All roofs shall be inspected prior to any roofing material being installed.
❑Yrs o
Will the applicant or future building m:cupam use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it heurdnu air comaminann ax dcOned by the Bay Area Air Quality Management all new materials for inspection.
vim]
❑Yes 5d+o
Ihave read the hvaNmus matarials reyvimmcnn untI udmemnati.95oINe Gldin,
riaHalNdr SaktyCadc.Satiw25505.235J1 and 25534.1 wdcrsWq NuifNc building
due s currcn"Ihaw a vnma that it is my mspoombility w noulY the t of N
regc' cma•whichmussEcmnpriortoiuumceofa 'Bataoro; /Signature ofAppl' ant Date
Dwneroonthori.dd gin I f
of D,w All roof coverings to be Class"B"or better