04080129 CITY OF CUPERTINO CON 'RA. +I .i
BUILDING DIVISION PERMIT 4,, ,r , .y _ .l.rev
BUILDING ADDRESS: CENTEX HOMES PERMIT No 04080129
NER'S NAME: PERMIT ISSUE DATE
AEWS NAME:
NE: SANITARY �ftOL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
uoo LICENSED CONTRACTORS DECLARATION Job Description
�S FF;j 1 homey affirm Net 1 am licensed under provisions Of Chapter 9(commencing
^ E with Section 7")of Division Sof the Business and professions Code.and my license is
to
full
semmeanaerre '
C REVISION--PORCH DETAILS
I Dam Contractor NO NEW PERMIT ISSUED/ ORIG. #04030082
Iqq--
AR TECTS DICKAlAag
�y'eZ i understand my plans ahull he used as public mune,
otoC
3
m LLOLicensed Professional <
8 OWNER-BUILDER DECLARATION Vl/1
a� I herchy affirm that 1 am exempt from the Contractor License Lew for the p
E0 O following reason.(Sccdun 7031.5,Business and Professions Code:Any city or county V
+�$ which mquman a permit to construct.alter,impmws.demolish,or repair any Sio=Uro
prior In its issumcu,elm¢quires the applicmtl for such permit to rile a signed statement
that he is llemned pursuant to the previsions of the Contractor's Licenm Law(Chapter 9 Sq.Ft. Floor Area Va a[ion
$ (commencing with Section 7000)of Division 3 of Ne Business and Professions Com)ur
that he,is exempt therefrom and the basis for N.alleged exemption.Any violation of $11 C3
Section 7031.5 by any applicam for a permit subjects the applicant to a civil penally Of APN Number Occupancy Type
tet more than five hundred dollars($500).
0 1,u awnu of the pmperty,mmy employees with wages u theirmle mmpenudon,
willdo Bre work and theswaum is nuimenmd.,offered rental.(Sec.7044,Business . 0 0
and Profcvioms Cade:The Conuacmr's License law does not apply m an Owner of Required IDSpeCt10OS
propenywho builds or improves themon.andwho doessuchwork himself orthrough his
own employees,provided Natsuch improvements ane nmimmirded oroRered far sale.If.
however.the building or improvement is mid within ane year of completion.the owner.
Wilder will have the burden of proving that he did not build or improve for purpose of
It".
1.as owner of the property,em emlmively cramli
nung with licemtra
ed contractors 10
an et the project(Sec.7W,Business and Professions Code:)The Contractor's U.
ccae law dues not apply to an owner or property he build.or improves thereon,and
who contracts for such projects with a Common (s)licensed pursuanOo OR,Contnetoes
License I.
❑lam exemptu c. B&PCfor this mason
nor
D.
WORKER'S COMPENSATION DECLA0.ATION
1 hereby srRrm under penalty of perjury arc Or the following declarations:
0 I have and will mainnin aCenificam of Consent to self-insure for WorkefsCompen-
ration,in provided for by Section 3700 of do,Liber Code.for the performance of the
work for which Nis permit is issued.
0 1 have and will maintain Worker's COmpermilm Insurance,in required by Section
3700 of the labor Com,for the Performance of the work for which this Patent is issued.
My Worker's Compensation Insurance carrier and Policy number am:
Carver: Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE _
(Tussection need not becompleted if the pumil is for mm hundred dollen(SIOD)
as less.)
1 cattily that in the performmce of the work for which this Permit is issued,I shall nut
employ any person in any mannerso As in become subject o the Workcrk Compensaiton
Laws of California.Dim
Applicant
NOTICE TO APPLICANT.If.after making this Comicam of Exemption.you should
become Subject in the Worker's Compensation previsions of the labor Code,you most
O foMwith comply with such provisions or this permit shall be doomed naked.
„zy y CONSTRUCTION LENDING AGENCY
[—r Ihereby Am.Nn Nen iia mnstonsam lending agency for the pcvermancc of
C> the work for which thin permit is issued(Sec.3097,Civ.C.)
W�Q Lunette's Name
Lender's Address
U C) I curtly that I have read this application and sum that the above information is
IL crammer.1 agree to comply with all city and county adinartma and stem laws relating to
U
building Construction.donvoand hereby¢Nop rposes. 'siva or Nis city to enter upon dm
W above-(We)agree
progeny for inspectiontorApurposes.
gys (We)agme to save,indemnify and kith harmless the City of Cupertino against
M Ilebilides.juegments.costs and experuet which may in any way eceme against mrd City
U 7 is C."AcSymije of Ne Starting of this permit.
r1- SPP CA E UNN AND WILL COMPLY WITH ALLPOINT Issued by: Date
Signature or po^ ter /6
plic�anlCD C Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant atom or handle harudous material
as dcOmed by the Cupertino nmlpal Code,Chapter 9.12,and the Health antl Safety
ode,&ocdon 25332(a)1 All roofs shall be inspected prior to an roofing material beim Installed.
E]yes iron P P Y g g
If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant o,fol building by the Bay Area
on devices which
emir ier'ruenus air contaminants ss defined by the Bey Area Air Quality Managcmenl all new materials for inspection.
District?
Yes
I have mad Ne huarma mamrialsreyuiremcnts under Chaplcrb.93of the Califon
Am al ode. ' rss 25505.3 33 and25534.1unmmundthaliflholoulding
dc s nal rally m ra t. t it i y reap.rould ity w notify cmupant^f Nc
re titre cntswh st nor ssanccof.c'mricamof c. /t Signature of Applicant Date
Owner Or authoris ant Tec
` All roof coverings to be Class"B" or better
CITY OF CUPERTINO CON 'RA. +I .i
BUILDING DIVISION PERMIT 4,, ,r , .y _ .l.rev
BUILDING ADDRESS: CENTEX HOMES PERMIT No 04080129
NER'S NAME: PERMIT ISSUE DATE
AEWS NAME:
NE: SANITARY �ftOL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
uoo LICENSED CONTRACTORS DECLARATION Job Description
�S FF;j 1 homey affirm Net 1 am licensed under provisions Of Chapter 9(commencing
^ E with Section 7")of Division Sof the Business and professions Code.and my license is
to
full
semmeanaerre '
C REVISION--PORCH DETAILS
I Dam Contractor NO NEW PERMIT ISSUED/ ORIG. #04030082
Iqq--
AR TECTS DICKAlAag
�y'eZ i understand my plans ahull he used as public mune,
otoC
3
m LLOLicensed Professional <
8 OWNER-BUILDER DECLARATION Vl/1
a� I herchy affirm that 1 am exempt from the Contractor License Lew for the p
E0 O following reason.(Sccdun 7031.5,Business and Professions Code:Any city or county V
+�$ which mquman a permit to construct.alter,impmws.demolish,or repair any Sio=Uro
prior In its issumcu,elm¢quires the applicmtl for such permit to rile a signed statement
that he is llemned pursuant to the previsions of the Contractor's Licenm Law(Chapter 9 Sq.Ft. Floor Area Va a[ion
$ (commencing with Section 7000)of Division 3 of Ne Business and Professions Com)ur
that he,is exempt therefrom and the basis for N.alleged exemption.Any violation of $11 C3
Section 7031.5 by any applicam for a permit subjects the applicant to a civil penally Of APN Number Occupancy Type
tet more than five hundred dollars($500).
0 1,u awnu of the pmperty,mmy employees with wages u theirmle mmpenudon,
willdo Bre work and theswaum is nuimenmd.,offered rental.(Sec.7044,Business . 0 0
and Profcvioms Cade:The Conuacmr's License law does not apply m an Owner of Required IDSpeCt10OS
propenywho builds or improves themon.andwho doessuchwork himself orthrough his
own employees,provided Natsuch improvements ane nmimmirded oroRered far sale.If.
however.the building or improvement is mid within ane year of completion.the owner.
Wilder will have the burden of proving that he did not build or improve for purpose of
It".
1.as owner of the property,em emlmively cramli
nung with licemtra
ed contractors 10
an et the project(Sec.7W,Business and Professions Code:)The Contractor's U.
ccae law dues not apply to an owner or property he build.or improves thereon,and
who contracts for such projects with a Common (s)licensed pursuanOo OR,Contnetoes
License I.
❑lam exemptu c. B&PCfor this mason
nor
D.
WORKER'S COMPENSATION DECLA0.ATION
1 hereby srRrm under penalty of perjury arc Or the following declarations:
0 I have and will mainnin aCenificam of Consent to self-insure for WorkefsCompen-
ration,in provided for by Section 3700 of do,Liber Code.for the performance of the
work for which Nis permit is issued.
0 1 have and will maintain Worker's COmpermilm Insurance,in required by Section
3700 of the labor Com,for the Performance of the work for which this Patent is issued.
My Worker's Compensation Insurance carrier and Policy number am:
Carver: Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE _
(Tussection need not becompleted if the pumil is for mm hundred dollen(SIOD)
as less.)
1 cattily that in the performmce of the work for which this Permit is issued,I shall nut
employ any person in any mannerso As in become subject o the Workcrk Compensaiton
Laws of California.Dim
Applicant
NOTICE TO APPLICANT.If.after making this Comicam of Exemption.you should
become Subject in the Worker's Compensation previsions of the labor Code,you most
O foMwith comply with such provisions or this permit shall be doomed naked.
„zy y CONSTRUCTION LENDING AGENCY
[—r Ihereby Am.Nn Nen iia mnstonsam lending agency for the pcvermancc of
C> the work for which thin permit is issued(Sec.3097,Civ.C.)
W�Q Lunette's Name
Lender's Address
U C) I curtly that I have read this application and sum that the above information is
IL crammer.1 agree to comply with all city and county adinartma and stem laws relating to
U
building Construction.donvoand hereby¢Nop rposes. 'siva or Nis city to enter upon dm
W above-(We)agree
progeny for inspectiontorApurposes.
gys (We)agme to save,indemnify and kith harmless the City of Cupertino against
M Ilebilides.juegments.costs and experuet which may in any way eceme against mrd City
U 7 is C."AcSymije of Ne Starting of this permit.
r1- SPP CA E UNN AND WILL COMPLY WITH ALLPOINT Issued by: Date
Signature or po^ ter /6
plic�anlCD C Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant atom or handle harudous material
as dcOmed by the Cupertino nmlpal Code,Chapter 9.12,and the Health antl Safety
ode,&ocdon 25332(a)1 All roofs shall be inspected prior to an roofing material beim Installed.
E]yes iron P P Y g g
If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant o,fol building by the Bay Area
on devices which
emir ier'ruenus air contaminants ss defined by the Bey Area Air Quality Managcmenl all new materials for inspection.
District?
Yes
I have mad Ne huarma mamrialsreyuiremcnts under Chaplcrb.93of the Califon
Am al ode. ' rss 25505.3 33 and25534.1unmmundthaliflholoulding
dc s nal rally m ra t. t it i y reap.rould ity w notify cmupant^f Nc
re titre cntswh st nor ssanccof.c'mricamof c. /t Signature of Applicant Date
Owner Or authoris ant Tec
` All roof coverings to be Class"B" or better