04030102 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR�IN 'URMATION fir,
BUILDING ADDRESS: CENTEX HOMES PE ""'04030102
20593 MURANO CIR TOT 50
OWNER'S NAME: PERMIT ISSUE DATE
CENTEX HOMES
E: SANITARY NO. CONTROL NO.
(925) 415-1600
ARClmECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECTPLUMB MECH
0 0 0 0
moo LICENSED COMRACTOR'S DECLARATION
u❑ I bermy affirm Wt l an Bmvcd under provisions of aspect 9rrr999 mcncing .Job Description
�W with Section 7")of on 3 of an Business iters der.a yliccneeis
infuumreamoff "`m SFDWL-3 STORY (PLAN 5)
D Z License Class Lia.x
—o Dam Contractor LIVING 1992/GARAGE 430 SQ FT
W ARCHITECTS DECLARATION
4y a, 1 understand my plans shall he need as public records
D-U
G� Littoral Profcssionel
5 OWNER-BUILDER DECLARATION
<F I hemhy affirm that I am exempt from We CanuacwYs License Law for the
O oyfollowing reason.(suction 703 1.5,Business and Profeamms Code:My city or county
which RgWRa a permit to toMWet,alter.Improve.demnRib,an repair my RWGWR
FZi prior m its iauarwu.alsu requires the applicant for such permit to file a signed statement
< deal he is licensed Pura,.,I.the pnivisiouof the Committee Uccma Law(chapter 9 Sq. Ft. Floor Area Valhi
�Fa (commencing with Section7MW of Division 3 offle Business and Professions Code)or ttsm OO
that he is oacmpt therefrom and tW bun far the alleged ewnpdm.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to s civil penalty of AISN Number }' Occupancy Type
our mare than low hundred dollars(S500): 1 a
❑1,u owner of the property,or my employees with wages as their sole compensation. 36619076 . 00
,ir#. G
will do the world and the srr turn is an,intended a offered for sale(Sm.70".Bulinus
and Profusions Code:no Conuacwr's Licemet law does tot apply to an owner of Required Inspec ons
property who Wildsorimperves theeon,and whodoessuch work himselforthmugh his
own cmploycue,provided Nat such improvements are not intended oroffemd Immk.If. / a
however.the building or improvement is sold within arc year of rompledon,the awner.
Wilder will haw the Woman of proving Nat he did not Wild or improve for purpoee of
ata.).
❑I,as owner of area property,am exclusively contracting with licensed contractors to bay
couwn the pmjo (Sec.]Dace,Guiness and Professions Code:) ,n Convertor.Lid
cones,IsAy6q a
ceo docs not
apply an owns of property who Wilds or impmws more,and.
contr \V/f77fC�/J Initr7[]/
who acts for such projects vac
a conwr(s)Iicenfarmersfarmers m Co
the CanuacmYa
Licence Law.
❑Tem exempt undo Sec. ,B&PCfor this mason
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm under poll,of perjury one of On following declarations:
I haw and will maintain aCcrufinre of Consent to air-insure for Worker's Compen-
rasion,in Provided for by Section 37W of the Labor Code,for the perfonna rm of the
wok for which this permit is issued.
❑1 haw and will maintain Worker's Compensation Insurance,as required by Section
37M of On tabor Code,far an performance of the work for which this permit is issued.
My
61
Camerr CERTIHLATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Cra sermon need not be completed i r the permit is for one hundred dollars(SIM)
less.)
I certify Nu in We performance of We work for which this Permit is issued.I shall not
employ any person in any Unmoor so at to become subject o the Workers'Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of FincoNiM you should
become subject to toe Workers Compensation provisions of We Labor Code.you must
.J z foMwill comply with such provisions or Nis permit shall be duumcd mwked.
E(7 CONSTRUCTION LENDING AGENCY
(-+ I hereby alarm dere ft.is a co.war atone,,for the famfurmanceaf
CL►
We work for which this pnmit is issued(Sec.3YO,Civ,C.)
W rs tandcr's Name
.a7 z Lender's Address
V Q I comfy Nat 1 have read this application and scale Nn dm above imcbrodun is
U. correct.1 agree m comply with all city and county Odiamas and sole laws mlming w
O V Wilding construction,and hereby authorise representatives of this city an enter upon dm
f33 a ow-mentioned property for impaction pugmses.
'C (We)agree w ave,indemnify and keep harmless the City of Cupenino against
In Iiabilitiu,judgments,cuts and cx1 .which may in any way game against aid City
U Z in consequence of the gaming of this Permit. Igg d b
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NONaPOI� y; Date
SOV
REGULATIONS.
G
07
ignewmafApplicDate e-roofs
HAZARDOUSMATEALSDISCLOSURE
RI , Type of Roof
Will We applicant tar future building oaupset store or handle hamrdous material
in refund by the Cupertino Municipal Code.Chapter 9.13,ave ththe Heaand Safety
Code.Sermon 23533(a)?
❑Yn X All roofs shall be inspected prior to any roofing material being installed.
OWill the applicant or future building Occupant use equipment or dsviar which If a roof is installed without first obtaining an inspection,I agree to remove
il havardons air comemina e as unlined by IM Bay Area Air Quality Management all new materials for inspection.
Dinner?
❑Yesv�
IhavemanthehcaSmu aleri,ls requiadm Sunder ChapterGaLifc Wilding /%
rias mooh Safety Code.Sada,25X15,35yrom25534.1 to ofnt thatifthe Wilding _ /' /
docsnmcurcnuyhow a Imam 0-1 itr my lespmtsihilitywwtify th<aeup for dle
m�t uyrme tonic mutt h met prior w issuance oCe kale of Occu
gnature of Applica Date
Domer m,uOori,m ager Data All roof coverings to be Class "B"or better