04030120 CITY OF CUPERTINO "#
BUILDING DIVISION PERMIT GON,,RAGTOR'�INFORMATIl IN ';
BUILDING ADDRESS: CENTEX HOMES PERMIT N%4030120
20c;97 MTTRANQ ( TP T.C)T AD
OWNER'S NAME: PERMIT ISSUE DATE
CENTE
E: SANITARY NO. CONTROL NO.
2
ARCHITECTTINGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
yOp LICENSED CONTRACTOR dunit,SDECLARATION JobDescri tion
1 hereby affirm thn 1 am licensed under provisions ofs Cock. 9(commencing p
with Secuan 7IX1U)ufDivisionJofthe Businea,�rof tuns Cade.and mylic -
J � in mum n ✓' G= FDWL-3 STORY (PLAN 2)
L�Z Da¢Licen '( l Convxmr
" �CrSDECLARATION IVING 1753/GARAGE 477 SQ FT
d< I Ummvan�lansnull used!ss e uspuW.hrb.. is
oat
o G Licensed Professional
3 OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
00 fallowing mann.n .(Section 7031.5,Busumo and Profusium Code:Any city or county
u m which requires a Permit to connotes,alter,improve,demolish,or mpair any structure
_Iy poor us its issuance.a6u requins the applicant for such permit to File a signed summent
fro
that he is licensed pursuing todoe premiums ofshe Comm or'sU..Law(Chapmr9 Sq.Ft.Floor Area V" Y286
as (commencing wish Section 7")of Division 3 of the Business and promotions,Code)or
i $ Nn he u s umpt them( on and the basis for she alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy e
not more Nan five hundred dollars(SM
36619076 . 00
p y Typ
I,u owner of the property.or my employees wish wages u theb sole compensation,
will do the work and rte suucwm is not intended a offered(or sale(Sec.70x4,Business
and Prolamin.Code:The Coromandel License Law dao no,apply so an owner of Required Inspections
property who builds or improves Neuron,end who does such work himself or through his
own employe..imovidad thatsuch improvem.ts art not intended m onerod forsala LL FINALE
however.Ne building or improvement is sold within one yet of completion,rte owner-
builder wiB have 0m Wrden of paving @u Inc did tams buil a improve far puopou of o cgs
akJ. �C`■aCN❑
❑1.as owner of Nc pmpcny,sun I.ivtly Contracting win licensed mnuuors to
construct the project(Sec.71149,Business and Professions Code:)The Conuacor's mmuLi- ���
`/
came Law dw'1 not apply to an owMr of property who builds of Improvesthemon,and a�005
who contracts for such projects wish a consroo r(s)licensed pursuant the Contractors K
Lkeme Law.
❑1 am exempt under Sec. .B&P C far shis moon H
Owner Dam ��
WORKER'S COMPENSATIONDECLARATION BUIL �i -h.f t•
thereby mfr.under pwltyofperjury..of dm following deduatiume `7 \4-:.,
I Aux and will maintain a Certificate of Consent to self-imam for Worker's Compos.
anion,as provided for by Section 3700 of the Labor Code,fa she Performance of she
worst,for which this permit is issued.
❑i have and will maintain Worker's Compensation Insurance,as required by Section
37M of the labor Cade,frodso performance of she wonlc for which this penmit is issued.
My w�orkae;Compensation 1.u/m�pce ca mics and Poligynutq IaamF:���-/
CERTIFl COMPENSATIOINSURANCE FROMWOR`Ki.Cip
CrbuwctionncednotbccanpkmdifiMe misisfwanehundreddofim($]WI
ar less.)
1 cndfy Nn in the performance of she work for which this p.is is issued,l shall rot
ampl.;any person in any manners as to become subject o dm Workers Compensation
Laws of Califamia.Dam
Applicant
NOTICE TO APPLICANT:If,afar making this CeniGum of Exemption,you should
become subject to the Workers Compensation previsions of the Lebo Code,you must
.,Z forshwith comply wish such povisio.or this pcnmit shill be dcemcd.1c d.
zCONSTRUCTION LENDING AGENCY
[—� I hereby ailing that there is a construction lending agency for the porfurmsum of
!�•7
she work(w which this permit is issued(Sec.3(197.Civ.C.)
a Q Undoes Namc
=z Lender's Address
U 0 1 certify shot 1 have mad this applicnion and mute Net the above information is
0 F WiWin I agree m Comply wish all city and county Ordinances of and sum laws relating o
OW bbove-pegionedniogand hereby auNon urposec& utivcs of this city ocnmrupon Nc
C17 shove-mentioned property for inspection pugous. 1
C (We)agree to ave,indemnify and keep harmless the City of Cuycnino against ll
to liabiliu.,judgments.cestsandexpemva which may in anywayaccroeagiont aid City
t.)Z in eonsequenec of do,granting of this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Id b
_ SOURC-ERy: Date
ssue�J'iULAMONS. ,r —
G(� e-roofs
nmurt of Applic omracmr Dam
sc
AZARDOUS MATERIALS DISCLOSURE Type of Roof
Willy s applicant or future building e.Chapter
orand t e Health armamrid
as defined by she Cupertino Munici al Cade.Chapter 9.12,and the Health and Safety
Code,Section 35533(4)?
❑Yam Na All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it ha.mcus air conuminamu chimed by me Bay Area Air Quality Management all new materials for inspection.
isoict?
C]Yes Nu
It maJ thehuudwu materials mquiremenu under Chapter 6.95 of Nc Glifos z /
nixHearn&SdetyCode,Secdwu35N)5.35533and75534.lunders=dNuifne Wildin
do.not carmmly have a.nam,that it u my mipnnsibilay to ropy de occupant of she
rtquirtmcnts which mug met poor est issmnccoc`ficam�Occupancy./ / Signature of Applicant Date
owner or durhorfLed agent i — Dam All roof coverings to be Class "B"or better