04030084 CITY OF CUPERTINO
BUILDING DIVISION PEPMIT CON TRAOTORANF®RMATION:
PWBUILDINGADDRESS: CENTEX HOMES """'04030084NER'S NAME: PERMIT ISSUE DATE
E: SANITARY N CONTROL NO.
ARCH I'IECDENGINEER: BUILDING PERMRINFO
BLDG ELECT PLUMB MECH
Loo LICENSED CONTRd swear
SOECons of chapter
Yw I hereby arrrm that I as licensed urvder pronsnifoAnsuio��fvCNpmr 9(common ing Job Description
<ZR with Scclian7").f Softhc Business iJ Co dmyh is
a« in full fo mderc
L cn , , A SFDWL-3 STORY (PLAN 4)
o Dam - antramr VING 1836/GARAGE 400 SQ FT
I undcrsswd my plans shall he usedaspuhlicn nrds REVISION--#04080131 (PORCH DETAILS)
LL� Licensed Pntfessim al
gO OWNER-BUILDER DECLARATION
3 i I 1 hereby affirm that 1 am exempt from the Conuacso's License Law for the
—
00 following mason.(Section 703 1.5,Business and Professions Code:Any city or county
which mquims a permit to<nuwct alter,improve,demolish,or repair icy structure
prior in its issuance,also re uims the applicant forsuch permit 10 file a signed statement
5 that he is Licensed pursuant to the provisioner the Co..,.'.LicenseLow(Chapter 9 Sq.Ft. Floor Area Valuation
¢mF$ (commencing with Section 1000)of Division 3 of the Business and Professions Code)or
that he is exempt therefrom and the basis for the alleged exemption.Any violation of $214700
Section 1031.5 by any applicator for a permit subjects the applicant to a civil penalty of APN Number Occas
nor mom man Am hundred dollar(M). Panty Type
❑I.uownotofthepmpeny,mmyemploycaswithwaguutheirwleeompcmdm.
will do Oe wok,and the awctute is not intended mroQend forsale(Sao.70",Business 36619076
and Professions Code:The Cmmacu is License Law does not apply to an owner of 0 0 Required Inspections
property who builds or improves themen.and whodassuch workhimselfortlwugh his HAA
ownwa.a cea,provided that such improvements arcnot intendedmpleend formic. �ai
ownevv,oy buildingde that su himissoldwithinoro year d compledorofftim.thenwmr-
builder will have the Immim of proving that he did not build m improve for purpose of
sale.).
❑1,as owner of Ne property am exclusively contracting with licensed contractors in
couwct the project(Sce.1044,Business and Prufcsfions Code:)The Contractors Li-
ce �� va005
nse Law does m not apply an motor of property who builds or improviserre
theon,and MAY L
who contracts for such projects with a contracmr(s)licensed pursuant to the Contractors
License law,
❑ 1 am exempt under Sec .B k P C for this masmn �'r�
Owr Data
WORKER'S COMPENSATION DECLARATION L.
1 hereby affirm under pmadly of perjury,one of tie following declanuou:
have and will maintain a Ccnibcate of Consent to self-insun for Workers Compete
sebar.as provided fm by Section 3100 of the labor Code,for the pertmnts.of the
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation I..,as requited by Section
37M of the Labor Code,fm the performance of the work for which this wmtit is Issued.
My Wor C. ..due lns''un cannot and Poiiq number
Carrie Cy"' Polity No.:
CERTIFICATE OF E%FMPIION FROM WORKERS'
COMPENSATION INSURANCE
(This scrim wed not he completed if the permit is for one hundtedd.11.(5100)
less.)
I certify that in Ne performance of the work for which this .it u issued.I shell not
employ any pawn in any manner so as to become subject to the Workers Compensation
Laws of California.Dam
APPlusum
NOTICE TO APPLICANT:11.after making this CeniOczte or Exemption,you should
become subject Le the Wmwr's Compensation provisions of the Labor Code,you mon
.Jz forthwith Comply withsuch provisions or this permit shall he deemed revoker.
zO CONSTRUCTION LENDING AGENCY
[-+ Ihcmby affirm that then is a construction lendingagere,fm Neperrurmmucuf
7a the wash fm which this pemit is issued(Sec.3091,Civ.C.)
Wa Lenders Name
z lender's Address
U O 1 certify that I have rad Nis application and sum Nat the atom information is
LL P correct I agree w comply with all city and county ordinances and state laws elating to
0U building construction,and hereby audeodm nepresenceites of this city to enter upon dhe
ahmvedes,juoned propertyest for inspection purposes.
F a (We)agree m sue[.Indemnify and Fop hmmkas the CITY of Cupertino against
I,, in
f ts.the corking ex ponscamit. may in any way eccmc agelnB said City
�)z A APPLICANT
of the granting of this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NO -POINT Issued by: Date /
RE L TION O - POI
a-roofs /
ngnatsm,of Apph.mJ actor Dam
H BOGUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code.Oupter 9.12,arW the Health and Safety
code. ltiea2ss3x(a)1
EYea !�'t(B,/�i— All roofs shall be inspected prior to any roofing material being installe .
If a roof is installed without first obtaining inspection,I agree to remove
Will the applicant or town Wilding wcupam sew equipment or devices which g anns P
havardous air contaminants u defined by the Bay Arca Air Quality Management
1V1L1, all new materials for inspection.
C3 yes RNu
Ihavcmad Cev doma M5.25quin 255M.I Chapmrb if Wild,,
nitss sen SafctYCedc,sccdmns x5505. my ammailuj.l.werMdwifdc building- J CJfi/
docs t c only ham a tenant.mar it u my rcapvnsihilitY w ratify the pant of the
m fine s �h,B asstbo me 'orwissu ofa 'fica¢p(pC //
gnature of Appli cit Date
Owner or authorind agent D,te Al I roof coverings to be Class'B"or better