04030119 CITY OF CUPERTINO T
BUILDING DIVISION PERMIT RECO;\.ixCT04�I05tMAT10,\N
�.a_.tai >•azt+ . oma.s.�g. s",;:?
BUILDING ADDRESS: CENTEX HOMES PERMIT N%4030119
20601 MURANQ CIR LOT 48
OWNER'S NAME: PERMIT ISSUE DATE
CENTEX HOMES 2527
ESANITARY NO. CONTROL NO.
925) 415-1600
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0Op LICENSED CONTRACTOR'S DECLARATION Job Description
i u� 1 kreby affirm dun 1 am lkcmcd under p ovistam of Chapter 9(co come g
widr Scedon 70lp)afDi ipn3af the Butiness C icevc is
eta Lmumreeanderr s f SFDWL-3 STORY (PLAN 2)
LM 4 Liccnsc Clsss �tt Lk.N
q onto Contractor LIVING 1753/GARAGE 477 SQ FT
ARCHITECT'S DECLARATION
1 undemand my plans shall k used in public records
Z'u
3 G S Licensed Professional
OWNER-BUILDER DECLARATION
.i i E 1 hereby affirm that I am exempt from she Canuactor's License law for tk
S O o following¢assn.(Section TID 1.3,Business and Profusions Cads:My city in county
$ which requires a permit to construct,akr,improve,demolish,or repair any stnaxum
prior to its issuance,also requines the applicant for such permit to file a signed transport
t�<
that he is licensed pursuant m the pmvisi..nfshc Contractors Lima.law(Chap.9 Sq.Ft. Floor Area V EI@7286
as (commencing with Section 7000)of Division 3 of the B usiness and Profasiam Curtail or v�
that k is exempt therefrom and she basis far the alleged eaempu0n.Any violation of
Sa.n 7031.5 by arty applicant far a permit subjects the milleant m a civil penalty,or APN Number Occupancy
not port Nan five hundred dollars($5001 P Y Type
❑Las owner oldie property,army employ=wish wagaas shermic compensation, 36619076 ' 00
will do the wok,and the scrumsre is notinundcd proffered forsale(Sec.]Oat.Business
and Professions Cade:The Contractors Lir'. es,a law donot apply in an ow=of Required Inspections
m
ppeny who buildscrimproves Nermn.andwho doessuchwok himselfor Waugh his
own employ=,povided Nat such improvements are not intended oroRered for sale.If,
however.the building or improvement is sold within one year of completion.lie owner-
builder will have tk burden of proving dol k did asst Wild or impose for purpose of
const FINALE®
❑1.as Owner of the ptoperi,am exclusively contracting with liccnud convectors to
construct she project(Sec.7044,wner oft and Profusions Cade:)The Contractor's Lid
cense Law d=not apply ban with
orpmbox(s who
ce seridsor Improves Comma,and,
who contracts(w such projects wish a canvacmRs)licensed pursuant o Ile ConvectorsLice ��
0It=v" APR 2005
Q lam exempt under Sca ,B&?Clot this reason
Owner Data rzp
WORKERS COMPENSATION DECLARATION 's U I r �I�\�V�
n
1 Mosby affirm under Penalty of of perjury one of the following declarations: I�.�L1-0 ��-.tj�
Y
1 have and will mar by etionCeptificano37M of 6,L Labor
for Workers Compcm
section,as hick this
(err a Section 3]00 of the labor Cade,for the peRormaac of nhc
wok for which Nis permit is issued.
❑I have and will mainuin Worker's Compendium.Inver .as required by Smfion
37W of the labor Code.for the performance or the wok for which this permit is issued.
My WmIm' Com sa`lti/m�a liox ince o and Policy nu/mb�r�asr� /
Carrier.�Zf �C// Polity NOWWORKa /� V
CERTIRCATEOOMP E%EMPI'I NN FROM WORKERS'
COMPENSATION INSURANCE
(This stains need not W complced if tk permit is intone Wndmdd.11ats($100)
or less.)
I eenify Net in the performance of the work for which this permit is issued.l s1ull not
employ any person in any manner o u in become subject m she Workers'Comfcnsauon
Laws of California.Date
Applicant
NOTICE TO APPLICANT.If,after making this Cenifica,of Exemption,you should
become subject in the Wakcr's Compensation provision,of the labor Cods,you mute
.,,Z forthwith comply wish such provisions or this permit shall k deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
[-+ I kmby dlUm than Vert is a construction lending agency far the Performance of
fY the wok for which this pcnnit is issued(Sec.3097.Ci,C.)
ILl A Undoes Name
7 z Lender's Address
U 0 1 certify the 1 have road this application end sou that she above information u
Uy P morcell agree to comply with all city and county ordinances and mute laws relating in
pU Wilding construction.and hereby.whorim mincamomms of this city in an=upon she
akvomentiuned pmperty for inspection purposes.
F 4. (Wo)agree to save,indemnify and kap himplears
an w City of Cupcnim id City
h incoflabiliuu,judgmcnt,costs and expenses which may in any way name against said City
UZ Aconsequence UNDERSTANDS
of this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON INT ISSue 6Y; Date
SOUR E E/��l9LAT10N5. n
=` e-roofs
9fgnamrt o(Appli HAZt4Dyc0'US MATERIALS DISCLOSURE Dans Type of Roof
Will the applic tit or future building occupant sort or handle harasOme material
as defined by the CupertinoMunicipal Code.Chapter 9.12,and nk Health and Safety
Code,Section 255320)?❑Yes �}(�/� All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection,I
Will the applicant or future Wilding=noun,esu c9uipmcm or devices which g agree to remove P
I'll havardnus air mroaro tri t as Med by thc Bay Area Air Quality hime,crium all new materials for Inspection.
District?
❑Yes No
I here mad the hvardous materials requirement under Chapter 6,95 of the Califon
ria Hcalib h Safety Code,Sceuom 25M5,25533 and 25534.1 understand Nat if the Wilding
d=not cuncnnly hast aenanL Nat u m my respond ild a oily the occupant of Na
rtyvi¢ments which mussk metprimuuaneeofaci-, of Qe /
> j Signature of Ag (cant Date !
ow rormnMrisdasem D„e L / All roof coverings to be Class "B”or better