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05060048 CITY OF CUPERTINO R '�� " �. ` BUILDING DIVISION PERMIT Cd T "C.�a `'U'. A'�.I0M,,', BUILDING ADDRESS: CENTEX HOMES PERMIT"G05060048 W NER'S NAME: PERMIT L55UE DATE IFONE: SANITARY N0. CONTROL NO, ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH o o LICENSED CONTRACTOR'S DECLARATION U 1 hmcby affirm that 1 am licensed under provisions of Chapter 9(commencing lob Description with Section 70M).f Division Sof the Dust..and Professmas Code.and my license Is in ren fame and are¢. TEMP POWER POLE License Class Lie.Is n Date Canmxmr ARCHrfECI'S DECLARATION �i 1 understand my ptans shall be used as public=am. Q u it8� Licensed pmfcasianal y OWNER-BUILDER DECLARATION 2 i 2 . 1 hereby affirm that I am eumpi from the Contractars License Law for the E m o following recon.(Section 703 1.5,Business and Profession Cade:Any city or county +�$ which requires a permit to construct.altar,improve,demolish,or repair any structure prior At its issuance,also requires the applicant forsuch permit to Ole a signed statement that he is licensed pursuant In the provisions or the Commutes License Law(Chapter 9 Sq.Ft. Floor Area Valuation z❑B (commencing with Section 7000)of Division 3 of the Buinu and Professions Code)or 3 that he Is exempt therefrom and Ne basis for the alleged exemption.My violation of .A,yyy y ,fa,y, Section 7031.5 by any applicant for a Permit subjects the applicant to a civil penally of 3 o'¢1Ra+l, Cr0 0 Occupancy Type not mom than five hundred dollars($500). C 1,as owner of the proprny,or my employees with wages as their ole emopenu0on, will do the work,and Meam¢m.1,Nthearnidmutilated rornale(Sec.7044.Business Required Inspections and Professin e nson Code:The Comsumes License law donot apply m an owner of q p property who buildsorimproves thercon,and who doessuch workhimxlf or through his own employces,provided that such improvements arc notimended oroRered for sale.if, however,Ne building or improvement mould within on year of mmple ion,the awncr builder will have the burden of proving that he did not build or improve for purpose of l,.). as owner of the property,am exclusively convecting with licensed contractors m c nsetuct the project(Sec.7044,Business and Professions Code:)The Contractors Li. cense law does not apply b an owner of property who build.m improves thereon,And, who contracts for such projects with a cont actor(s)licensed pursuant the Contractors Lkense Law. ' ❑lam ex der Sec. ,B&PC far 1167 Ow Dam WOR OM DECLARATION I hereby allism under penalty of perjury one of the following declarations: I have and will am trona C.Ream afConunl toxlGimurtfor Workers Campen- sation,u provided for by Section 3100 of the labor Code.for the performance of the work for which this permit is issued. ❑I have and will maintain Workers Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Wor can ns%iioonnalnsuuruceumicrand Politynumberart: CaMer: f/I (.rJ Policy No.: _ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thisuction need not mcamplemd ifthe permit is foronc hundred&It=(SIM) or loss.) I certify Nat in the performance of the is peyymmtissued.I shall not cmployany person In Any marenSlijitlimsmbeFeasssublFstufieWo pastures Law.of Call(osair Oah. Applicant — NOTICE TO APPLICANT:If.a(mr��l!hh eking this Certificate of Eacmplhon,you should become subject m the WorkerY CohSpenution provisions of the labor Code,you most �z forthwith comply with such provisions or Nis permit hall W Named mwkcd. z O CONSTRUCTION LENDING AGENCY [tiE I hereby Arm Nat Vert is a combustion lending agency for the performance of th work for which this permit Is issued(Sec.309'1,Civ.C.) QLendces Name .7 z Lender's Address U Q I certify that I have read this application and sum Mm the above information is 14 H comect.I agree m comply with all city and county andinames and sum laws relating to C) building construction,and hereby authorize representatives of this city to toter drum the yyhh W shove-mend...d property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of CupmNno against V;I Ilabllides,judgmenu,cuss and expenses which may in anyway acme against said City U^ in conAPPL4 NTeUNDERSTANDSof IAND his rmit.WILL COMPLY WITH ALL NONPOINT ISS y: Date —7 R E TIONS O Re-roofs SiIrmtumofAppIicarWComAml A Data HAZ DOUS MATERIALS DISCLOSURE Type of Roof Will Ne applicant or future building occupant atom or handl,havardous material ' u de0ned by the Cupertino Municipal Code,Chapter 9.11,and tiro Hcalth and Safety cad,.Schon 1ss32(a)7 Yes All roofs shall be inspected prior to any roofing material being installed. ❑ Nu Will the applicant or future building occupant use equipment or Jcvices which If a roof is installed without first obtaining an inspection,I agree to remove em it havardou air conmminen u dcMcd by the Bay Area Air Quality Management all new materials for inspection. Di.bkt7 ❑Yu I have mad the haudous materials requimmenu under Chapter 6.95 of the Court. ni4 Health&Safety Code,Section 15505,25533 and 25534.1 understand Nm if the building does not cmrtnlly how a¢nut,that it i9 my rmsponsihil' to no I. the occupuI of the require w d mpri iasdm,e amaraeupe-1 ignatureofApplicant Date Owneror authorized ag m All roof coverings to be Class "B"or better Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 coo Fax(408)777-3333 �UPEI�TINO Building Department JOB ADDRESS: PERMIT# 6 � Sps'Ob•y�- OWNER'S NAME: -S PHONE GENERAL CONTRACTOR: FAX I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date CITY OF CUPERTINO TEMP POWERCITY OF $CUPERTINO PERMIT APPLICATION FORM APN# 36 If tDate: Building Address: Owner' Contractor: Phone: License #: Con act � Phone- Cupertino Business License#: Building Permit Info: Elect Job Description- Residential escriptionjResidential Commercial ❑ CostofProject• l� • U v Qty. if Applicable Fee ID ee a on Fee Group BTEMP Temporary Power ELECTRICAL EPERMITFEE Lect. PernuLkwrnce ELECTRICAL BUSLIC Business License BUILDING •