04110138 CI TY OF CUPERTINO
BUILDING DIVISION` PFiRI�IT _.._• 4,0
LO �l', alYi� yv� - p�
EUILDING ADDRESS: CENTEX HOMES PERMI7,N V4'1 I0�.3��
7308 RAINBOW DR
OWNER'S NAME: PERMIT ISSUE DATE -
CENTEX HOMES 2527 CAMINO
E; SANITARY NO. - CONTROL NO.
(925) 415-1600
ARCHr1ECDENGINEER: • BUILDING PERMIT INFO
.. - BLDO" EI.BCi' PLUMB MECH -
'+10Q LICENSED CONTRACTOR'S DECLARATION - Job Description
fl 1 it
"nor that I am limnactl under provision,of Chapter 9(mmmenc9ng -
n�2 with Section by
hereby
Division Sof the Buslrauss and Profcasmu Code,and my Become is
in mu muse aneeGea SITEWORK/ELECT/T FORMERS _
M_ License Lim I.m.gALE®
9 Dam Contractor __
ARCMITECI'E DECLARATION
'� 1 underwnJ my p4na alNl K uicd u puNic rccnrds �V
9a. Limensod Professional
OWNER-BUILDERexeptDECLARATION L 06
f I hereby aGirm Jut I sus exempt from the Canuauors Iicanw Law for the -'- - - - - -
as following mason.(Section 70113,Busimas and Promumu Cale:My city Of=my _ .
which mquims•permit to emnruct,alcor,i.p..demolish,car repair any.,met.. gil -,0000
1-Z'yn prior m to issuance.alto requires the applicant for such permit to Ole a signed Moment
< ow he is licensed pursuant to the provisions of the Cmuecmrs License law(Chapter 9 Sq.Ft. Floor ABU Valuation _
a (commencing with Section 7000)M Division S often,Burnessand premium;Cuticle,
that he ts.pt,M.wf..and the basis for the alleged v^ptim.My to1Wm of
Sermon 7051.5 by any applicant for a permit subjects the applicant o a civil penalty of e 0 - - - - --Occupancy Type -.
not mom than Evehundme dollar(51001.
❑i,u owner o(Jte property.m my a rmloycu with wages as theirsolecompenudon, -
wllldo thework.aM thesuuaum la nainmMW moff,md forum(Sec.7044.B"res,
and Profmalaes ra
Cade:The Camemn Licem na
License Law dal apply man owner or Required Inspections -._c:Lliz_
'propenywho builds or impurcuthemen,andwhodoevuchwerk himsel(arthrough his
own employees,provided that such Improvements are our Intended maQered for me.If. _-
hawevan.tho Wildingorimpmwcn,iswldwithinamyeuofmmpledm,Lhawu.
builder,will have the burden of proving Wt he did not build or improve for purpose of
ssle.).
t. an,owner of the property am exclusively Contrcting with licensed conuaaan he
C 1.1 the project(Sec.7044,Business and Rafeams.Code:)The Conoacu U• .. -
«rue Law does noupply manowner ofproperty,who Wilds crimprovcs thenen,sed. + '.-' •-'-•
whocontucts msmhprojecu with a conuamoNs)licensed pursum m the Connattoh
Law
❑tun see tootle,Be B&P C for this means
a, Dame _-
W KENB N DEC RATION
1 hereby affirm under penalty of perju o owt decls adorn:
1 hew and will milnW n e Certificate of 6nuumt to self-Iuum for Worker's Compere- '
cation,as provided for by Section 5700 of the Labor Code.for the performance of the
work for which this permit is issued.
1 have and will maintain Weakeh Compensation Insurance.as required by Section -
5700.1'the Mbar Cad..for the pedormanee of the work for which this permit is income. '------- __-_ -
My Worker's Compensation hummuct,curler and Policy number am:
Caller. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This sectim nmdaat be completed lithe permit is foranehummul dollen(5100) •-cur I..) _
I certify that in the performance of the work for which this permit is issued.I shall not
employ any person in any manner w as he become subject to the Workers Compeesadan -- - - - _
Lawsof CalifomL Dam '-
Applicant
NOTICE TO APPLICANT:If,after making this Cenificatc of Exemption,you should -
become subject to the Worker's Component provision of the lobo Cade,you maw
,JO forthwith Comply with such provision a it
this permshall M m
deeed revoked,
Z` CONSTRUCTION LENDING AGENCY
EIbereby.M.that them sea consumerism ism lending agency for the perfumn> the work for which Rets permit ts same(Sce.3097.Civ.C.)
LL7 ELemurs Name
gl z Lemm's Ad =a .
U C 1 cenify pts,l have read this application am Lute that the also.infon Atha.is
um correct,lag=to comply with all city and county ordinances and Nm laws misting m
ob building construction.and hereby authorize repeosenutives of this city as come upon the
W .hove-mentioned property for inspection purposes i
�'gL I (We)agree to save,indemnify and keep harmosts the City of Cupertino against
V) IlabiliJ Jmgmems,cmtsandesperum,which may in anyway acermagalestuld Cityhe , nee of the
U nning of
APP ANTI UNOENuTANDS AIND00!LL COMPLY WITH ALL NON-POINT Issued by: Date
SO REGULATI I
1 Re-roofs
Ill-mum o ApPli JC .acme amIy' of Roof
H RDOUS MATERIALS DISCLOSURE -!pe
WIIl tic applicant m forum Wildin omupanuum or lundlc haumoes material
u defend by the Cupertino Municip ode.Chapter 9.11.and,he Health and Safety
1�tij,f2
n,Sccu..25531(.)7 All roofs shall be inspected prior to any roofing material being ins Iled.
Yes o
WRI the applicant or fuwm building occupant caw equipment or devima which If a roof is installed without first obtaining an inspection,I agree to remove
t havardWs air conuminanu u Je ed by tho Bay Area Air Quality Management all new materials for inspection.
❑Yes
Rha.rcW the huaWnes muedals mquimmems underClupter,695 afJm Cilifonlth&SaictyCade,Section,25505,25555 am 25534.1 undernom dad Yore Wilding
of currently hsve.tenses.that It' my mapoulhill,y m notify the occupant omen hleh unlsemapnor wwa0r esti eco 61 Signature of Applicant Date
(/p(.� ,
04tr�cWlaudhori,Aagent Date All roof coverings to be Class"B"or better