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04020051 F"ILOINGADDRIESS: ITY OF CUPERTINO + ' .ten ` '" " BUILDING DIVISION . . -PERMIT CAIN'T"AXTQRSINk' PERMIT NO04020051 4020051 OWNER'S NAME: PERMIT ISSUE DATE SARON GARDENS , T.T.r ONE: SANITARY G. /Qg'/2i'A*0111. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELELT PLUMB MECH a 0 0 0 +�aop LICENSED CONTRACTOR'S DECLARATION EY 1 hereby affirm that I am limned under provisions of Chapter 9(commencing Job Description a wish Smtion7000)nf DivisiW .fdm Busigysand Pro(cuiuns CoQc,and my][can _ in full fo���.p9¢clfea K �/ 7/J3 5�? Llcenus9IId'��tie.« TEMP: POWER POLE w qqq Dam /G/7Y eonmacme CONTRACTOR: CENTEX HOMES FINALIEO �� CHI ELTs I t�Htlafsund my plans shall he used tic ads al �7 3° Learned Pns(cui...I MAR 1 0 2004 OWNER-BUILDER DECLARATION E0 2 I hereby.('Siem Not 11. exempt from On Contractor's License Low for the �a� O O which ng reason.(Semon]1151.5,Business and Ihnfassiou Cade:Any city armory NG which requires a permit re pain s;he alcor,improve,de ant limimh armil l m repair any atement �uaa FZy Pnonois ccoved,momiatt.the pirmniapplm.fO.C.norcrmiuo rete.Loadssmment Nat heir licensed pursuant to Nc of Divisionf theeBusintorind Proilaw(Chepmr9 Sq. F[. Floor Area ValuatiQp4OO $ Oammene (commencing therelon iment and basis far artheeed...epton.Anynns Cnde)of 4 Oat he B exempt therefrom and the buss for the alleged exemption.Any violation of Section 7051.5 by any applicant for a permit subjects the applicant to a civil penally of APN Number Occupancy Type not mom don Ove hundred dollars(5500). 36619048 . 00' ❑1,u owner of tW property,m my employees with wages u Neirsole compenution, willdo@ work,and NaammumsnotintendedmoQemd(orsale(Sec.]OM,Business .. and Profen min Code:The Cansactors License Law docs not apply in an owner of Required Inspections property w ho bui Ids or im proves Neuron,and who does such work hlmwlf or through his own employees,provided Nat such improvements arc not Intended"offered torsade.If, however.the building or Improvement is sold within one year of compdeson.the owner. Wilder will have the burden of proving that he did not Wild or improve for purpose of tile.). 6 1.as owner of the property.am exclusively contracting with licensed mnvacmns to construct the project(Sec.7044.Busineu and Professions Code:)The Conmc(or's U- ' tense law does oat apply to an owner of property who Wil s or improves damen,and who contracts for such projectswith aeontracmr(s)lke puravammthe Cormistmfs _ Lines.Law. ❑l an exempt under Sec. A ,B&PCfor Ph.re n Owner Data WO 'S CCMRNSATInN DECLARATION hereby am under Penalty of perjury one of thf i).g declarations: \i 1have and will marry a Smile. 3mm of ConsentmCode.far for Worker'sne of cm worn, r providedhthis for by Ss issued.]700 of the Labor Code.for the pedarmanm of the work for which Nis permit is iuvetl. ❑I have and will maintain Warkess Compensation Insurance,an required by Section 5700 of the labor Code,for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy numberam: Cartier. P-414el� PolicyNe.:WG ;'y'V93y CERTIFICATE OF EXEMP71ON FROM WORKERS' COMPENSATION INSURANCE (Thiess brat need not iremorpi ed ifthe permit le i.e.hundmddnllus(SI00) or less.) 1 certify Nat in to performance of the work for which this permit is issued.I shall nm employ any person in any manner m as to become subject to Ow Workers Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the labor Code,you must ,J O forthwith comply with such previsions in this Permit shall be deemed revoked. z "" CONSTRUCTION LENDING AGENCY 1 beach,alarm Our Nero is a consvucann lending agency for the perfurmanm of the work fm which this permit is issued(Sec.3W7,Civ,C.) Q Lattices Name D Z Ianim's Addnas t.7 Q 1 certify that I have mad this application and state that the above information is H correct.I agree to comply with all city and county eminences and state laws relating to Q V building construction.and hereby audience representatives;of this city in enter upon the �u] above-mentioned property for inspection purposes. ;!!F We)agree to save,indemnify and keep h the City of Cupertino against q,judgmcns.cuss and expenses whit in any way acme against said City quence of the Starting iCANT UN ST�mS' L COMPLY WITH L�INT Issued by:S �&L DateCE R�Pip _ Re-roofs A" HAZARDOUS MATERIALS DISCLOSURE Date Type of Roof sail applicant or future building occupant stow or handle hazardous material by the Cupenino Municipal Code.Chapter 9.Iz.and the Health and Safety [3 en zss5zca)7 ��//'' All roofs shall be inspected prior to any roofing material being installed. Ycs QJ NeWill the applicant or ffu`ture building occupant use midpment or devices which If a roof is installed without first obtaining an inspection,I agree to remove zardous air cenlaminanu u dcOncd by the Bay Area Air Quality Management all new materials for inspection. Disuict7 ❑Yes j4Nu I have mad the haeumnws materials re camderChapt,6.95ofOnCalifon- nxHmlth&SafctyCmc,Sm d 25554.1 command that if dm Wilding does not cumiyn �a mapouihili(y m re fl'y cempant of the rcyuimmcntsdhi nanmoraceniricamn m < Signature of Applicant Date ' Ow r as zed agent cafe All roof coverings to be Class"B"or better CITY OF CUPERTINO .; Z TEMP POWER © S� UPEkTINO PERMIT APPLICATION FORM APN# � 6 � n Dater ^ D Building Address: Owner's Name: Phone#: �d�e o �r.e�y/S LLC 72S-- 7(>6—SZSZ Contractor: Phone: License #: Contact �e Phone: Cupertino Business License #: JJ ,& 9. 5 Building Permit Info: Elect ❑ 7e <vP/ �/e Job Description: Residential K Comm rcial ❑ Cost of Project: 1 Qty!if A lic ble Fee ID Fee Description Fee Group \ BTEMP Temporary Power ELECTRICAL EPERMITFEE Elect. Permit Issuance ELECTRICAL j BUSLIC Business License BUILDING