04120098 (2) CITY OF CUPERTINO �"�
BUILDING DIVISION PERMIT CONTRACTORINFORMATION
BUILDING ADDRESS: PERMIT NCO 4 12 0 0 98
-11525 MURANO CIR
OWNEWS'NAME: - - --' FERMITISSUEDATE
11 CENTEX HOMES 22 /17/2004
ONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LGo LICENSED CONTRACTOR'SDECLARATION JobDescri tion
i Z C I hereby affirm that 1 ane limmaed under provision,of Chapter 9(commencing P
<U with Section'/")of Division 3 oflM4ncu
Buand Professions Code,and my license is
nfunreat.nd,film TEMPORARY POWER
j pal License Class Lic.R
n Jes Date Contractor
- - - -- .
,HARCHITECTSDECLARATION
Or I understand my plans shall W used u public records
3 o In Lkcnud Profuts...I
S OWNER-BUILDER DECLARATION
.� y 1 hereby affirm that 1 am exempt from Ne Conlmcrore License Law for the - - -
p O following ration.(Section 7(n L5,Business and Pmretiuos Code:Any city or county
X 2� which requires a Pewit to eonswct,altar,improve,demolish,or repair any structure
prior an its issuance,also requires she applicant for such pewit w file.signed sutsment
i< thathcisliccnudpursuanttothcpmvision,oftheConuactur'sLicensclaw(Chapter9 Sq.Ft. Floor Area Valuation
'k-G (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
i $ that he is exempt therefrom and sits hues for the alleged exemption.My violation of
Section 7031.5 by arty applicant fora pewit subjects the applicant a..hall penalty of
not mom Nan fits hundred dollan(S50o). ' B 4 - Occupancy Type
0 I,u ownm of tW pmpcny,m my employeuwith wage u thele mk eompenudon,
will do Ne work.and aha swnum u not intended oroRcred fossalc(Sec.70u,Bunneu
and Professions Code:The Conuamor's Live Taw does rot apply m an owner of - Required Inspections
papery who Wilda orimprowes themon,and who doessuchwork himselfortnaugh his _
ownemployera,provided that each improvements arc notimm� oroRemA forsaie,if,
however,the building or improvement is sold within core yeu of completion.the owner-
builder will have the hurdm of paving that k did oat mild or improve fur purpose of
tile.). `
,u owner of the Property,c.7044.
04.Business sis and Professions with licensed censers l- _
construct the not (Sec.toOCs,wnofandProfessionswho
Code:)The Cwdamon, red \\
canoe law don,not teen owner of paper(who Wilds or improv lemon,and
whocontractsLace for each Projects wiNaeonnactor(s)Iiaued Pursuant blk ConvactoYs
License law e\i_
❑lam ex pC undo B PC for this an _
own a / \)
KER'S OMP ON CZAR TIO -
IhembyaRiwunderpenaltyof perjury one oftha fol to declared...:
I have and will maintain a Cerllric2a of Conxnuomlf-insure fm Worker's Compere- - -
.tion,.provided for by Section 37M of Inc Labor Code,fm the Performance:of me
work for which this permit is issued.
1-11 have and will maintain Worker's Compensation luurantt,u required by Section - -
37Mofthe Labor Code.far rhe pufowanee or the work for which this pewit is issued.
My Workers Compensation Inwnnce carrier and Policy number ruse
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(chis maroon need not be compicmd if de,pewit is far one hundred dollars(S 100) _
or leu.)
I canary,that in the performarea of site work for which this Pewit is issued,l shall and
employ any Person in any mannero,az to become subject to the Workcri Camper.tion
Iawsof Cali(omia.Date -- - — -- - _ - ---- - -
Applicant
NOTICE TO APPLICANT.If,after making this Certificate of Exemption.you shouw
trcome subject in the Worker's Compensation provisions of the labor Code,you mus
0 z forthwith comply with men provisions or this permil,hail be dcemed remkcd.
zCONSTRUCTION LENDING AGENCY
[-� I hereby affirm than Vert is a eon,feuction lending agency for the perfurmanm of
the work fur which Chia pewit Is issued(Sec.3(197,Civ,C.)
[[7 L<ndcrf Name
D z Lender's Address
V O 1 ttnify that 1 have read this application and suits that the above information is
LL E' cerrggL I agree a comply with all city and county Ordinances and mute laws relating t0
pU buildingconswction.and hereby authonm repmaentativiceaf Niseity theater upon the
[Ll ahmcties judgments,
propertysit for ins
pection purposes.
•�y (We)agree to sass,indemnify tad keep hawks.the City of Cupcniw against
N in
esunce of the granting of this esmit. may in anyway attic against said City
CJz inconsequcnee of thegrantingA pewit.
^
APP LIC UNDER ANDS AND W 'L COMPLY WITH ALL NON-POINT Issued by: Date
'OU LIS'E EGULATI ,I—
�lCX 1A., Re-roofs
ort of ApplinnVC.nuecmr
HAZARDOUS k ERIAIS DISCLOSURE Type of Roof
Will the applicam or future building.ccupam.mre or handle a on,material
as defined by the Catarina Muni u Code.CTapmr 9.13,and the call and Safety
rdc.secd.n u53z(.n All roofs shall be inspected prior to an roof. material bei.
❑Yes P P Y g g installed.
Will thea scant or future building occupant use a If a roof is installed without first obtainingan inspection,I agree to remove
PP 6 p .Air uofdevicesenitu P g
District?
us air chnuiminanu u cd by the Bay Arta Air Quality ManagcmcnC all new materials for inspection.
ores
1 have read the harardtws muenalsmquimmenu underChaplcrti.95 orthe Califs
ria Hca] cry Code Saxoons 25N)5.25533 and 25534.l understand trim if the Wilding
ne
dogown wa.mou'dosta my rtsponsihilitymmoify nccupou or the
re .
is most Wmapd.r 'uuanttofaCcnihc ofOccu SignatureofApplicant Date
t /
weer or aathrdmd.,an[ - _ ,m All roof coverings to be Class'B"or better
�, Community Development
i, 10300 Torre Avenue
Cup
o CA 95014
I® ✓ Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEf�TINO
Building Department
JOB ADDRESS: PERMIT #
--;5- G2� - "- O�I�2a�9g
OWNER'S NAME: PHONE #
GENERAL CONTRACTOR: #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the followin information:
60 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishin
-flectrical
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/Con ctor Signature Date
CITY OF CUPERTINO
L.' TEMP POWER
�CUPEI�TIN0 PERMIT APPLICATION FORM
APN# / d �� Date
Building Address:
Owner's o #.
Contractor: Phone: License #:
Contact: Ph o e: Cupertino Business Licehse #:
Building Permit nfo:
Elect ❑
Job Description:
Residential ❑ qomm,,tcial
Cost of Project:
if
A fi •ble Fee ID Fee Description Fee Group
` TEMP Temporary Power ELECTRICAL
EPERMITFEE Elect. Permit Issuance ELECTRICAL
BUSLIC Business License BUILDING