05030039 CITY OF CUPERTINO '�^w x9 ` �^' a-*" ' -`
BUILDING DIVISION PERMIT CeO iTRAC ' 1h. NVOI.iM.ATI "
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BUILDING ADDRESS: TAYLOR WOODROW HOMES PERMIT NO.05030039
10280 PARK rRP.T?.N LN # A14
OWNER'S NAME: PERMIT ISSUE DATE
TAYLOR WOODROW HOMES 230
E; SANITARY 4. CONTROL N0.
(925) 365-3100
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
iG=O LICENSED CONTRACTOR'S DECLARATION JobDescri tion
�+ 1 hamby affirm Nat 1 un licemtd under provisional of Chapter 9(commoreing P
with Seen.7").f Division 3 of the Busines.and Profusions Code,aM my licrnx 4
n� mmllmmeande e, NEW CONDO. (1938 ' -LIV. SPACE)
zg= a"sea R ARAGE 5681
al, Da¢ Canlru.or
ARCHrtECT DECLARATIow
I
Manyy lea unite Itis C-34 (BMR UNIT)
io iocest R
q OWNER-BUILDER DECLARATION
Hi i horeby aMmn that I am exempt from the Conuactafs License Law for the
o fallowing mason.(Section 70315,Bushels aM Prefcasiva Code:My city or county
K S O! which requhma a permit to construct,alter,improve.demolish.lir repair any structure
i} prior W his hatumo.also requires the appllea,forsoch perentt W Ne a signed sutemcm
< thuhe4liceaWmoment an the Prevision ofthe ContractoraUcems, aw(Chapter 9 Sq.Ft.Floor Area Valuation
as (comm ncingwith Soction7B00)ofDivision3OfNOBusin mdPmfmionsCodt)w $241650
.. Rut me 4 exempt therefrom and the main for the alleged eumption.My violation of
Section 7031,5 by any applicant for a permit objects the applicant W a civil petulty of APN Number Occupancy Type
not roam than R.hundred dollars(5500).
0 I,u owner orthe property army employees with wage u Netr ante eompenadan.
will do the work and the shOnune is not intended orofremd formic(Sec.7044,Basmew Required Inspections
and Profeadoa Cade:The Commutes Limua e Law does not apply to an owner or q p
property who builds of Improv,themon,and who densities work himself ar through his
own employes,provided thatsneh improvements arc not Intended"offered forme.IL
however,the building or improvement is Bald within can year ofcompledw.the owner.
builder will have dive burden of proving that ho did not build Or improve for purport of
sale.).
0 1,as Owner of the property,am exclusively contracting with licensed rnnmemn to
construct the project(Sec.7064,Business and Profusion Code:)The Conuacmr's Li-
cave Law deal out pply W an owner of property who Wilds or improves demon,and ,
who contacts for such pmjecu with a etntrneor(s)liceand pursuant he Ne Communes
License Law.
0 1 ren exempt under Sec. .B k P C for this mum
Or Data
WORKERS COMPENSATION DECLARATION
1 hereby MEMO under penalty of perjury one of the following declarations:
0 1 have and will maintain ac.Nfi.m of Consent to anlFmsum forWohe'scompcm.
mile.,Is provided for by Section 3700 of the labor Code,for the performance of the
work for which this permit is issued.
0 I have and will maintain Worker's Compeuadon Insurance,Is acquired by Section
3700 of the labor Code.for the performance of the wart for which hila permit is Word.
My Worker's sCompensation Insurance carrier and Policy number am:
C.Oicr.rYL4itC, CE2fl PolicyNo.; tXO7-7CSZo
CERTIFlCATE OF MPION FROM WORKERS'
COMPENSATION INSURANCE
froths sa0a oced not W completed If de permit 4 fortune hundred dollars(SIM)
or leu.)
1 unify,Net in the performance of the work for which this permit is Iuend.I Nall not
employ any person in any mennerso Is W become subject W IM Workcri Compensation
laws of Cmiforols.Dau
Appllunt
NOTICE TO APPLICANT:If,after making this OmiResm of Exemption.you should
become subject to the Worked Com atmation provisions of Out labor Code,you mus,
0 O forthwith comply with Inch provisions or his permit shall the domed revoked.
Z"' CONSTRUCTION LENDING AGENCY
[.n E2 I hereby M.Nat Nem in•ronstmcdnn lending agency for do perfurmaece of
C> the were for which Nis parent,4 town(Sec.3091,Civ.Q '
4 Q Lander'.Nurse
z Lender's Add.
U0 I comfy Nn 1 haw mad Nis application and sum Nat the show Infammon 4
8.F cortin 1 Agree W comply with all city and county ominames and mute Irv"mining W
OU Wilding communion.and hereby autbmie,representatives of this city W entre upon de
[TJ above-mentioned progeny for Inspection purposes.
(Wc)agree to ave,indemnify and kap humless Ilan City of Cupertino All
in liabilid udgments.eau ande,penues which may in any way accrue again said City
Uz in PLICNRCO of Ne granting or this permit.
A UNDERSTANDS AN WILL COMPLY WITH ALL NON-POINT Issued by: Date
RCE R GULA ONS.
l e ti f 146 Re-roofs
Sign ofAliplicarmlContriC5r am
HAZARDO MA 1AISDISCLOSURE Type of Roof
Will ft applicant or future Wilding occupant more,or handle ha7aNaus manorial
u deMod by the Cupertino Munic 1 Code,Chapter 9.17.and the Health and Safety
code.Sagan 75532(.)7 All roofs shall be inspected prior to any roofing material being installed.
[3 yes is
Will the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit havardo.,ay.mmminanu a�dcdncd by the Bay Area Air Quality Management all new materials for inspection.
District? H/
❑Yes Nu
I haw mad the WeMdo,matedna requirements under Chapterli.95 orthe center.
at
Heal &SarnycaM.Secoune 25xu.25533 and 75534.I urdemund thatlrthe Wndmg
d t c ntiy have a tenant,Nm It my responsibility W notify the acupm,M de
lame which test W m p'or luumenc CcrdMMo Occup y. Signature of Applicant Date
Own oramhod>nd agent Date All roof coverings to be Class"B"or better
r