05030040 CITY OF CUPERTINO ••: I< - e '��'te ?« " �•—,`
BUILDING DIVISION PERAUT ;CONTRA TUR INFORMATION ,
BUILDING ADDRESS: TAYLOR WOODROW HOMES PE ""x05030040
1 ()5)Ro PARK GREEN 111 4 847
OWNER'S NAME: PERMIT ISSUE DATE
OTA
E: SANITARY NO. CONTROL N0.
(925) 365-3100
ARCHITECDENGINEER: BUILDING PERMIT INFO
BLDG EO PLUMB MEOCH
u o o LICENSED CONTRACTOR'S DECLARATION Job Description
V 1 hereby an.Nal I em planed mcw
under provisions of Chapter 9(mming P
with Section 7gMl)orDivi lou 3 of the Business etM Professions Code.and my license u
A in mutoaaMeffem NEW CONDO 1742 SQ FT LIVING
[�? Larose Contractor
E ARCH S DECLA AT 15 S Q. FT. GARAGE
undcnu my pun e I used u pis cmc
D N
5 LON
icenu mfessioosl
OWNER UILDexcept
EMe Com tent
I herchy.Ebro than 11. causin rose Me Camns Co e:Any
Law for the
c O following mann.permit
I RD 1.5,Business and improve.
de ons Cada:Any city ar county
$� which esquires a permit to ennswc4 glut hnprnw,demnlLrh,or repair any Awetum
_it prior to its Issuance.also acquires the applicant former,permit to file.signed slamnont VVY333
that he is licamd pamant in the provisions drum Camextur's Llano Law(Chapter 9 Sq.Ft.Floor Area Vali
3 (commencing with Section 70W)af Division 3 ofthe Biukeuand Professions Code)or
that he is exempt Ihafrom and the basis for the Alleged Candi d te.My vioadan of
Section 7031.5 by any applicant for.permitmbjecu the applicant u a Civil penalty of APN Number Occupancy Type
net roam than five Wndred dallars(uon). 36940017 , 0 0
❑I.As away or de psapeny,or my,wplay=with wages As deb sok compensadon.
will do the work,and the smtttua is Out intended as offered for ask(Sec.71M4.Estms Required Inspections
and Profession Code:The Commutes Liceense Law does an[apply as an owner of q P
property who builds or improves therem.and who decamchwork Mmselfor through his
own employees,provided thatauch Improvements an nothmanded aroffered for We.if,
however,Ne building or improvement is mid within oro year of completion,the awner
builder will have the burden of proving Net W did ant Wild or improve far purpose of
sale.).
❑1.as owner or the property,w exclusively contorting with licensed contractor,u
construct the project(Sec.7044,Busin...and ParfeWons Code:)The Conbacurs I.I.
cove law does not apply o an ownu a property who Wika or improves therms,and
who contncu for sues projects with a contrxur(s)Ilcmmd pursuant te the Con ramr's
License law.
❑I am cssmpt under Sec. .B k P C far this won
e Dau
WORKERS COMPENSATION DECLARATION
1 hereby ME m under penalty of perjury am of the rollowing declarations
❑I have and will maintain a Certificate of ConscnuoselLinmm for Workers Compen.
salon,As provided for by Section 3700 or the later Code.for the poor..na of the
wart for which this permit is insuce.
❑I have and will maintain Workeea Compensation Inseam,as required by Section
3700 of the Labor Code.for the performance of the work for which this permit is hadul
My Worker's Compensation Insurance easier and Policy�nu.m.aber am: �j
Cartier. �"'fT���A`G� PolkY No:L,-I—I0d C
64 CEIMFICA— TEMP ION FROM WORKERS'
COMPENSATION INSURANCE
frhxmcda mood not W completed line pemlt is(wore WnthW doR.rs(s ad)
m leu)
I unify that In the Performance of de work for which this permit is imad,I shall not
employ any pecan in my manar an As te became subject in the Workers'Compensation
I..,of California.Data
Applicant
NOTICE TO APPLICANT:If,after making this Ceniffmic of Exemption,you should
become subject to the Worker's Compensation provisions of Ne Labor Code,you must
.J O forthwith comply with such provisions or this perralt shall he decreed meted.
by CONSTRUCTION LENDING AGENCY
{.. I werhy.from Out then is a construction lending agency far the Performance of
fYr> the work for which this permit is Wood(Sec.3097.Civ.C.)
IT7 QLanders Name
7 Z Lender's Md. .
U O I aNfy that 1 have read this application and sum that de move information u
Coram I agree o comply with all city and county ordinances and state laws relating u
O Wilding construction.and hemby auderia mpmummadws of this city u enter open de
UJ Above-mentioned property for inspection purposes.
(We)agree in save,indemnify And kap humkas the City of CupeNaa against
ti y Hab111des,judgments,costs and axpeues which may in any Myaceme Agalaat said City
U 7 In ucntt of the LnminL orchis permit.
a� PLIC NT UNDERSTANDS AND WILL COMPLY WITH ALL N N-POINT Issued by: Date
S URCE ECULA r
(/' y, t Re-roofs
Signatur of AreplicmtlContmor Da
HAZARDOUS ATERIAIS DISCLOSURE Type of Roof
Will the Applicant or forum Wilding aceupmt atom or handle huardoes material
u darned by du Cupertino Mantri I Code.Chapter 9.11,end de Healthand Safety
Code.s yes W31a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes o
Will the applicant or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit haurdnm air contsminan flood by the Bay AMA Air Quality Management all new materials for inspection.
DImHCi7
❑Yes u
I have mad Ne heasNtws maarlel,nyulmments under Chapterfi.95 of site Caliron
fila Health&SaletyCWe.Salons21305,15533ud1l534.1undersandt ifde Wilding
e currently haws tenant Nu I Ire mY roapansi alt u notify the=upset of the
nqulm mlwhia mwtWmctpda I„amaaracemneama pansy Signature of Applicant Date
M11O cr w authwb1K ,0s All roof coverings to be Class"B" or better
r_