05030050 CITY OF CUPERTINO
PERMIT `� R
BUILDING DIVISION rTORINFOMAT19N-
��, I 7,�7�7 �L,
BUILDING ADDRESS: TAYLOR WOODROW HOMES PERMIT NO-0 5 0 3 0 0 5 0
10280 PARK GREEN LN ft R49
OWNER'S NAME: FMIvUT ISSUE DATE
TAYLOR WOODROW HOMES 2300 CAMINO RAMON. STE 10L 07/20/2005
E: SANITARY NO, CONTROL NO.
(925) 365-3100
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
296Job Description
LICENSED CONTRACTOR'S DECLARATION
I he m I sm,licensed under previsions or Chapter 9(commencing
acd=
with S I of Di
3 of dec Business and Pustmai..,C.da,md my It...6
A> inmummandeBact. NEW CONDO. (19381 -LIV. SPACE)
_C.O.ti �GARAGE 568 '
Y It ARCHrrSCrS DFCLARATIW D-46
1�.
41,vay P;
b a [A'CRY FF'ofassumal O;1ELUILDER DECLARATION
g9 l hereby affine 11181 1 am exempt from live COMFICUFT'S License Law for the
a following resser.(Section 703 1.5,Business and Professions Code:my city or county
1§� which requires;&permit to consuruc,,altar,improve,demolish,or repair my souclum
Z S2 prior in its issuance,also to the applicant far such permit to flic,a signed mHemcm
Nal he is licensed pursuant to the provisions,of dee Cmunames Limuse Law(Chapter 9 Sq.Ft.Floor Area Valuation
(commencing with Section 70D0)of Division 3 of the Buslocarmd ftfuraim.Codc)or $241650
Wt be,5 exempt thearafroart and the basis for the alleged exemption.Any violation of
Section 703I.5 by guy applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
am num than live hundred dollars(M).
0 1,st,owner of the property,or my employce,with wags a their mIc comparvation, 369480i'l . 00
will do the work.and the structure I,actimmaked orofferml bustle(Sec.7044,Business
and Professions Code:The Conumumej LianaLaw does not apply to an an=of Required Inspections
property who buildsorimpoeves thereon,and who dommettwork himulfor through his
ourecanployeam,provided thatsuch imprawmenumarm not intended aroffiscal formle.If,
however,me building or improvement is sold within am year ofcompledon.the Owner.
builder wilt have the human of proving that Im did ram build or improve for purpose of
ank.)
C]1.as owner of the property,am exclusively contracting with licensed cormactam to
construct tho project(Sec.7044,Business no ftfiessimen Code:)The Cormier's U.
action Law does not apply to an Owner of prapany who kalids or Improve daemon.and
who contracts for such projects with a contramar(s)licensed personal to ft Communes
License Ln-
E3 larenum.pt.mansce —.1liki'ClIcadd...
sur Data—
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury am of the following declarations:
0 1 have and will maintain a Cenirml6.fCmtw.tt.i.,..f.Wolk esCp..-
.do.,as provided for by Section 3700 of the Labor Code,far the part...of the
work for which this pmmii is issued.
0 1 have and will mamurn Worker's Compensation Instant=,as required!by Section
3700of the Labor Code.far the pceformuturce of the work for which this permit is intend,
My Workces Compensation Insurance carrier and Policy number am:
Cartier.!tk�� Palley N..:rX,&s_77CJ2 C),
ATF.OF EMPTION FROM WORKERS'
COMPENSATION INSURANCE
(nor merhan need Out be completed Burro Permit islaronce hundred dollars($100)
co Is.)
I certify that in the Performance or the work for which this permit is issued.I stall not
employ any person in my counter an as to became subject to the Wori Comptcrunction
Laws of California.Data
eat
NOTICE TO APPLICANT.It.after making this Certiricam of Exemption,you should
became subject to(he Wokee's Componsedon provisions of the LAW,Code you a.
z fortaneitia comply with such previsions or this permit Shadl be,chance kd.
vy z 0
CONSTRUCTION LENDING AGENCY
1 thereby affirm that thare iso consuractimi lmdeS.poxy to,the ptufaverance.1'
ai> the work for which this permit 4 burned(Sm.3097.Civ.C.)
Q Landices Name
D z Lander's Address
U0 I Mrify out I have read this application and stain that the Above information is
I,, correct.I agree in comply with all city and county ordinances and sate In"slating to
0 building coustrecdon.and hereby authorin mimemmadive,of this city to enter upon ft
fA above-mentioned property for inspection purposes
(We)agree to an,indemnity and keep tumbled the City Of Cupertino against
B id menu,ensu which may In any way accrue xi M y
"I"'
z be or me granting of im�
NT
PPLICANT NDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
an"'expashad
Nis
1110RCE RE LAnoNS. J
I .7/
( 4,105 Re-roofs
Signa oFlApplicarearComrstror W11 Data
HAZARDOUS M49VMALS DISCLOSURE Type of Roof
Wil de,applicant or future buildmi;occuna man or handle humandous material
ro,defined by the Cupertino Muriel Code.Chapter 9.12.and the Halide andSafety
Code Section 21112(.)7 All roofs shall be inspected prior to any roofing material being installed.
Oven 7
Will the applicant or future Wil ng Occupant=equipment or devices,which If a roof is installed without first obtaining an inspection,I agree to remove
ifi
emit haxapdous sit carearaimma a dyfired by ft Bay Am Air Quality Management all new materials for inspection.
District?
C]Yes
I have send the hvardnus materials requirements under Chapter 6.95 of ft Califor.
nia Health&S&Icty Code.Sections 255M.25533 and 23534,1 understood!Joe if the building
tl�mr a x nayhavely I,-,tureen,deal it 4 nWrCtpo=ibiliiy to nordly the(merparL Of the
e.� ' b3�&vmOfACcmfic1A`"4.pTy. Signature of Applicant Date
momisgul&Let Data
0. All roof coverings to be Class T"or better