05030079 CITY OF CUPERTINO z«{• a +� - %°'
BUILDING DIVISION PERMIT ONTK&OTOR IN) ORMA tON"
Zi.
BUILDING ADDRESS: TAYLOR WOODROW HOMES PERMIT NO.05 030079
OWNER'S NAME: PERMIT ISSUE DATE
TAYLOR WOODROW
111ME: SANITARY NO. CONTROL NO.
(925) 365-3100
ARCHITECDENGINEER: BUILDING PERMIT INFO
BO EO Pell
O
300 LICENSED CONTRACTOR'S DECLARATION JbDescrihon
F I lureby&Huta that 1 ma licensed under proaielmo
u of Chapter 9(Commencing p ,
a� wide Section 7001h of Divion 3 of the Business and Professions Code,and my license is
� in lull fares and effect. ��� NEW CONDO. (2052 ' -LIV. SPACE)
= urn c L .. tom „ RAGE 359 '
Date tun nJ ARCH CSDEC
masloLA AT C-39
4i eased 'ectal
OWNER-BUT ER DECLARATION
hereby alnrm deal I em exempt from tike ConRecmra License law for the
D wing mean.(Section 703 1.5,Business and Professlons Cade:Any City Of county
$ which requires a permll in Construct.alter Imp ow,demolish,or repair any swewre
prior to its ismance.also requires ape applicant for such permit to rite a signed statement
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that he is licensed pursuanOo the provision of du Conuacter's License Law(Chapter 9 Sq,Ft.Floor Area Valuation
(commencing with Section 70DO)of Division 3 of the Business and Profwiom Cole)or $248539
that he a therefrom and therefroand Ne basis(or the alleged emmption.Any violation of
Section 7031.5 by my applicant for a permit subjects dee applicant to a civil penalty of APN Number Occupancy Type
am mom than five bundred dollars(5500).
❑1,u owner of the pmpwy,m my employees wide wages u duo wle ampemdon,
will do the work.and the m9Ctun a notintended or offered for sale(See 70/4.Busintes Re uired Ins ections
and Professions Cade:The CommcaM1 License Law does not apply a an owner or q P
property who builds or improves deeaon.and whodousuchwork Mmselfor through his
own employm,provided that such Improvements an Imtinundel oroRede l forme.H.
however,the building or improvement is mid within arm year of completion.the owner.
builder will have the burden of proving that he did Out build or improve for purpose of
ask.).
❑1.as owner of the Pope",am eacluuveiy...made,with Bwtsed eanamtan Or
commtet dee project(Sce.7044,Buaims and Professions Cede:)7k Commeemes U.
cents law dm not apply to an owner of prepeny.whe builds or improv deemon.and,
who contracts for such projects with aeon,racmr(t)licensed pursuant of the Contraca's
Licence Law.
❑Iamexemptunder Set .B&PCfaraiemuon
owner Dam
WORKER'S COMPENSATION DECLARATION
1 hemby air=unclear peaky of perjury ane of the following detiaudIDn:
❑I haw and will maintain a CCniEaa ofComent in self•IneneforWarkersCampen-
nation,an provided for by Section 3700 of the labor Code,for the performance of thea
work far which this Permit Is issued.
❑I have and will maintain Workers Compensation Insurance.at acquired by Section
3700 of ce labor Code,for the performance of the work forwhich thug permit is Issued.
My Work es co_m emaattion Insumna carrier and Policy number am:--r�{
Carver.C" A.a1'e, r Dfi�. Policy Na.: 0101 I rue
CERTI�P ION FROM WORKERS
COMPENSATION INSURANCE
(Tho section need not W completed if the permit is for one hundred dollars(SIM)
or las)
I ardfy real In the performance of the ,it for which this rental,is issuecl,I shall nth
employ any Paan in my mmnerm as an becntac subject in the Workers'CompenmNon
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:IL a0cr making this Cer iriate of Exemption,you should
become subject to the Worker's Compensation provisions of the labor Cots,you mm
O forthwith comply with much provision or this permit shall W deemed annotate,
Z tiCONSTRUCTION LENDING AGENCY
F.t T hereby turbot can f.its mnsuuetlan anding agency for dist perrwmana of
r4> the work for which this permit Is issued(set 3097.Civ.C.) '
W Q Leaders Name
z Lender's Addmas -
U Q 1 matify that 1 haw mad this application and mute died dee show information u
FCOMM I agree to amply with all city edm county ordinances and sum lawn relating in
V building construction.and hereby mahoriw repmentatlws of this city to enter upon the
w above-mentioned property for Inspection puapums.
�'fY (We)agree in taw,indemnify and kap hanmiess 0te City of Cupertino against
w+tn tiabll Lmenu.cj=,-deapemen which may in my my acenm against said City
U 7 In PLICA oUNDE 9TrNDSthrNo WILL COMPLY WITH ALL ' INT Issued by: Date
Fl SOURCER GU TA /
Re roofs
Signatu o ApplicamaCant cmc Dau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIII the applicant or future Wilding occupant mare or handle hausdous material
as deRmd by the Cupertino Mandel
Cade,Chapter 9.12.and the likable
and Safety
Cade,section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yea
Will the applicant or futureding Occupant use equipment or devise which If a roof is installed without first obtaining an inspection,I agree to remove
emit huardmu air cu ancrananu rred by the Bay Am Air Quality Management all new materials for inspection.
Mania?
❑Yes o
T hew reW the huardwsmateOn3 aqui nuunderChapter6.95ofdieCalifor-
nia Ith&SafctyCode,Scetiau25505.255JJ 574.landemancl thedif the ildin
d no currently have t unapt.deo it a miMllly m ratify du occas I of
he enuwhkh Oat It is
erd teat '1 Signature of Applicant Date
Own w ulhod7 sat /Date All roof coverings to be Class"B" or better