05100167 CITY OF CUPERTINO ..,,�;ay,
BUILDING DIVISION PERMIT CONFRCTORNF; M. TI . '
BUILDING ADDRESS: TAYLOR WOODROW HOMES PERMr17NO.05100167
OW NER'S NAME: PERMrr ISSUB DATE
TAYLOR WOODR
E:
SANITARY NO, CONTROL NO.
(925) 365-3100
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
i18p LICENSED CONTRACTOR'S DECLARATION
e M I knoeby affirm Nat I,m licensed under provisions of Chapter 9(commencing Job Description
with Sceuon 7Waf of Division 3 of dm Budneu W Profesalam Code,and my lk-aam u
ate„ in full to=anderfen / �( TRUSS CALCS
jvnx LicenseClau Us.»�ayo56 B -
p Dam /1� cnnuannr IN HOUSE ONLY-NO NEW PERMIT
7W ARCHITECTS DECLARATION
1 understand my plans slWl W used a public record,
byU
r o Licensed Professional
5 OWNER-BUILDER DECLARATION
<E 1 bunchyMaso ,(Tum that 1 am eusin from the noinacfe.M.Co License city
c for the
0 0 followwhich
masonperm(section]U]LS,Business and Pmfcssium h,or re our m a truclu y
<m which roquires a Permit m construct,thealter.Improve,h Perot t ore pair ed swment
pow miuiereadp puralusuant
roto the thovisio or for such permit Lium signed(Chapter
hapnem
< NotedatRcemca parstam 7000)dDieioM of Nr comrxmralicenmltawsCode)9 Sq.F[. Floor Area Valuation $0
e�� (commat mnc omoup, Sectioom and the ha Sion 3 of ad egaBusiness ompt Proon.Any
Code)of
� Out me u eumpl thetn(rom and Om boat for Ote dlegcd exemption.Any violation of
Session 703"by any applicant for a permit subjects the applicant In a civil penalty of APN Number Occupancy Type
not mart Nan five hundred dollars($sell). 36940002 . 00
I,as owner of Ne property,or my employees with wages as dm rmic compensation,
will do Newark Code:
eeno unot Nmedrdarawdos out a(Ser.he an Bann or
and ertywhoM cede:Thr canmcmrs and
,w dons out apply lf rt owne a Required Inspections
.a
,property who ,pmol ed out i ch i non,and who am mu,intended
utmfferedelfor Naugk lou
awn employ=, Nal suck improvrmats art not oun fc mpicti ed for sale.lr-
Wilderr,Nc building or improvement u sold within one year ofimprowuan,the owner-
Wilder will have the buNan of proving Nal bo did not Wild or improve for puryox of
sale J.
❑1,as owner a thr property un exclusively contracting wide Bcemed umaram us be
construct the project(Sec.7014.Buuneu and Professions Code:)The Commoners Li-
ccvc law docs not apply to an owner of propenywho Wilds or improves thereon,and
who contracts for Such projects with a conVictua(s)iiien,ed pu bion to she Contractors
Licerue law.
❑lemeaemptunder Seu .BQPCror Numsson
er Dam
WORKER'S COMPENSATION DECLARATION
1 hereby,Rum under penalty or perjury,arc cf Ne fallowing dabo goons:
137W.f
him and will maintain aCcrufinm ofComent m self-intim fm WmkersCompen-
,as provided for by Secure 3700 of Ne Labor Code,for the performance of IW
for which this permit is Wood.
have and will maintain Workers ninpumadmo Insurance,a required by Sawn
the Labor Code,Tor Nc performanceof Ne work for which this p.it is issued.or Cp�e,nssat�o huurence carrier and Policy number areer. m ICCd Mi PoImy"..: D6 nao
CElmFlCATEO EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
fThu suesen need Imtbccoeoplcmd if ted permit at foranehundmd dollars(SIM)
or mail
I certify that in the performance of the wart for which Nis permit is issued,I Nall not
employ any person in any manrmrao as to become subicci to led Worears'Comperes tion
Laws of Glifomia.Dam
Applicant
NOTICE TO APPLICANT:If.after making Nu Cenifinm of Exemption,you should
become subject m the Workeru Compensation provisions of the Labor Code.you muse
.J O fsushwith comply with such provisions or Nu Permit shall bo domed rewked.
Z"" CONSIRUC`DON LENDING AGENCY
Fr 4 I hereby of ion that Nem us construction landing agency for the pe itermsnce of
C' > me work fur which that permit u iuued(Sec.3197,Civ.C)
Cp tenders Name
z Lenders Addreu
C)Q I certify that I hale mad this application and sum that Ne aWve information u
fy f
cannot.I agree to comply with all city asd county ordinances and sum laws relating to
QWilding construction,and hereby auNoriu repm representatives o(thu city enterthe
upon
W construction,above-mentioned property for inspection purposes.
F„ gy (We)agree m save.indemnify and kap hnmleu be City of Cupertino agsaimt
t,; limilklm judgments.casts said expermes which may in any way acmuc against said City
C.1^ APPL CANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCEREGULATIONS.
Sign¢ arApp�,nam/C m. Dam
5. Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the appliant or future Wilding nocturnes sort or handle havNous material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
.Sauon 25532(a)t
❑Ya All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding octvpart tau rgtipmen;ordcvices which If a roof is installed without first obtaining an inspection,I agree to remove
Smit ha'ratdnus air cormorants as defitmd by the Bay Area Air Quality Management all new materials for inspection.
Ontric4
[]Y. �T1a
1 have mad the hazardous materials requirements under Chsapter 6.95 of the Califor.
nix Health @Satiety Code.Sccuam 25505.25533 and 25534.I understand that ifthe Wilding
does not cmrendy haw a mnant,out it at my respmmibility in Imary the occupant of the
"qulremcnts ren W met u>neeor,cnn;rteaf ra Signature of Applicant Date
owner ar aallodx<d agent Dam All roof coverings to be Class"B"or better
.