05020007CITY OF CUPERTINO
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BUILDING DIVISION PERMIT,C�QN`RACT�QR,INOMAT%,A1V
BUILDING ADDRESS:
TAYLOR WOODROW HOMES
PERMIT No05020007
OWNER'S NAME:
PERMIT ISSUE DATE
NE:
SANITARY NO. COOL NO.
NTR
I Q 1
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
A N re1NP
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
P
y affirm that 1 am Ilceed under provision of Chapter 9 (commencing
I Wrathy ns
with Section 7M) ofDividan 3 of the Buemesa and Prufesdum Code, and my license Is
mfull eander t.
UcenseCClan Lte.N
FOUNDATION ONLY
P PERMIT #05040089
Dam cdn a m
ARCHnECTS DECLA TION
1 undcruend my plana shall W used as public mmols
Licensed Pmfessian.l
OWNER -BUILDER DECLARATION
I beRhy aRrm that I am exempt from the Commences License Law far the
following mason. (Sudan 7031.5, Business and Professions Cade: Any city an county
which requires a permit an constrocs alcor, improve. demnlim. or minor my strommn
prior an its issuance. also requites the applicant forsuch permit to file a signed statement
Lice. law(Chmner 9
Sq. Ft. Floor Area
Valuation
But W is licensed pursuant to the interval.. of WC Commences
(commencing with Section 7000) of Division 3 of the f usinruand Professions Coda) m
91343279
that he is exempt Onerous, and due basis for the alleged exemption. Any violation of
APN Number
Occupancy Type
Section 7031.5 by any Applicant for a permit subjects the applicant to a civil penalty of
not mare Nan five hundred dollars ($300).
❑ I, m owner of the property, our my employees with wages as their able compensation,
Required Inspections n
will do the work. And the swctum is not intended or offered for auto 7011, Boameas
and Protraction Cade: The Camtmalars Liceme law dace at ApPly,m an owner of
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property who bulids or improws laermn, end who does such work himself or through his
own employees, provided that uch Improvements are net intended or offered forlate. If.
however, the building or Improvement is said within am you of completion, the owner.
builder will haw the burden of proving last he did Out Wild or improve for purpose of
role.).
0 1. as owner of den property am exclusively contracting with licensed contractor to
construct dte project (Sec. 7044. Business and Professions Cade:) The Canusclnra LI-
ceme law docs not apply to an owner of property who builds at improve thereon. and,
who canmaM for such pm)eets with a con=t.(.) licensed putoomi m the Convectors
Licrnm law.
lamanorptunMSm. ,Bh PCforthismaann
owner Data
WORKER'S COMPENSATION DECLARATION
10 I hereby Affirm under penalty of perjury orc of the fallowing declarations:
❑ Ihaveand will mainuina CeNOesteofComenlwwlf-Insumfor Workers Compere
,
salon as provided for by Section 3700 of the labor Code. for the performance of the
won or which out. permit is issued.
1 haw and will maintain Workers Compemdon Insurance, as required by Schon
3700 of the labor Code, for Ne performance of the work for which this persalt is house.
Woloemr.WaCom����ggqqemanon can or and P011rynumM4.7
Camler.4YJF PolicL3ORKE4S' O
C'
3�,"+CGS
FROM WORKERS'
C T IC EXEMPTION FRNo.OM
.
COMPENSATION INSURANCE
OMPE I
(Thlssemon need notbccampkted If tic pcnait is fmane hundred dollm ($100)
our len.)
I canary that in Ne performance of the work for which this permit Is issued. I shall nm
employ any penin In my manmr an as an became subject to the Workers' Compensation
Laws of Califomia. Data
Applicant
NOTICE TO APPLICANT: If. afar making this Certificate of Exemption. you should
become Subject to the workers Compensation provisions of the Lahnr Code, you most
'
forthwith comply with each provision our this permit shall I e decreed revoked,
i
CONSTRUCTION LENDING AGENCY
I hereby a111. that mem is a mnavucnnm leading agency ser do Perfarm.um of
dte work for which this permit Is issued (Sec. 3097, Cih, C.)
Lenders Name
Landar. Addmex
I certify that I law rand this application and sate mat the above information U
' conecL 1 agree to comply with All city and county ordinances and slate laws mledng m
building convection. and hereby aumodw repseamblows of this city to enter upon lac
above-mendaned Property far impaction proposes.
( (We) mgme to law, indemnify and keep harmless the City of Cupertino against
i liabilities, jmgmems, cross and expenses which may in my way moue agaWt said City
I. consequence of the graming of this permit.
' APPLICANT UNDERSTANDS ANP WILL COMPLY WITH ALL NON -POINT
Issued by: Date
REGUL ON
Re -roofs
Type of Roof
Sign red AppllcanUCantraoo Data
DISCLOSURE
HAZARDOUS MA Als
Will lac applicant our future Wildi cupmt mom or luMle hvaNam material
ss dcfinnd by Ilse Cupertino Muni 'pal Co e. CNpter 9.13, and ere HuIN and Safety
Core, Sudan 255320)?
All roofs shall be inspected prior to any roofing material being installed.
❑Yes No
If a roof is installed without first obtaining an inspection, I agree to remove
Will dre applicant or future Wilding acaupent tee equipment or devices which
mit hazvdoex air conlaminanu eSAlcroad by the Bey Arca Air Quality Management
all new materials for inspection.
Distant?
X11/
❑Yee u
1 haw mW the hmNous materials requirements under Chapter 6.95 of the adifor.
'
raCaSemom 25505,333 and 25531. I understand mu ifinWilding
e n curtnatlyhowa tenons that ifk my r.up .IbIIIIy to notify the ace upmI nr me
requimm nus whim us, trimiaa .Ccmrm.te rpc
Signature of Applicant Date
All roof coverings to be Class "B" or better
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