05030065 CITY OF CUPERTINO kz*,.k 3z '^' ' '"" s `'• .' `
BUILDING DIVISION
PERMIT dN_TItATO1Z"='(N'EORMA,TTQN•
BUILDINGADDRPSS: TAYLOR WOODROW HOMES PERMITNO.05030065
OWNER'S NAME: PERMIT ISSUE DATE
TAYLOR WOODROW HOMES 2300 CAMINO 5
E: SANITARY NO. CONTROL NO.
(925) 365-3100
ARCHIIECDENGINEER: BUILDING PERMIT INFO
BLDG ELECT(� l� PLUMB MECH
ly l�
�O ii LICENSED CONTRACTOR'S DECLARATION
P I beroby afMm that l am licansed under provWons of Chapter 9(Commencing Job Description
N Section 7IX111)of Division y olds Busimsf and Professions Code,and my licnue m
a�
in full NEW CONDO 1691 SQ FT LIVING
;n: uanroc.j ue.g 02 SQ. FT. GARAGE
F4 ARCHITECTS DECLA114TION,
SC de mY PI Elbe
Sul
G @cd Pn
11401111
OUDECLARATION
uaffirm
at lam exempt From the Communes Law for IW
following moon.(Smo 7(71.!,Business and mess Code:My city our county
which auiru a permit in cnnsualoe Improve,demn11W,
or rtPsir any nuctum
—
Z> prinrnitsissuance,amumqulrestheapplicantfonuchParmitinRle..ignedsukment Val$2ilil030
<
that W is licensed pursuant to the provision of dm Connector's License Law(Chapter 9 Sq.Ft, Floor Area
$ (commencing with Section 7000)of Division 7 of the Business and Pmfallons Code)or
that be ii exempt therefrom and the but,for the alleged exemption.My violation of
Section 70713 by airy applicant for a permit subjects du applicant In a civil penalty Of APN Number Occupancy Type
nut ream than me hundred dollars($50o). 36940017 . 00
❑I.nowrcrsfthe property,army employees with wagesu theirsnmeompensedon.
will do Newark,and theswctum Isnot lmmnded orancmd parole(Sm.7014.B". ns Required Inspections
and PmR lona Caan.
ds,The Cmcmrs ucuun Law dao Int apply m an answer of 9 P
property who build,or improves demon,and who does arch work himself a through his
Own employee,,provided thm,uch Improvements are natlmmnded onarfa ed fa,ate.If,
however,the building or improvement Is mid within mrc 2e r of wmpledon,the Owner.
Wilder will have the burden of proving that ha did ret Wild or Improve far purpue of
um.).
❑1.as awrcr of the property,am exclusively contracting with liaised anuacm s m
construct the project(Sec.7(14,Business and Pro(eaa min Cade:)The Conner o's Li-
ccom law does not apply m an owner of property who builds or improves deouan.and
who commom for such projects with aeonuutor(s)licensed purscant to the Comranafs
License Law.
❑lam exempt under Sea .B d P C fe,this outcome
Owner Data
WORKERS COMPENSATION DECLARATION
1 hereby aM m under penalty of perjury ow of the following declsr.vons:
❑Ihawand will maintain.Cerdlicamof Communsel6lnum fo WodmrsCompan-
udon.as provided far by Scedon 77M of de Uthor Code,far the perfmmence of ds
work our which this monk is issued.
❑1 haver and will maintain Worker's Compensation Insurance,u required by Section
37M of she Leber Code,for the performance of the work fn which this permit is load.
My Worke' ompensWonlnannmeanierand Policy number am:
Carrier. ,^L Policy No.:ZD/J �
CERTIFICATE OP E)(EMP ION FROM WORKERS'
COMPENSATION INSURANCE
(Thiamclion need not W compleed tribe permit Is for onehundred dollars($101)
nr leu.)
1 cerdfy that In the performance of the work for which this permit is Issued.I shall not
employ any person In any manner an as in became subject to the Workcn'Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If.after making this Cedilicam of Exemption,you Mould
become subject to the Worker's Compensation provisions of the V Wr Code,you mon
0 O roMwith comply with such provisions or this permit shall k deemed revoked.
z r~N. CONSTRUCTION LENDING AGENCY
[•+ I hereby afimp that there is a coutuctinn lending agency for the performance of
w>
the work for which this permit is Inad(Ser.307.Civ.C.)
a^p tondos Name
7 Undertc Address .
U 0 1 cenify that I haw read this tcppimo on and atsm that IW i W m Information u
I2.E comtt 1 agree in comply with all city and county ONinancesand msm laws relating in
0 Wilding cauVuction,and hereby amorine representatives of this city to Color upon the
W tcWw-mendaned property far Inspection porpne}
(We)as=to on,indemnify and keep hamnlw the City of Cupertino against
rq imbili6a,judgmens.toms SW expense which may in any way tcaue against said City
C) Inc MIL
ICA a ms D STANDS ANDWILLWILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCEREGU ONS
Re-roofs
Si use of p canucomncmr Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
ds.pplica l or future Wilding occupam atoou n handle hoadous material
u defined by the Cupertino MunicVrCodC.Chapter 9.12,and IW Health and Safety
Code.Section 25532(.)? All roofs shall be inspected prior to any roofing material being installed.
❑Yet u
Will the applicant or forum bis'ding ocpant user equipment or device which If a roof is installed without first obtaining an inspection,I agree to remove
mit harmdnn air contaminants u Med M1y ticus Bay Area Air Quality Mengemcm all new materials for inspection.
District?
❑Yes u
mWYle hvaMnusmaerhls requirements under Chapmr6.95 ofthe Califon
alth IyCade,Smedona25505,21333 sod 25534.1 understand thatifte Wilding
as nut currant how a nano that It Is my mspoutldlity m Imtify the Occupant of the
mqul entswhic mlpdorwlssuaremofaCeNnamoroca cy. Signature of Applicant Date
wrier at&nth and agent Da All roof coverings to be Class aBn or better