05030091 CITY OF CUPERTINO x `�? �' * + e'. r "'
BUILDING DIVISION PERMIT CONTRA(;T0'R INF�A'T19N %
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BUILDING ADDRESS: TAYLOR WOODROW HOMES PERMIT NG.05030091
OWNER'S NAME: PERMIT ISSUE DATE
IlkTAYLOR
E; SANITARY NO. CONTROL NO.
(925) 365-3100
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
3c6 LICENSED CONTRACTOR'S DECLARATION Job Description
I hereby ararm that 1 am licensed under previsions of Chapter 9(commencing
with scNon 70(11)of Division 3 of the Business and Proteasiom Code.sad my licenm ie
mraErameandenem NEW CONDO. (1742 ' -LIV. SPACE)
Da
z License CI Ue.a gytractor p,GE 515 '
ARCHITECTS DECLARA N A-6 (BMR UNIT)
nu d in m s 1 recd as public reco
StOs Li oPmfc onel
a
OWNER-BUILDERexemptDE DECLARATION
g .by.(Sere thus I I.S.exempt
fare tie Cssion r,Lke y C Law for the
D O (allowing.amn.permit
t 71131.construct.aineu end prafealens Code:My<m or county
$ which require a permit re resthe •@r,harrow,dem ails t ri repmr any twmu.
Sec pdmmits iasum..duanttothe the applicant for Such Canarniuorile A emrm Signedstatement
-�< thuW Is licensed pursuant to the provision of the CuntncmriUcense law(Chspusr9 Sq.Ft.Floor Area Valuation
$ (eanmcneing with Section 7000)of Division 3 of the Business fund Pmfwiom Code)in $217333
that he Ice stumps merefmm and the basis for the alleged exemption.My violation of
Section 7031.3 by my applicant for a permit subjects me applicant to a civil penalty of APN Number Occupancy Type
nut mare thm 0.hundred dollen(5500).
❑ do
hwouaf the property..mYwPlayee withfageastietr smr sale .e",Busi on,
will do the wants.n,Cdd.aweurelanm inusnded Or ense,Lwdo Out
704n,wnerofmam Required Inspections
pro property
who
code:The Conuacmn Ucn.and who Law arca ret apply lf rt owner of q P
p.pertywhob,proat viimpm.ach imreverwho danouhwork endedi offeself red far
his
Own employee,p.vior i Wtsackimprovementsinnot inatof nplemm.We ala U.
bawevrt Ne Wilding orimp.wmentis soldwithinoreyearofcompletion,tleowne-
buihder will have the WNm of proving Net he did not Wild or Improve for arwm of
ssle.I.
❑1.as owner of the property am excluelvely contracting with licensed c4nuacmre to
eonswct the pmjea(Sec.7044.Business and profession Cade:)The Conuacmra U-
nxe law docs not apply to an owner of p.peny.fW Wilds or Improve thereon.and
who contracts for such projects with aconuacer(a)licensed pursuant to W Conusctoes
License law.
❑1 sm exempt under Sec. .B At P C for this reason
Owner Deus
WORKERS COMPENSATION DECLARATION
1 hereby aalrn under pcuslty of perjury has of the following declare acme
scation,❑1 have ono will maintain eCeN3iceus of Consent,Code.fort for performance
a ce of the
weak(r hick this
for by Ss on 3700 of de Labor Code.for me performance of the
wank for which cels pmnit U issued.
❑1 have and will maintain Worker's Compensation Insunna,as required by Section
3700 of the Labor Code,far the peRarmmm of the work for which this permit is blued.
My Worker,gompastallas Insurance carie and Policy number am:
Carder. Policy No.: WGROERW:S 1L11��7�L
ER Fl TE OF EXE
MON Me: KEWOR RS'
COMPENSATION INSURANCE
Creh section recd not becampleved If tit permit olmone hundnddollan($100)
or less)
I certify that in me perfotmance of the work for which W e Permit Is means,I shell ne,
employ any person in my enamor an as to become subject in the Worker'Compensation
Law,of Cable.].Data
Applicant
NOTICE TO APPLICANT:If,after making this CcaOcne of Exemption,you should
become subject to the Worker Compensation provisions of the Labor Cada you must
.,Zforthwith comply with such pmvulan Or the Permit shall be dammed romked.
„zO„ti CONSTRUCTION LENDING AGENCY
[.r Ihcrbyef0rm the,ft.is construction lendingsgecy Tar the arrormaeae of
�i> the work far which this permit is issued(Sec.3097.Civ.C.)
0.Q Leaders Nana
ice. z Lender,Add=
U 0 1 coolly that 1 have read this application and taus thin the be.information b
W U mr.n I agree us comply with all city W county aNimunces and left heading In
0 rVWilding construction,and Wmby mmodn apfeuna0vu of mu city Of color upon me
W above-mentioned property for inspection Purpoms
(We)agree in save,indemnify and keep homeless Oe City of Cupmino agdnal
req lieblllti orasadtaansns which may In my way erne gainst aid City
U 7 in loo unxe of g ting of anis arnil.
a APPLICANT UND ANDS AND WILL COMPLY WITH ALL N N-P INT Issued by: Date
SOURCE ULAT
a ( Re-roofs
SiggleurcofApplicLoCominamor Dam
AZARDOUS MATERIALS DISCLOSURE Type of Roof
Will plicant or future Wilding occupant stare or I le havardous material
y tie Cupenino Muniei ode.Chapter 9.11.and the Health and Safety
cod.Section VS5321 All roofs shall be inspected prior to any roofing material being installed.
Cl Ye u
Will the applicant or future building acupant use equipment or device which If a roof is installed without first obtaining an inspection,I agree to remove
emit haardnus air eonuminsnu u sad by tie Bay Arta Air Quality Management
all new materials for inspection.
Disuicl7
Yet
I hew real dus ha andmn materials requirements under Chapter 6.95 of the Califar-
nu Safety Cade,Sam=25505,25533 and 25334.I understand that Wave Wilding
not cu ity how a tenant,mat it is my responsibility m treaty the upon of the
Iremaets ih atbcmm norm ataCcollicamof c gpcy. Signature of Applicant Date
Owner ur oduo agent Dx. All roof coverings to be Class"B”or better
c