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CITY OFCUPERTINO
INF tiMAT. ION;
BUILDING DIVISION PERMIT
CONTTjU TOR
BUILDING ADDRESS:
TAYLOR WOODROW HOMES
PERMIT NO. 05030046
OWNER'S NAME:
PERMIT ISSUE DATE
TAYLOR WOODRO
E:
SANITARY NO. CONTROL NO.
(925)365-3100
ARCHOECryENGINEER:
BUILDING PERMIT INFO
BLDG PLUMB MECH
O O
LICENSED CONTRACTOR'S DECLARATION
Job Description
P
1 hereby affirm that 1 an licensed under previsions of Chapter 9 (commencing
"SeNan70(10)of "hubs 3ofthe Bush and Nofevlum Code,andmylicenwis
m rmuaree and erreet• f,{/
NEW CONDO. (1938' -LIV. SPACE)
Dam rc c rens
ARAGE 568'
ARchrl7EcrsDEcu oy
'
B-23
lundc rdmyplamshalMuadsspuhlk.
ccnscd P ssio
OWNER -BUILDER DECLARATION
Wreby of im that I am exempt from om Contractor's License Law for the
owing meson. (Section 1031.5, Business and Professions Cade: Any city or county
which acquire a permit to consumer, alcor. W prow, demolish, a repair any structure
prior in its issuance, also requires the applicant for uch permit to Ole a signed alemenl
Sq. Ft. Floor Area
- Valuation
that M u licensed pageant to the provisions of the Contractor's License Law (Chapter 9
(commencing with Section 7000) of DiAsian 3 of tre eupnea and Professions Cade) or
$241650W
t attempt mercmha fmathe bots for the alleged enMy Nolauon of
M iattempt
APN Number
Occupancy Type
Scatter 70313 by any applicant for a permit subjects tre applicant to a civil penalty of
not mom Dun 0w hundred dollars ($500).
❑ 1, as owner orde property, or my employees with wages as tree sale comparisons,
Required Inspections
will do the wok and the momman Is not Imeeded arartcrcd Retain (Sec. 7044, Buaneae
and Professions Code: TM Conummr's License Law doss not apply m an owner of
q p
property who buildsorimproves dier oo,andwhodocs suchworkhimselfoINough his
Own employes, provided that such Improwm=u art not im ended proffered focalt if.
howaver, the Wilding ar improvement is Bold widen ore yev of=mpleuoo. the owncr.
Wilder will haw IM burden of pwaiag must he did nm Wild or Improv far purpose of
ale.).
❑ 1. as owner of the property, am eaclusunly contracting with licensed =atracmg In
coestmct me project (Sec. 7044, Business and Professional Code:) M Contractor's Lb
came law does not apply to an owner of property who Wilds or improves t emon, and,
who contracts for such Projects wile acontrvmr(s) licensed pursuant in to Committees
License Law,
O 1 am exempt undo Sec. . B At P C far this meson
Owner Data
WORKERS COMPENSATION DECLARATON
1 Mrcby air= under penalty of perjury aro of Ne following dsWNos:
❑ I have and will mainuin nCerJOsuof ComenuoulGlm ea for Workeh Compere
amara, as provided for by Section 37M of the labor Code, far the performance of the
wok for which tris permit Is iuncd.
❑ 1 have and will maintain WorkeA Compensation Insurance, as required by Section
37M of the labor Code, far the performance of Ne work for which Nu permit is Issued.
My Worker's Com naauoa msunnee srtiv and Polity n�u-.mfber use:
Cartier. s�, ,�LS1 Polity No.:
CERTFICA OF EKEMFOON FROM WORKERS'
COMPENSATION INSURANCE
(Thu secure sed not W completed if ted permit l,rarone hundred dollen ($IM)
or leas.)
I cenify that in the performance of the work for which this permit is Issued, l shall not
employ any pegon in any manna as in become subject to the Workeri Compensation
Law, or California. Data
Applicant
NOTICE TO APPLICANT: IL after making this CertiOmm of Exemption. you should
became subject to the Worter's Compensation previsions of me labor Code, you mea
foMwitr comply with ace provision Or the Permit still W deemed mvaked.
UC LENDING AGENCY
Cat
crmmm,TION
them lending agency far me per(ormenee of
1 Meshy ahem Net marc b
tic work for which this permit b Issued (Sac. 3097, Civ. C.)
s ed (Sec. 30
Lender's Name
Lender's Addreu
I 1 centry Na 1 haw red this application and sum that dee strum infmmaman is
com%L 1 agree to comply with W city and =only ordinances and sum laws relating m
Wilding construction. and hereby authority reprs=udws areas city to cnur upon me
aWw-mentioned property for Inspection purposes.
(We) agree an caw, indemnify and keep l umleu the City of Cupertino against
j Iubilitis,judgments, csts and expemu which may in any way accrue against said City
inconvgwnceof useUNDERSTANDSciffliof �ANhisD WILL COMPLY WITH ALL NON OINT
Issued by: Date
SOURC LATIONS.
^/
"J24/1S
Re -roofs
Type of Roof
ign a pplicanVConuvmr Dalm
HAZARDOUS MATERIALS DISCLOSURE
It the applicant or to= Wilding oaupart am orhandlc haardos materia
fined by Oe Cupertino Municl I Code. Chapter 9.13. and de Health and Safety
Code. Sceuas 35533()7
All roofs shall be inspected prior to any roofing material being installed.
❑ Yes
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or fmurc bis' Ing nccupam ma eyuipmenl or device, which
.
cmlt hanardom air contaminants a 0ncd by mu Bry Aree Alt Quaiily Management
all new materials for inspection.
Dlsuict7
❑ Yes
[ hammed the hvanlnusmauMals requirements underChapter6.9501 do Califon
afaty Codc,Sxum%255U5.25533md25534.l undcnund traifNe Wilding
an my haw a tenant Nat It is my responsibility m nom me ace ant of gee
ire w' mugWmetpdormlssuanceofaCcioncam 0c=P
Signature of Applicant Date
All roof coverings to be Class "B" or better
ow r anmarirzsd agent Da(9