05030056a;;
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CITY OF CUPERTINO
BUILDING DIVISIONPERMIT
r4("ONTRACTOR INFORMATION ?�
BUILDING ADDRESS:
TAYLOR WOODROW HOMES
PERMrrNo'05030056
OWNER'S NAME:
WE;
PERMIT ISSUE DATE
SANITARY NO. CONTROL NO.
(925)365-3100
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONIRACIOR'S DECLARATION
Job Description
licensed under provisions of Chapter 9 (comting
I hereby &Man that 1 am Chmu
with Section 7000) of Division 3 of the Business and Profession, Code, and my license is
in roll reree and Arc L �p
N W CONDO 1691 SQ FT LIVING
License Cl Lic.•
2 SQ. FT. GARAGE
Date contrutor
ARCRf1ECrS DECLARATI
-
un rad my plans shall he used u public menr
cenmd sus
OWNER -BUILDER DECLARATION
May affirm Net I am ucmpt from the COnmutors License Law for me
ng reason. (Section 7031.5, Business and Pmrcamom Cade: Any city or county
which requires a Permit On construct. ship Improv, demolish. Or repsir any auotture
prior ser its Issuance, also requires the applicant for uch permit m file a signed statement
that he is licensed pursuant n the provisions of me Common's Liume live (Chapter 9
Sq. Ft, Floor Area
Val"ibil030
(commencing with Section 7000) of Division 3 of me Bmineu and Pmfculnns Code) or
that he 4 exempt therefrom and dm basis for de alleged Assumption. My violation of
ApN Number
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty of
oat mom than five hundred dollars ($300).
36940017.00
❑I,uownuofmaproperly,Ormyemployeewithwagesu Meirmleeompm flon.
e ns
Required Inspections
will do the wa&- and dosWetwe 4 not imanded oroncred foraa4($a. 7044, Basneu
and Professions Cade: The Commiserates dao cal License law dasol apply m an patter of
q P
property who builds or im prove thereon, and who doessuch work himself ser mmugh his
own employees, provided that such Improvmenu are not Intended oroffered for ale. If,
however, the building or improvement 4 mid within ane you of completion. the owver.
builder will have the burden of proving that he did an, build or Improv for purpose of
ak).
❑ I, as Owner of the property. Am exclusively contracting with licensed contrmtar, In
contract the project (Sec. 7044. Busaess and Professions Code:) The Construes s Li.
term law does not apply to an Owner of property, who Wilds or improves themes, and
who contracts for such projects with aeonuecmr4) licensed pursuant m me Contrmtors
License law.
C]1 am exempt under Sec. . B R P C fu mis reuon
owner Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm under Penalty of perjury arc of the following dnelumem:
❑ 1 ban and will maintain a CertiMteaf Covent in ulf-insum far Warkele ComNn.
union, As provided for by Station 3700 of the Labor Code, for me performance of the
work for which Ws pumh is iuucd.
❑ 1 have and will maintain Worker Compensation huurance, As required by Section
3700 of the labor Code, for the performance of the work for which this permit 4 issued.
My Woftce mP nudon hu mans carrier and Policy number are:
Cartier. CQ Policy No.:
CERTIFICATEOFEX MPrIONFROM KERS•
COMPENSATION INSURANCE
(Thisucticw aced not be competed l f the permit 4 fare= MMrtE dollars ($100)
or less.)
1 certify the, In the performance of the work for which this Permit B Issnetl, l Nell am
employ any person in my mannerm As in become subject to the Workers' Comps uumon
Laws ofCalifomla. Dam
Applicant
NOTICE TO APPLICANT. IL after making this Certifiesm of Exemption, you should
Measure subject In the Workers Compensation provisions of the Labor Code, you mum
formwim comply with such provisions or this permit shall be among! ra nked.
CONSTRUCTION LENDING AGENCY
1 hereby from that there 4 a convection ending.$.my for the perfomana of
the work for which this permit 4 issued (Sec. 3097, Civ. C.)
Landes Name
Lender's Address
I cenify that I have read this application and sans mu me above Information 4
comma 1 agree to comply with all city and county ordiencea and sum laws relating to
building construction, and hereby authorise representatives of this city to Amer upon ft
above-mmummd proficr y for Impaction purleus
(We) agree to save, indemnify and keep hemnleu the City of Cupertino against
Iiabilitiee,judgmcnts, toss and expanse which may in any way seethe apron cid City
A PLI UNDERSTANDS S ANDMOL
WILL COMPLY WITH ALL NON -POINT
Issued by: Date
S C EG 0
f
Re -roofs
Type of Roof
Sign of ApplieanUCantnean am
HAZARDOUS MATERIALS DISCLOSURE
WII1 me applicant ser (mart buil ing occuP., more u handle havidom material
As dented by the Cupenira Ma.M Code, chi Pmrem and the Hcalm and Safety
Code, Section1553xanAll
roofs shall be inspected prior to any roofing material being installed.
[:]Y. o
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant ser fawns bui g Oeeuput use equipment or devices which
it huardam air canamimmte u Hord by the Bay Arta Air Quality Management
all new materials for inspection.
District?
❑ Yes
Ihaveread thehomtdommmedals q i mrnuundttCNpmr6.95ormeCalifor-
& S fayCOde, Sectiw25505,25573 esu 25334.1 ummaimM bassinet building
oat not c dy have • tenant, that it 4 my responsibility m nad fy de occupant of Ne
mrrm wn Amum Mmet riormwu AcamincamoraPanty
Signature of Applicant Date
All roof coverings to be Class "B" or better
ownerrat rived. Ant Da
01