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CITY OF CUPERTINO777777777;77,w
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BUILDING DIVISION PERMIT
CON kiCT0R INF0RMATIOr�kg �
BUILDING ADDRESS:
10281 TORRE AVE it 827
TAYLOR WOODROW HOMES
PERMIT NO. 05030062
OWNER'S NAME:
PERMIT SUE DATE
TAYLOR WOODROW HOMES
E:
SANITARY NO. CONTROL NO.
(925)365-3100
ARCHITECrYENGINEERt
BUILDING PERMIT INFO
BO EO PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
Job Description
P
I hereby affirm Nn 1 am licensed under previsions of Chapter 9 (commencing
with Section 70M) of Division 7 of the Business and Prefessivas Code, and my license is
in full forme and orloa
NEW CONDO 1691 SQ FT LIVING
License LI..M
Dam—cumncmr
f$TA SQ. FT. GARAGE
clirmcl's DEcu o
my plena shell he used u uhtic rt ds
men=d fc
OWNER -BUILDER DECLARATION
miry alnnn Ihel I am exempt (rem the Conuaerofs License Law for the
ollow CX..JOS (Section ](171.5, Business and Profetions Code: My city or coumy
wh' mquhas a p rmlt on Construct, after, mine". demolish, or repair My structure
Prior m its issuance, Alan requires tie applicator forsoch permit =lite a signed Moment
Ft. Floor Area
Vdl
war Y liccnaed pocamenr m the pmlchow ofdm ConVmwel Limcw aw(OwPmr9
Sq.
$0ggl.030
(commencing with Section 7") of Division 3 of the Businues and PmRuions Code) W
Out he Is eumpt Therefrom and the basis for the alleged exemption. My violation of
APN Number
Occupancy Type
t for. permit subjects the applict m a civil pmuuy Of
Section 7031.5 by any applicanan
.., more than Ove hundred dollars, (ML
36940017.00
0 1, u owner of the property or my eroployeea with wages u mei,=le Compensation.
e ns
Required Inspections
will do the work, and the =lure is not intended or offered for sale (See Most. BuOmaa
and Profesuan ou Cade: rCantneto's Liceue law, n donot apply m owner an owr of
9 P
property who builds or improves thereon, and who does such wart himself or through his
own employees, provided that such improvements she notinmoded oroffercd forssla. It,
however, the building or improvement is sold within one year of completion. the owner.
builder will love the bordan of proving Out M did ant build or Improve for purpose of
sale.).
0 h a owner of the property, am exclusively contracting with licensed contractor to
conatrect the project (Sec. 70", Business and posices o a Code:) The Contractor's Li-
cense law does not apply to in owner of propeny.who Wilds or improves thereon, and
who contracts for such pm)eeu with a conummr(s) Iicen=d pursuant In the Contnctar'a
License Law,
0 1 am exempt under Sec. . B ,4 P C for this moon
Owner Due
WORKERS COMPENSATION DECLARATION
1 hereby affMn under penalty of perjury oro of the following declo n om
fmrfomh Camper
IO. andiddf nh oLdnf37W.fft
UbrCf.f.
provided fpe by Section 7700 of the labor Code, fm me Rrforma"e of the
work for
want fm which this permit is iasmQ
0 1 have and will maintain Worker's Compensation Instuance. u required by Section
3700 of the tabor Code, for the performanceaf tim work for which this permit u issued.
My Worker's �ompe��n��ua�tio.n Insurance �Ca,re.�w and Polity number art:
Grrier: v �a7 n f✓ Policy No.: i-7
9;;
CERTIFICATE OF PX PDON FROM WORKERS
COMPENSATION INSURANCE
(This=ties need nut hecamptcwd If tie permll Is forone hundved dollsoo(SIOIB
or lila.)
1 cenify that In the performance of the work for which this permit is ist wd, l shall not
employ any person in any manner ser at In hemme subject to the Workerf Compensation
Laws of California. Dam
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject to the Worker's Compensation Provtsionl of the gab" Code, you must
foMwith comply with such provisions or this permit shall bo deemed evoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that Move is • construction lending agency for de performance of
the work for which this permit 4 Issued (Sm 3097. Civ, C.)
Lender's Name
lender's Address
I certify lost I have read No application and mm war the above inforeadun Is
correct. I agree to Comply with all city and county ordinances Md sate laws misting m
Wilding cowection, and hereby authodm representative of mu City m Color uPnn the
above-mentioned property for Inspection pmposea.
(We) agree to save, Indemnify and keep harmless the City of Cupertino agAinel
a lits, cocostsand expenses which may in any way atom againstsud CHy
ihbllums•
n a rseling of this permit.
(CANT UN RSTANDS AND WILL COMPLY WITH ALL NONPOI
Issued by: Date
SOUR GU IONS.
Re -roofs
zt
={nature C HAZARDOUS MATERIALS DISCLOSURE Dam
Type of Roof
ill applicant or future building Occupant store orhandle hassrdoas material
as deOncd by Ote Cupenino Municip ode. Chapter 9.12, and the Health and Safety
Cole. Section 25533()7
All roofs shall be inspected prior to any roofing material being installed.
❑ Yeat
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future Wilding occupant use equipment or devices which
t huardou air conuminl u dC d by the Bay Area Air Quality Mmgcmcnr
all new materials for inspection.
District?
0 Yes
I hue mad the hevardousmstcuahnqulrements underC7up er695of Ore Califor.
nla Health&SafciyCode.Scedmu23305,25533na12753d.lundcnundOmifthe Wilding
Joca rotcunenrlYh=aloe mat itmm embilaymnad theoccupantnfthe
reqs in u me ustbeeo. beef«
Signature of Applicant Date
All roof coverings to be Class "B" or better
weer a horir is ens Di.
I