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CITY OF CUPERTINO"�'�
GO�RACTOR I FORMATI16 �
BUILDING DIVISION PERMIT
BUILDINGADDRESS:
TAYLOR WOODROW HOMES
PERMITNO.05060232
OWNER'S NAME:
PERMIT ISSUE DATA
TAYLOR WOODR W HOMES
2300 CAMINO
E;
SANITARY NO. CONTROL NO.
(925)365-3100
ARCHITECTIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
Job
bereby affirm Nm 1 Am licensed under pmmlons of Chapter 9 (commencing
with Section 70X111) of Division 3 of the Business and Nolemiana Code, and my Iiceaw B
nfallfamembi 1. io��o
REVISION--CALCS & HOLD DOWNS
Llaenm C a Lic. M
Dam canumar—
NO NEW PERMIT ISSUED/ORIG. #05020007
ARCHITECT DECLARATION
Its adVas slid Aspubf no
Licensed factional
OWNERE LDER DECLARATION
I homily norm Nm I am' pt from No Convenors License Law for the
allowing mman. (Section 7031.5, Business and Profession Cade: My city at county
which inquires a permit to construct. alter. Improw, demolish. o repair my structum
prior M its issuance. aim mquiina the applicants far permit w file, sigrmd sutement
h licensed ConbaCmr. Wsnc law(Charter 9
Sq. Ft. Floor Area
Valuatio$115
Om W pursuant m the Provigmasof the
(commencing with Section 7000) of Division 3 of the Business and Prof roam Code) Ca
Nn he is emmpt therefrom and the bash for the alleged assumption. My vialdon of
APN Number
Occupancy Type
Section 7031.5 by any applicant a permit subjects the appliemt to a Civil penalty of
not mom than five hundred dollars ($500).
3 6 9 4 0 017.0 0 .
❑ I. ea menu of the property. m my employees with wages m their sale compensation.
Required actions
will do the work. And Onmoemreisnatintended mnifetedforwe(Sm.7044,Busimas
And ProfeWnal Cade: The CAmVmmra License Law does ani apply m m MW or
9 P
propenywha builds m improv thereon, and who dmssuch wok himmlfor Waugh his
Own employees, provided that such improvements art not intendW oroRerM for sale. IL
however, the building or improvement is mid within am year of cempletion, the owner.
build' will haw the burden of proving that he did not build or Mprow for purpose of
tele.).
O 1. as owner of the property, am emlusively mommadog with licensed m mmmus, m
construct the project (sec. 7044, Business and Professional COCA:) The Cmtraemrs U.
acne, Law don not apply w an Craw of pmpeny who builds a, improv Merton. and,
who contracts for such projects with a mmummK.) licensed pursuant m the Convacur.
Liana. Law.
❑ I em exempt under See .B k PC for this mason
Owner Date
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury am of the fallowing declarations:
❑ 1 havemal will meinuin • Ceadficau of Consent m mlfdmuro forworker.C.P...
moan, m provided for by Section 3700 of d e Labor Code, for the Performance of W
'
wink for which Nb permit is issued.
❑ 1 haw and will maintain Worker's Compensation Insurance, m required by Section
3700 of the labor Code, fm the parformaecA of the wait far which Nil permit is issued.
My Wohch CamPenmtim Insunna canis and Policy number w-s�:y,.[7
Carries: Yi•>t-al.��C'l% Poliry No.:.S.6li.L��
CER77FICATEOF J�(EMP110N FROM WORKERS'
COMPENSATION INSURANCE
(Tbla sed na mad swim completed little permit is for one hundred dollars SIM)
or less.)
I certify that in the performance of the work for which this permit is issued, )shall not
employ any permn in my mmmr an a in become subject to the Worlers'Compensadon
Laws of California. Data
Applicant
NOTICE TO APPLICANT. If, after meting this Certificate of Exemption. you should
become subject As Ne Worker's Compensation provisions of the Labor Code, you most
forthwith comply with such provisions o this Permit shall bu deemed mwked.
CONSTRUCTION LENDING AGENCY
1 hemby M. Out ware is a Construction lending agency ter the perrarm:mrt of
we wink for which this Permit is issued (Sec. 3097. Civ. C.)
-
Leaders Name
Lender's Add.
I madly that 1 haw mad this Application and Bute that the above Information is
torten. l agree to comply with all city and County aNlnances and sues law. relating m
building ecnsuuctian, and hereby mthorine mpmsenudws of Oil City m enter upon W
show -mentioned property for inspection purposes.
(We) since in mw. indemnify and keep harmless the City of Cupertino against
Babilities,judgmenu,com and expenses which may In my way same al4iml laid City
in eonsequemc of the panting of this Permit.
ANT UNDERSTANDS ND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
OUR REGULAEON5.
"
Re -roofs
signor AppficanVCa D'
H=US MA ALS DISCLOSURE
.l pe of Roof
Will the sprite bulidi g upmtstore m handle haardous mmcrial
As tle0ned by the Cupedno Muniai I . chapter 9.11. and the Health and Safety
code. Section 25532or
All roofs shall be inspected prior to any roofing material being installed.
Y' u
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment or devices which
e.R havarc out I,coounicam m Good by the Bay Area Air Quality Management
all new materials for inspection.
Distria1
❑ Y' o
I haw and the hmardms materlalarequiremanu under Chapter6.95 of the Califof.
th&smclyCada, Seedmu755(15.15533uW2553/.1.m nundthuirwc building
does not mscntly haw a tem., that It u my maponsthility m mdry W ocmi ml of the
atmmnuw'Ir bemI anima afaCCnifteawar u
Signature of Applicant Date
(mus I �
"B"
All roof coverings to be Class or better
O cr or authorirsd agent are