05030061 CITY OF CUPERTINOBUILDING DIVISION DIVISION PERMIT KONTRACTOR=INFORMATI01
BUILDING ADDRESS: TAYLOR WOODROW HOMES PERMIT NO.05030061
10280 PARK GREEN IN ff 828
OWNER'S NAME: PERMIT ISSUE DATE
TAYLOR WOODROW HOMES . 2300 CAMIN
E; SANITARY NO. CONTROL NO.
(925) 365-3100
ARCHITECT/ENGINEEX: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Y0, LICENSED CONTRACTOR'S DECLARATION Job Description
fi 1 hereby same that 1 am licensed under provisions or Chapter 9(commencing
a,� with Section 7010)ofDivlslon 3 of the Business and Prokadan,Code,and my license is
In fall to.a ad affect. NEW CONDO. (2052 ' -LIV. SPACE)
g E Did, 'no
. ser GARAGE 3591
ARCHITE SDECLA A C-28 (ORIG. )
"kzliez u pas rec
3 License: rofcsalonal
5 OWNER-BUILDER DECLARATION
I bunchy e1111.that 1 am esempt from she Connotes Imnse Law for thw
O o following Masan.(Suction RD 1.5,Business and professions Code:My city or county
Zn 9 which requires a permit to construct,alar.improve,dcmoliah,or repair any structure
—Z See prior to its issuance,also requires the applicant forsuch permit an Ole asigned statement
FF < that hcis licensed pursumttoMeprovisions rdtheComnctor"sLiccnxlaw(CIMPcr9 Sq.Ft.Floor Area Valuation
C 9 (commentlng with Sation](NIO)ol Divieionln(thc Butlneu and profcsrinns CMe)w $248539
— Nn he isu
empt therefrom and the bub for the alleged exemption.My violadon of
Secdon 7031.5 by any applicant for a permit subjects du applicant M a civil penalty of APN Number Occupancy Type
our mare than five hundred dollen(M),
❑I,u ower of rets pmpwy,w my employees with wage u thwirsete c mpenudon,
w0ldo the work,and thesnueure is atmundedarancud rot sale(Sec.7044,Business 369488±? Required Inspections
and Profustou Code:Ibe Contractors Liaise Law dace not apply M ns an owner of q P
property who build,or improves thereon,and who does each work himsel f ar through his
own employees,provided that much Improvements,AM not Intended anoffered for We.If,
however,the building or improvement Is gold within am year of canpleuon,the ownm-
builder will have du burden of Proving that M did not build or Improve far purpose of
ukJ.
Cl I,As owner of Mw property,am excluively contracting with licensed eomexuars M
construct the project(Sec.7044,Business and profeWons Cade)The Contrscter'a Li.
cause law does not apply M an owner of property who builds or Improv N rnum.and
who contracts for,uclt projects with a crammer(s)licensed pursuant to the Contractors
License law.
❑lamaemptunderSet .BAPCfoethbresgon
Data
WORKER'S COMPENSATION DECLARATION
I herchy Mm under penalty of perjury ane of Mw following declan0ons:
❑I have and will maintain a CenlftauofGonseat M sett-Wum forWm1 xrseampon-
ution,an Provided for by Section 3700 of Ne tabu Cad^.for the Performance of Mw
work for which this Permit is issued.
❑I have and will maintain Workers Compensation Insurance,As required by Section
3700 of the Labor Coda,for the performance of the work for which this permit Is issued.
My Worker,Compensation
Insurance carom and Policy num��Tber"''tee �'''
Card- S� Q� Policy Na.:
CERTIFlCATE OP EXEMPTION FROMWORKERS'
COMPENSATION INSURANCE
(This auction need not bu completed If the Permit Is foronc hundred dallara(S100)
or less.)
I anify that In the performance of the work for which this Panel,is Issued.I sball not
employ any person in any ormaeru As M become subject M the Worken'Compcwtion
Law,of California.Dau
Applicant
NOTICE TO APPLICANT:If,after making this CertiOcale of Exemption,you should
become subject M the Worker',Compensation previsions of the labor Code.you must
.,O forthwith comply with such P0vbmM Or this Permit shall be deemed revoked.
„Zxy CONSTRUCTION LENDING AGENCY
(.w Thereby affirm Mol Nen iso ronstmctinn kndin{agency for Ne perfarmatwe of
C> the wash for which this permit Is Issued(Sec.3097.Ci,C.)
6Wi Q Landers Namc
7 z Lender's Address
f,)Q I madly that 1 have reed this pplicathon and state that Mw show Information is
U, r' eorutt 1 apo m comply with all city and county aNlnmas and scam Iaw missing m
Qiu building answction.and hereby uNoric,reponnmli.of Nis city m enter upon Ma
[LI show-mentioned property for Inspersion purposes
gy (We)egree an save,indemnify and kap hummu the City of Cupcnina against
h Iiebilide dgmenu,cuu And
aof pensns which may In my way acme a{alnst old City
U 7 late LICA greasing
COMPLY WITH ALL NON-P01 Issued by; Date
F7 OUKE RE ULATI
Re-roofs
Signatureo IicanVContram M
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
II the appllcmt or future building occupantamm orhandle hevndons material
tined by the Cupertino Munic I Code.Chapter 9.13,and the Health and Safety
Cade,Section 255324)7 All roofs shall be inspected prior to any roofing material being installed.
Yes C94
Will the applicant or rumre bui int acupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit haurmus air contarem,u u ncd by the Bay Area Air Quality Management all new materials for inspection.
Dlstdct7
❑Ya u
I have read thcherudmesmateriebrequiremenu under Clupur6.95 of the Califon
an 85 fctyCode,Sxtimu 25505.25533 25A4.Iandcncand matlfCw building
wt c filly Mw a mr.4 Nat his my Lethy b noury Mw occupant of Ne
men
'whi14 ch nmIPrio f Ccm near ,Pen Signature of Applicant Dale
owner 0adads e I Da All roof coverings to be Class"B"or better