05030066 CITY OF CUPERTINO +'' <
BUILDING DIVISION PERMIT7rpCO3-N R CTOR,I�NF RMATION
BUILDINGADDRESS: TAYLOR WOODROW HOMES r�nmfN0'05030066
10280 PARK r=FN T,N it RIF;
OWNER'S NAME: PERMIT LEVE DATE
TAYLOR WOODROW HOMES 2300 CAMINO- RAMON STE 1017 07/20/200S
E; SANITARY NO. CONTROL NO.
(925) 365-3100
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
o l! o
30o LICENSED CONTRACTOR'S DECLARATION ]Ob Description
i�u I hereby,(firm BW I am licensed under provitiom of Chapter 9(emm ecneing
wish setion 70(10)ato' 'ion 3ofthe Budnessud Prefeftl^��C�ade,Citi mYlicemeh
R inrullfaceande0ett � (p NEW CONDO 1691 SQ FT LIVING
'�' Lieenacel Lld.g 502 SQ. FT. GARAGE
Duo: 7r DECr
AI4CHDECr DECLA ATO
I anti and m loon a II u u pas c
A.
Ir 4p caved ,e th anal
OWNER-BU ER ECLARATION
13 q I hereby 4Rirm that I am a pt from the Comminute,License Law for the
lowing mason.(Section E013,Business and Professions Code:My city or County
$ which mu ma,a Pemrit a construct.slur,improve.demolish.at repair any suunum
prior its lnuneo.d.requires Je applicant features permil to file a signed uaamem
< that he is licensed pummm re On pmvipiomof ted Contractor's License U.(Chapter9 Sq.Ft. Floor Area Val$��T1030
z�m (commencing Mth Scetion7000)ofDivision3aftWBuMn mdPrafeWom Code)or
e R 9 But he"Ins exempt therefrom and the basis far,the alleged exemption My violation of
Suction 70365 by any applicant for.permit subjects the$PPimant m.Civil Penalty of APN Number Occupancy Type
nut ream 0.n Fite hundred della.(s500). 36940017 . 0 0
El I,uowmrofBapmpeny,armyemploymwithwagetu Neirwlccompenutlon,
will do the work,and On structure it netinanded Oroffered forsam(Sec.7044,Business Required Inspections
and Profession,Code The Comommes Lkeme Law dean not apply to an owner of q P
property who bulldsor improves thereon,and whodms mchworkhimselfortluough his
own employees,provided that such improvements un notimended oraBered ferule.IL
however,the Wilding or improvement it sold within one year of completion,the owner-
Wildu will haw the burden of proving that be did not Wild or improve for purpose of
ask.).
❑1,as owner or tit property am exclusively contracting with licenced eonvaetan to
temtmtt the project(Set.7044.Business and Professions Code:)The Cormenals I.I.
came Law date not apply m on owner of property wed Witt or impmm garcon.acd
who conmens for such projects with Acontracmr(0 ticemed pursuant to On Connecta's
Lkenu Law.
Q 1 am exempt under Sec. .B S,P C for this moon
13700of
t Data
WORKER'S COMPENSATION DECLARATION
1 Mreby dorm under punaty of perjury one of the following declarations:
h.ve and will mdnW n aCemicateof Cement m,dbimure fa Warkett Compen-
,u provided for by Section 77M of the ISWr Code,ter the penmmanec of On
for which this permit ts issued.
haw and will maintain Workers Compensation Instuua.u required by Section
the labor Cade,for the performance of the work far which this permit it luued.
mIme.CoCampemlgon lnaurame carrier and Polity number are: " 7 O
er.aL(r Policy No.:
ERTIFICA EXEMPTION FROM WORKER
COMPENSATION INSURANCE
(Thh section reed notbucempleted If the permlt Isforone hundred dollars(SIM)
or loss.)
I certify that in the performance of the work for which this Permit is issued.I.hail raw
employ any person in my manner an As to become subject m the Wahen'Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT.If.after mains this comneste of Exemption.you should
necome subject re On Wari er's Compensation provtsiom of the labor Cade,you must
OZ forthwith comply with Much pmdatnm or this Permit mall be accrued mveled.
z O CONSTRUCTION LENDING AGENCY
Ihereby AM=that them is a construction lending agency for the performance of
!Yi> the work for which this permit Is issued(Sec.3157,Civ.C.) '
QLeaderi Name
z Lender.Addmn
U O I«Afy that 1 ban mad this applied"and sum that On above Information Is
F cormc.I agree in comply with all city and county ordinances,said nate laws elating to -
0 building construction,and hereby,uthorim aepmentafive.,of this city M enter upon the
above.mentionW Property for Impaction porposet
(We)agree in Five.indemnify and keep hatmlw the City of Cupertino against
rA liMillIOes.judgments,costs uta expemas which may In any way,anus ag•Wt mid City
I
PPLICUNDERSfANDS AID SILL COMPLY WITH ALL NON-POINT Issued by: Date
S CER GULA IL
S. /
t Re-roofs
Signnu i'AppncsntrConuacor Date
HAZARDOUS AMRIA SCLOSURE Type of Roof
WIII Ilan applicant or future building occupant stone or handle havallou mtesid
asdc0nedby tis Cupertino Munici Code.Chapter 9.12.and the Health ted Sdety
Code.Section 25532(.)? All roofs shall be inspected prior to any roofing material being installed.
40 ❑Yu o
Will thn.ppntat t or rutnm bui g acupant ata equipment er dneea whish If a roof is installed without first obtaining an inspection,I agree to remove
emit ha'rardau air contaminuu as nc0 by the Bry Am&Air Quality Management all new materials for inspection.
District?
❑Yes er
Q
es ardau,materials requirements under Chapter 6.95 or the Califor.
CLYCOdc,S.,tun,25505.25533 ted 25534.1 understand that if the buildingJly he .anent, t I m spamibility u artery the ecu tit or the
man =nor,CmJReamo� up Signature of Applicant Date
own r,atneri>edagent 7 Dnm All roof coverings to be Class"B"or better
e