05030067 CITY OFCUPERTINO
BUILDING DIVISION PERMIT 'rQIN1''O t1'TIQN, `:.
BUILDING ADDRESS: TAYLOR WOODROW HOMES PERMIT NO.05030067
10280 PARK GREEN TiN ;� P17
OWNER'S NAME: PERMIT ISSUE DATE
TAYLOR WOODROW HOMES 2300 CAMIN
E: SANITARY NO. CONTROL NO.
(925) 365-3100
ARCHITELTENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0
app LICENSED CONTRACTOR'S DECLARATION Job Description
1 batch,affirm that 1 am licensed under pmvirmalof Chapter 9(commcnein{
rR1 with Section 7100(h of Dlvidw 3 of Ne Business and Profculuv Cotle.and myli Mae
infill forte and e0ect. /CLJ NEW CONDO 1691 SQ FT LIVING
j'�z Littnmcw c , 02 SQ. FT. GARAGE
t Ilk—
all Date Contractor
ARCHITELTSDECLARAT BMR UNIT NO CONSTRUCTION TAX
1 and.mnJ my ns shell W road u public Rea /
i W Icenttd Geinna
'ice OWNER-exemptBUILDRDE Ce ContaON
N herchy o1Rect that 11. exempt from the ContnnCa License Law for the
o wins mason.(Section 8131.5,Business and dem ll Cade:Any city or county
$ which leyulma•Permit to emsmucl,abea Improve,h Permit i n repair any structure
prior 1.thatWitacensed e,slwrean ft tbeishoussnt off Cohmesm'mieesseaned w(ChAmem
p€� Ilulbeis licewepursoentm the pmvisiom o(Ihe Conummh Licewlaw(ChaptIX9 Sq.Ft. Floor Area Valuation
y+ $ (cmnmencing with Section 7000)of Division 3 of th $'
e Businamand Profession Code) 211030
thm M is attempt Ilercfmm and the basis for the alleged emmption.Any violadon of '7
Section 7031.5 by my applicamfor a permit subject the applicantmanewt prat of APN Number Occupancy Type
.at more Nall five hundred dellaR({5007.
0 1,u owns of the property,w my mmployees with wage u Nem cele wmpewUon,
69400t? . 00
w1II da file wod4 Nd dR aWCIaR 111101 Nlellded IXORCRd for GlC($G.7Dw,BGinC51
and Pmfeasion nlue Code:The Camooes Liwlaw don ant appy to wner an aof Required Inspections
property who Wildsorlmpmves themon,add whodocl ie ch work himsellwtilmugh his
own employees,provided that such improvements are not intended mo0tred for sale If.
however.the Wilding or improvement is mid within one year of completion,the owner
builder will have the Wrdrn of proving that he did not Wild IX improve for purpose of
ask.).
0 1,as Owner of the property am exclusively contracting with licensed conuacmra an
construct the pmjen(Sec.7044.Business and Profusion Code:)The Contractor's LI-
cew law does not pply in an owner of property who Wilds or improws Ihemon,rod,
who contracts for such projects with a crematoria)licensed pursuant On the CanmmtOeI
License Law.
0 l aro exempt under Sec ,B"P C for this reason
Or
Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penury of perjury ane of the following declarations:
0 I have and will maintain a CW Mate ofCowmt mull-imum forWak xCmwpcn.
nation,as pmvldel for by Section 3700 of the Labor Cotle,for the performance of the
work for which this permit is Issued.
0 1 have and will maintain Worker's Contamination Immanw,as required by Section
3700 of Ne Labor Cade,for the performance of the work fmwhich that permit is ivued.
My WorkeYs Campenmiw Insunntt Grier and Policy number ase:
Carrier. 6412 JI-e— CARP Policy Na.:OCIb,
l b��
CEIMFICATEOFf.XEMPf70N FROM WORKERS'
COMPENSATION INSURANCE
Cl section need notbecomplemd if the Permit is forone hundred dollar(SIM)
U,Iesx)
1 cenify that in the performance of the work for which this permit is iaswd,I shall not
employ any person in my manner an as In become subject mase Worken'Compew0on
Law'
of California.Data
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become Subject in the Worker'a Compensation provisions of dta L lWr Cetle.You must
z.. foMwilh comply with men provisions Or this permit shall W domed raveled.
„zy O CONSTRUCTION LENDING AGENCY
I bemhy afrnm Net the.Isacalnuwdon lending agency far the perfurma ata
Oar.9 the wark for which this permit is howd(Ses.3097,Civ.C.)
Va QUndoes None
0.. zLender's Addmcs
U 0 I cattily Nm I have read this application and sat¢thin the above infornesum 4
Un" Move.1 agree to comply with all city and county aNanmte
lmces and laws m
miming
0 building construction,and hereby Suthudre representatives of this city m enter upon the
W above-mentioned property for Impaction purpome
agree to" ,indemnify and keep harmless the City of Cuperlim against
l•y y Iia G, gmcnm,cmumdexpewswhichmayinmymyamueagaimtuld City
U 7 i onwgw c of dm{.ming of this permil.
r1• PPLICAI UNDER ANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
S CER GUI.ATIO
f Re-roofs
Signmu Ap I/Cont Or I Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicam G rut.Wilding oecupant mom IXhandlc he'rardous matariai
as defined by the Cupertino Mun ryl Code.Chapter 9.13.and the Health and Safety
Cock.S 3y.35 (a)7 /yl All roofs shall be inspected prior to any roofing material being installed.
❑Yes d/Nu
Will de applicmt or fuutture 'ding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit ha/ardmG air comuminum, e0ncd by the Bay Arta Air Quality Management all new materials for inspection.
District?
0 Yes
the mad Ne Iwranlnusmmerlals mquimmcnu under Chapwr6.95 or Ne-Califor-
eHea "Safety Code.Seeuonst5N15,23333 tied 25534.1 undetRantl thuifthe Wilding
coolant wrrnlly w s tenant cut it is my mspomihillty R nodl'y the rwupwt of the
rcyulrc mwhicmusbe pdormlasu Cmlfic ofocupenc Signature of Applicant Date
s
o er ar aatbarizeI a I Data All roof coverings to be Class"B"or better