05030068 CITY OF CUPERTINO �yya
BUILDING DIVISION ?T- T0R4NF0b9' A"T10PERMIT
'e:"tt• ry,,l{4
BUILDING ADDRESS: TAYLOR WOODROW HOMES Pr"h"`No'O5030068
OWNER'S NAME: PERMIT ISSUE DATE
TAYLOR WOODROW HOMES 2300
E: I SANITARY NO, CONTROL NO.
925) 365-3100
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
3 C j LICENSED CONTRACTOR'S DECLARATION Ib Description
I hereby affirm that 1 Am licensed under provisions CSCrIP
u of Chapus 9(comencnems
^� nfullfotice std eOm Divi'onlof the BuslreasuM Nofudans Co@,aM mylicemc6
;'z License
I Lie.. NEW CONDO 1691 SQ FT LIVING
;8rq' D comnmr a 502 SQ. FT. GARAGE
d ARCH17ECrS DECLAR I
2 1 u dcrnand y p u
J
Liccnac mfcaaional
OWNER-BUILDER DECLARATION
1 hereby affirm Thal I am exempt fmm the Conoacmfs License Law for the
O O fallowing moon.(Section 703 1.5,Business and Professions Code:Any City or county
$ which requires A Permit an ennmuct.Altar,improve.demolish,or repair my structure
Prior An its Issuance,also requires the applicant for such permit to rile a signed statement
< that W is licensed purnam an to provisions of doe Cairman'a license law(Chapter 9 Sq.Ft.Floor Area Val$gibd 030
x€� (commencing with Section 7000)of Division 3ofthe Basbeaaand Profetdon,Code)or
that he Is exempt therefrom and the basis fm the alleged caempth n.My vloladon of
Sado.7031.5 by any Applicant for a permit objects the appimsm m a coil penally of APN Number Occupancy Type
not mare man five hundred dollars(5500). 36940017 . 0 0
❑Lasawoerofthe property,ormyemployces with wgeagadebmlemmpenutim,
will do the wart,and me structure Is hot intended orolfeeed rortak(Sec.70th,Business Required Inspections
and Professions Cade:The Co nnetwea License LAW does vel apply u e in owner or q P
property who builds or improves themon,and who does such work himself erthrough his
own employcca,provided that such Improvements arc not intended oronered forsale.if.
however.the building or improvement is sold within one year of completion,im owner.
builder will have Ne burden of proving that ho did not build or improve War purpose of
ask.),
❑I,As Owner of the property am exclusively contracting with licensed mnuacton u
contact the project(Sec.7004,Business and Professions Code:)The contractors U.
roue law does not apply to An owner of property_wife Arias ar improves therein,and
who contracts for such prejeccs with acomactor(s)licensed pursuant m the Cnnuumfa
License law.
Are,❑1 exempt under Sm. .B h P C for this mum
woes Dau
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of We following declamations:
❑I have and will maintain aCcNOcate of ComarnuoselGinsum for WorMer's Compen.
Radon,As pmvlded for by Section 3700 of Ne labor Code.for the performance of the
Work for which this permit Is issued.
❑1 have and will maintain Warker'f Compensation huursnce,As required by Schon
3700 of the Labor Cade.for tie performance of the work for which this permit is issued.
My Worker's Compensation hunrance camas and Policy number arc
Cartier,�Q Polley N.:' �C Policy
PTION .Ca$_CZ
FROM ORKERS'
COMPENSATION INSURANCE
Crds smdon need not Its completed little permit Isformc hundred dollars(SIM)
or leu.)
1 certify that in the performance of Ne work for which this permit is issued,I And not
employ any person in any mannerm As to become subject to the Workers'CompensNon
Laws of Califomh.Dau
Applicant
NOTICE TO APPLICANT:If.after making this Certinute of Exemption,you should
become subject an the Worker's Compensedon provisions of the labor Code,you mon
O forthwith comply with such Provisions or this Permit shall he deemed rev
oked.
,Z.r CONSTRUCTION LENDING AGENCY
14
E~ thereby affmn that there is a construction lendingagenry for the Performance of
ai r>,r the wells for which dui pemrit is issued(Sm.3097.Civ C.)
aQ Lender's Name
z Lender's Mdmss
V 0 1 ceNfy that I have read this application and rota that the allow information N
D. T+ correct.l agree to comply with all city and county ordinances and Bute laws mining m
0 rU" building convection,and hereby authodm representatives of this city an Cove upon ft
W ahovcmendoned property for inspection purposes.
(We)agree an gave,indemnify and keep harmless the City of Cupertino against
na cA liabilities.judgments,costs and expenses which may in my my emcee against laid City
to PLICAUNDERSTA gDs RIND WILL COMPLY WITH ALL NON-POINT Issued by: Date
S URGE EGUU N
Re-roofs
Slgnat '6tAppfi&. CcaArWm, I Da
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will tho applicant or feature building..partnam or handle huardaus material
As;de0ned by the Cupertino Munidp ode.Chapter 9.11,and ft Health and Safety
Coda,Section 75537(,)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yoe 0
Will the Applicant or future buil 'ng occupant ase equipment Or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hanNuu aircmtsnowu cd by rhe Bay Area Air Quality Management all new materials for inspection.
DIa ict7
❑Yea
I ve real the bactrdws materials requirements undcrChapwr995afthe Califor.
nia Health S4rmyCode,Saoivo25505,25 3w25530,1u mmdthnifde building
Mt c ho ha a unmt I mponsihility u-Dory the oceupant of the
genre tsw n un be p a ar Tmtaaramp Signature of Applicant Date
ncror mthomtd egem '771'/ate All roof coverings to be Class"B"or better
e