05030071 CITY OF CUPERTINO *^�`d' 5w;wpx;:, v .R '�'^*�' ,�� `" 7
BUILDING DIVISION PERMIT �CgNfRACT�OAANVORMATION
BUILDINGADDRFSS: TAYLOR WOODROW HOMES ""'T"05030071
OWNER'S NAME: PERMIT ISSUE DATE
TAYLOR WOOD
E: SANITARY NO. CONTROL NO.
(925) 365-3100
ARCHITECVENGINEER: BUILDING PERMIT INFO
BLDG ELECT O PO MECH
O
�oo LICENSED CONTRACMWS DECLARATION Job Description
uJ FF I hereby arrlrm that I am licensed under provisions p
ons of Chapter 9(commencing
a� wilb Section 7")of Division 3 of then Business and Professions Code.and my license is
inrullfone andeNEW .CONDO 1691 SQ FT LIVING
�t4� Deems Cl s ffsn Quo Muur 02 SQ. FT. GARAGE
Y d
ARCHITECTS
I anDCC TI
Y ' d rhnJ m ns sl lin mco
3�
and U.Mad carousal
N Oat I An exempt
from
OECLARAT ON
em
a I I herchy.(Sean that 11. uusin from the Comtracmra License Law for m,
RN0o whichfollowingmamapoonken 7 os0.8uainssand mprve.de ate Ca le:Anycity mmlum
which reyulma a pans t m construct.eller.Improsu demolish.ri mash any ewcwn
°z C prior m it issuance.calm requimep applicant Contractors
m rile a cense signed statement q. �$�Q 0 3 0
F< thatac es limned Section to the f Dieleus of the Corer"sore Lhenalaw(Cha m9 S Ft. Floor Area Val 1
S s (commencing withthedlone and the
basis
3 of the Busialleged
esscu mtl Prereson.An vl Coda)of
Net Ile t exempt Uenfr"n and IM bsis far the Jlegcd eumpton.Any violNon of
Section 7831.5 by any applicant for a permit subject the applicant to a civil penalty of APN Number Occupancy Type
net mem In.Rw hundred dollen(s5W). 36940017 . 00
❑1,u aver of to property,a mY employes with wges"tear solecomp,natan,
will do the work•and the sauces.is.,Intended"Offered renal,(Sec.7044,Business
And Prefesdous Coder The canvassers Utuue law tan nal appy m an ower of Required Inspections
property who builds or improv thereon,and who does itch work himael f or through his
awn employes,provided that such improvemcral not museded"offered Russia.If.
however,the building or improvement H mid within one year of completion.the names.
builder will have the burden of proving that he did not build or improm for purpose of
sale.).
❑1,As owner of the property,em exclusively convecting with licensed con=curs in
construct the project(Sec.78th,Business end Profession Cade:)The Contractor's Li-
cense law dos not apply at an owner of Property who builds or improves thereon,and
who contracts for such projects with a eonvacmr(s)licensed Pursuant to the Contractors
License law.
❑1 am exempt under Ses. .B 0 P C for Ihla rtewn
Dat
WORKERS COMPENSATION DECLARATION
I hereby air=under penalty of perjury one of to following declandome.
1 have and will maintain a CeNBeamof Conant male-i"um for Worko'sCompen-
amion,M provided for by Section 37W of the labor Coda,for the performance of the
work for which this permit is issued.
❑1 Marc and will maintain W"kcr's CmmP,Nedae Ieunne.a required by Section
3700 of the labor Code,for the performance of the work f"which this remail is issued.
My Worker`s cmaja1ms__mion Isunex artier and Policy number arc: ,.c7
Cartier. a"C.. C� Policy No.:0(00 1 �
CERTIFICATE OF PILON FROM WORKERS'
COMPENSATION INSURANCE
(Thisaeelim need not bo completed if the permit is forms,hundred dollars($I00)
or Ica.)
1 comfy that in the perfomaa of of the work for which this permit Is Issued,I shall net '
employ any person in any manner an as in become subject to the Workers'Compesation
Laws of California.Dat
Applicant
NOTICE TO APPLICANT.If.after making this Certificate of Exemption.you bouW
become subject to We Worker's Compensation providoe of the lab"Code,you must
.J 0 foMwith comply with such provtios or this Permit shall le deemed revoked.
z CONSTRUCTION LENDING AGENCY
(--i lborebya ..ft.Nen t a connmctinn lending agency rot de performance of
yv> the work for which this permit Is issued(Sec.3897,Civ.C.)
W 0 Lendera Name
z Lender's A6dreu
fJ z I mnify that I have read this application and Out that the shove information t
{7w f cancel.I agrees to comply with all city and county ordinances and stn laws muting t
O
U building construction,and hembyanthadn represemvws of this city to enter upon ft
W above-mentioned pmpenyfor inspecton purqus.
(We)agree to ave.indemnify and keep hamlet the City of Cupertino adSmhat
rA Ila s.judgment,cuts and expenses which may t my way accuse against mrsCity
U con neeofthe grantint of this
APPLIC UND RSTANDS LL MPLY WITH ALL NON- INr Issued by: Dale
RCE EGU 1 N .
16 Re-roofs
sign not AppllsnVCmnvacmr Dat
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the Applicant"future bull Ing Occupant am or handle haamous material
As defined by isle Cupertino Muni c Cade,Chapter 9.13,and the Health and Safety
Code. O Yes 355334)? All roofs shall be inspected prior to any roofing material being installed.
40 o
wit the.ppe[ann of metre og aeetp.nt uu,gdpmeel"a "s wnWh If a roof is installed without first obtaining an inspection,I agree to remove
emit ha aditus airconumienu a�,rfood by me Bay Ase Alr Qualhy Manag,ment all new materials for inspection.
District? /
❑Ys �N
arc read the hxsamnua materials requirement under Charter 6.95 of the Califuw
At until SafctyCo ,Scctiom35505,25533 d25534.1undcntodoulfmc building
of cu nlly 11-a enrol.Net h is Ibilily t nttl'y me"cupml J.
men n h mel u t aacmtB[aareem y Signature ofApplicant Date
Ow or authonssd agent D
All roof coverings to be Class"B"or better