05030072 CITY OF CUPERTINO r' 'A' r
BUILDING DIVISION PERMIT ONTRA.CTg1iN�'UtMATIU '
BUILDING ADDRESS: TAYLOR WOODROW HOMES PERMIT NO.05030072
OWNER'S NAME: PERMIT ISSUE DATE
TAYLOR WOODROW HOMES 23
E; SANITARY NO, CONTROL NO.
(925) 365-3100
ARCHITEC (ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MICH
0 0 0
.0o LICENSED CONTRACTOR'S DECLARATION Job Description
1 literary AIR.Nat 1 un licensed under provisions of Clupu 9(emanational
n� ntin Secmea�tfecDlvldon 3 of0u Businessland ProfessionsCode.and my imamm
191 Lie w Lk g 'fib NEW CONDO 1691 SQ FT LIVING
m canmananr 502 SQ. FT. GARAGE
ARCHRA
I un and y Is s s c he
J
Licemd dculoul
I.-
OWNER xemin frmC ContraON
I herchy alarm Nal 11. exempt from Ne Cssion o :Anyc Law for the
whichfollowing ores a Permit to construct.
t.Alam, and r Pm,demolish.
Cole:repair
y or mainly
oure
$ which rots iss a a pertnh re ennswcL slur,improve,demolish,nr repair any gwdum
pdorNiu iensedpglmroqulmnbo applicant for CchPermit micensrile 4e ave wanmem
< thot hcialiccnmdpursuantanthe provieloMo(the Canummr'sLkcnmiaw(ChDamr9 Sq.Ft. Floor Area Val$�ibd.030
As
D (commencing with Section 70DO)of Division 3 of the Boatman and Pmfmiona Coda)ur
that he t,exampt dumfrom end the but,for tits alleged exemption.Any viDladon of
Section 7031.5 by any applicant for a permit subjects the applicant an a civil penally of APN Number Occupancy Type
not marc than flue hundmd dollars($500). 36940017 . 00
❑1,o ownerk.the property,rc cturc Is not amployes with wages s Neje cele eampenssdm,
And Pr Newark.and Ne o Cannrmice.mnded Low it Act Apply 70aa,Busircu Required Inspections
orapantl enywhiou Cotle:The Canmecanrs License Lew doss ret apply N an owner is q P
Own enywhe Wlprovidmprveach improvements
who m notimende himulredNrugh his
ownemployes,ping orIthat oeh Improvementsinnot(mm�dedmploti n,fwssk.If.
however.Ne building or Imp(Moving said within Ago,Wild of completion,purpose
owner.of
builder cord Mve ate burden of proving Nn he did wt Wild or improve(p pugom of
uk.).
❑1.As owner of the property am exclusively cuumaniing with licensed ronuacanrs an
construct the project(Sec.70th,Bualnau and produc oro Cade:)The Commutators Li-
cape law dura not apply an an owner of property who Wilds or improv theme.and
who con accts for inch projects with a conations)Ilcerad Pursuant an Ne ContracmM1
IYenu law.
Cl 1 am exempt under Sec. .B 0 P C far Nu won
Owner Due
WORKERS COMPENSATION DECLARATION
1 Mmby drum under penally of perjury aro of Ne following d lmdou:
El I have and will mainuin s CUIRIpm of Conaem to sel61esum Tar Warkees Compen.
salon,As provided for by Section 3700 of On,labor Code.for the Md...of the
work for which this pormh is Issued.
❑1 have and will maintain Worker's Compensation Inatvance,u required by Section
3700 of the Labor Cade.for the pcdarmanm of Ne work for which this permit is issued.
My WorktM1 CampewJan Insurance artier and Polley number ate:
Cartier. , rib Polity Na.:
CERTIFICATE OPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not he completed If the permit Is(aro a hundrtddollars(1100)
nr Icsa.)
1 certify that In the performance of the work for which this permit is issued.)shall not
employ any person In any meanerm At an become subject an the WorkW Compensation
Laws of Califomu.Dau
Applicant
NOTICE TO APPLICANT.If.after making Nis Cci iOca a of Exemption,you should
become object an the Worker's Compensation previsions of out,labor Code,you must
.,O forthwith comply with catch prnvWou u thio permiuhall be deemed mvoked,
z'� CONSTRUCTION LENDING AGENCY
I••i I hereby affirm that Nem Is a miuwction lending agency for the Performance of
(Y.7 the work for which this permit Is issued(Sm.3097,Civ,C.)
CQ Lenders Name
z Lendets Addw
U O 1 cuary that I have read this appliculon and sum that the above information is
By. correct.I agme an comply with all city and county ordinances and sum laws m W ng to
O EliU Wildiag construction.and hereby aunhoginc opmencratulm of this city an enter upon ft
above-mentioned property for Inspection purposes
(We)agree an save,indemnify and keep Ingram the City of Cupptime against
y liabilidp iodgments,cats and expenses which may in Any coy among against Wad City
U z I In PrISN-aseltRe of me granting of this Permit.
PLICA UNDER)T NDS AND ILL COMPLY WITH ALL NON-POINT Issued by:9 Date
r FSE RE ULATIO _ 1(V Re-roofs
ApplipnmCan an mHAZARDOUS IAIS DISCLOSURE Type of Roof
III the applicant or too=building Occupant nam an handle husrdaus mamrial
As defined by the Cupertino Munk 1 Code.Chs,W 9.13,and Ne Healthand Safety
Cade,Saturn 15531U)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes u
Will the applicant or future W ins occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
rd
emit huaons airconu c n, fined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yu
ullive Na huardnus mawrialsmquimmenu underChapmr 6.95 of thc Caliron
a a at gfmy COda Seefians153U3.755 3 15334.luntkrsundthatif the Wilding
ou mol cure tly be.s man,that 11 r nsihllllyannatil'y the accts ant of the
m cements hichmu in pd I of cn(OpmotOccuO y. C Signature of Applicant Date
Owner utharizeda rot 7 D� J All roof coverings to be Class"B"or better
C.