05030073 CITY OF CUPERTINOP °' ?7-1 • ^10 V4 .I,, M- .• ^'
BUILDING DIVISION PERMIT C0NTR,OtFDRIINFO TIOn .e
BUILDING ADDRESS: TAYLOR WOODROW HOMES PERMIT N005030073
OWNER'S NAME: PERMIT ISSUE DATE
TAYLOR WO DROW H 230
g; SANITARY NO. CONTROL NO.
925) 365-3100
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BO ELECT PLUMB MECH
dOO LICENSED CONTRACTOR'S DECLARATION Job Description
MMM 1 hereby af0rm that I am licensed under provisions of Chapter 9(commencing
with Section 7000)o(Divigp 3 alone BusineseeM Prafeulms Coda.and my tic.I.
^� in fall Some and off«L bLp NEW CONDO 1691 SQ FT LIVING
i 5 tea c Maor a a
SQ. FT. GARAGE
AR 3 DECL3RAT1
;S 1 u sen n II psi
License feat oW
Oat I A.BUILDER DECLARATION
I hcrchy.(firm that 1 1. esemnl from No Conlr«core :License Lew co Nc
Z O following mason.permit
7031.5, t,Business and improve,
moralist.
Code:Any city err county
Zip which its
n pctmh re sires M 1,eller,improv,de ermit t,nr mash any anmtuM
Zip prior to Ward pursantus Me thevisio offar each permit to Nc a Law igned(chapter
pp isthat he
mmealiccnsedpuectim7 th)ofDiviaion3ofLCO u,in. LlancPaw(Chapter9 Sq.Ft.Floor Area Val42ib11030
r4 S (eommendng with S«don 7000)of Divisionlo(Nc Buslnessond Profmion Cnde)or
.. That he is exempt Merchants end the basis for U4 alleged esemptlan.Any violation of
Section 7031.5 by eny applicant far a permit subjects the applicant M a civil penalty of APN Number Occupancy Type
not mom than Bw hundred dollars(5500). 36940017 . 0 0
❑I,As owner Of the Properly,or my employees with wages AS Nen role campewtion,
will Me the work,and the met.u not intended or offered for We(S«.7044,Busircv
and Profeadon Cade:The Co mmems License Paw Man set apply M an awnv of Required Inspections
properly who With orimprova Thr4can,andwhodonsuch work himeelfor0vough his
awn employees,provided that each improvements as not Intended oroffead formic.If.
however,the Wilding or improvement is cold wiudn oro year of completion,the owner
builder will have the burden of proving that he did not Wild or Improve for purpose of
sale.).
❑1,as owner of Ne property,am elusively contacting with licensed conuMMra m
convect the project(See.7044,Business and Profession Cam)The Comnetor'e Lt.
cense Paw don not apply m an owner of property who builds or improv Thereon,and
who contracts for such projects with a conlnclor(s)licensed punuant M the Cmeactoh
L4eme Law.
❑l am exempt under Sec. ,B&P C for this amem
Owner Dab
WORKER'S COMPENSATION DECLARATION
1 hereby dlerm under penalty of perjury arc of Me following declarulnns:
❑1 have and will rosin afn•Cer ifioao(Consent he self-lawn,far Workers Compact,
Milan,u pmvidW for by S«tian 3700 of The labor Code,for Ne Performance of the
work for which this permit is issued.
❑1 haw and will maintain Workers Compensation Issuance.sa required by Section
3700 of the Labor Code,for the performance of the work fn which this permit is issued.
My Worker's nmpenadonlnsuanee carrier and Policy number tee: __ -,
Cerner. �� Policy No.: sj—//v�J'j+i—J
CERTIFlCATE OF EMPITON FROM WORKERS'
COMPENSATION INSURANCE +
(This motion need not becompleted Elie permit Is(reran hundred dollaa($100)
ar ten)
1 cenify Not in the perfarmance of the work for which this Permit is issued,l Nall nor
employ any person in any manner an a M became subject mtie Workcre Campenation
Lawes of Celifoma,Date
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should
become subject M the Workers Compensation provisions of the labor Code,you nom
vJ z forthwith comply with such provisin.or this Permit&hall bu dcemW rooked.
.Zi O CONSIRUC71ON LENDING AGENCY
rLE l hereby affirm that there is a conversation lending agency ror the performance of
;> the work for which this permit Is Issued(Sec.3097,Civ.C.)
W C Lendcrl Name
z Lenders Addms,
U Q I certify that I have mad this application and sem that the above information u
comm.I agree to comply with all city and county ordinances and sub Tawe mating M
O building connection,and hereby authada representatives of this city M enter upon the
W move-mentioned properly for inspection purposes.
0.r (We)egme to Live,indemnify and keep barmless the City of Cupertino against
n.w fA iabilisa.,judgments,Cosa end esperues which may In any way amu.against said City
C)zon nee of the gnndng of this permi
APPLI NT UNDERSTANDS A L COMPLY WITH ALL NO -POI Issued by: Date
3 RC REGU DONS.
Ll �/ Re-roofs
Sign rcof APPIIcanVCan +M Da
HAZARD MATE A ISCLOSURE Type of Roof
Will the applieam or !Y
uildin �ccupantimrcmhandle heLiNous malarial
As defined by the Cupertino Municip de.Chapter 9.12.and the Health and Safely
Code,Section 25532(x)? All roofs shall be inspected prior to any roofing material being installed.
❑Yea o
Will the applicant or fubm W' mg«cupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit h4O�air contaminants as --I by the Bay Ama Air Quality Management all new materials for inspection.
OlanicR
I haw real the hvaNnusmatenau rcyvircmcnu undu ChapterS95ofdMGlifn.
n' Safmycode.S«tiau25505,25 33 2531.1 undcrmndthal(tia Wilding
nota rely sea tenanaN niMlity M aaify Me..P.,or the
M Inman wh' m be met ' r oIacauncabofOccu cy. �s Signature of Applicant Date
y/ DJ
Ow arsuthonrzdegcnl DEW All roof coverings to be Class"B"or better