05030076 CITY OF CUPERTINO
BUILDING DIVISION PERMIT " NTRY�kQR-IN 'C1Tt�'11xf
r•'• txu: ..re#v," h`�,^.n ,vg .'PrA
BUILDING ADDRESS: TAYLOR WOODROW HOMES PERMIT 110.05030076
10280 PARK GREEN LN if R42
OWNER'S NAME: PERMIT MUE DATE
TAYLOR WOODROW HOMES 2300 CAMINO 2005
E; SANITARY NO. CONTROL NO.
(925) 365-3100
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG
O PLO MO
a repj LICENSED CONTRACTOR'S DECLARATION Job Description
a+(� I hemby affirm WI I am licensed under pmvWnns of Chapter 9(commencing
with Section 7000)afD!vi.i.O 3 of Ne Bush .and Professions Code,mul my license is
infullfomeandeRett (p NEW CONDO 1691 SQ FT LIVING Linen L�z502 SQ. FT. GARAGE
con r
ARCNITE S LAR IO
Ins and y I s
License eemanel
OatNE -B LDER DECLARATION
.� 1 ounce.
.(Arse on I am exempt(tom the Conlns Co License law for the
which regmason.permit
i 7113 1.5,Business and Pmfculum Cade:My tiny er county
$ which requires a pmrmil re eonsweL ahs,impmw,demolish,orrepaira sig any ned statement_ZSo pdormiscenedpotesualto the the applicant for nchpormilmicense Law(Chapter
that be puraent to the of Division
ofare ofm Btudim.mi cvalsw(Chapmr9 Sq.Ft.Floor Area Val Mn1030
$ (cat he
xem with Section 7000)of Division3 the al Bushy.andprofenyviolaab)or
Net he u exempt therefrom and nee hue for dao alleged exemption.Any violation of
Section 7031.5 by m0•applicant for a permit subjects the applicant 10 a civil penally of APN Number Occupancy Type
net more Nm Ave hundred dollen($5001. 36940017 . 00
❑i,m wnuofthepmpeny.mmyemploymwiNwageantheirmlemmpenution,
will do dao work and lheswctme ianmimencied oroEered Fertile(Sec.7044,Business Required Inspections
and Profwiens e Code:The COnmemes License law does not apply 0 an owner of q P
p ropeny who bui Ida or improves Neuron,end who does such work himsel f Or awash his
own employees,pmvided Nan such improwmeressn not intended oraRened forsee.If.
however.the building or improvement Is said within one year of completion,the moral.
builder will have the burden of proving that ke did not build or improw for purpose of
ale.).
O 1.as owner of are properly,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Cade:)no Communes U.
cenx Law tines not apply to an owner of propeny.who builds or improve daemon.and
who contracts for such projects with a conuactor(s)licensed pursuant to the Concrete
License Law.
rl I am exempt under Sec. ,B&PC fathts mum
Owner Data
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty Of perjury one of the following declualiea:
❑I have and will mammin aCenifican of Consent in self-insure for Worker'Compen-
sation,as provided for by Section 3700 of the Latter Cede,fm the performance of the
work for which this permit is issued.
❑I haw and will maintain Worker's Compensation Insurance,as acquired by Section
3700 of the Labor Cade,for the performance of Ne work for which this permit is loved.
My Worker' COmpeueam Wheaton tamer and Policy number ani
Cartier. Poli) No.: 12b
CERTIFICATE EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thissection mail not hO completed If t e permit is faomchundred dnllars(5101)
or less.)
I amity that in the performance of the work for which this Permit is issued,l Nall not
employ any person in any manner an it to become subject in the Workers compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:IL after making this Ccnifieale of Exemption,you should
became subject to the Worker's Compensation previsions of Ne Labor Code,you aver
Oforthwith comply with such previsions m this permit shall N deemed tcvnkcd.
,zi r~0 CONSTRUCTION LENDING AGENCY
[.r Ibereby affirm Nat den iso mnnnctiom londingagenry for dm p urtam occ of
�i> the work for which this permit is issued(Sec.3097.Clv.Cd
ALendch Name
z, Lender's Add.
t.7 0 1 Maly that 1 haw mad this application and sum that than Room information is
correct.l ague in amply with all city and county ordinances and sum laws relating to
0 building construction,and hereby authorise reprosenidws of Nis city to enter upon the
W above-mentioned property for inspection purposes.
(We)agree le saw,indemnify and keep harmless the City of Cupanino against
ccn liabill ,judgments,costs and expenses which may in any way section against said City
PPLIC rise aOUNNa RSTAN of this D LL COMPLY WITH ALL NON-POINT Issued by: Date
OURcl ECU ON .
y Re-roofs
Sign in o'ApplicanUComm7cler Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Wdl One applicant afuture building Occupant sow or handle harardam material
as defined by the Cupertino Muni o Code,Chapter 9.12,and the Health and Safely
Cade,Section 25532(.)7 All roofs shall be inspected prior to any roofing material being installed.
171 Yes
Will the applicant or rulum building occupant use equipment at devices which If a roof IS installed without first obtaining an inspection,I agree to remove
emit ha.wdous air contaminantsu )fined by the Bay Area Air Quality Management all new materials for inspection.
District
❑Yes O
ave the huardaus materials requiremenu under Chapterfi.95 Otani Cabror.
nu alda&S ctyCOde,Seedao25505,25533md25534.1undcmtsnd Nmifdae Wilding
J 1 on tiny h e te t.Net I ie y pouibilip to mealy the a<upan of the
eras hien pd n fat &woo panes Signature of Applicant Date
vera .mnadndag Blue All roof coverings to be Class "B"or better