05030080 CITY OF CUPERTINO
BUILDING DIVISION PERMIT , �URx1C' QR INFiI' MAT,YOI ,n
BUILDmGADDRESS: TAYLOR WOODROW HOMES PERMITNOO5030080
OWNER'S NAME: PERMIT ISSUE DATE
TAYLOR WOODROW HOMES 2300 CAMINO RLMON, StE 100 07/20/2005
E; SANITARY NO. CONTROL NO.
(925) 365-3100
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�oo LICENSED CONTRACT'OR'S DECLARATION Job Description
1 hereby"m met 1 un licensed under pmvinons or Chapter 9(commencing
nfulSba anA0y.f iAE
Saoneas and Profeal.0 Cade.and my license is
NEW CONDO. (2052 ' -LIV. SPACE)
Z Damn`'4 Lic.# of
ARAGE 359 '
- CTS DECLARAT D-40
M,au I t ublic me
Oe
go. Li.Lf& cuianel
5 OWNER-BUiWER DECLARATION
I Wrchy affirm that I am comp,from the Commoners Licence Law far me
D owing mason.(Sects..703 1.5,Bananas W Prefeumu Code:My city or county
�}$ which requires a permit to convect,alar.improve.demollah.or repair my stmcturo
-Zi prior to its iuuaceala requims 0u applicant for such Permit to file a signedatateme.t
that he is]!=hand purmentu the previsions ofine Conuacmrl Lumuc iow(Chaper9 Sq.Ft.Floor Area Valuation
(commencing with Sermon 7000)of Division 3 of me Busineu aM Pmfessiom Curie)ur $248539
mu W u.tempt therefrom and me bub for me alleged exemption.My violation of
Secdon 701.5 by aY applicant for a permit subjects the applicant in a civil peachy of APN Number Occupancy Type
no,mare man five hundred dollars(M).
E]I.u ownea of the property,err my emplaces with wges u thetrale cmmpeessuon.
willda we.,it.and thermostatic bent inundM or.111ad Outside(Sec.70".Basins Required Inspections
and Proressions Code:The embitters Un•••raw dao a,appy e to an owner of q P
property who Wildserimpmves thereon.and who dmasuch workhimmIrmthmugh his
Ower employees.provided that Cush improvements K not Intended confirmed for We.If.
however,me Wilding or improvement is sold within one you of completion,the owner.
builder will have the burden of proving that he did out Wild or improv for purpou of
"
k.).
0 I,as owner of the pmpeny,am exclusively contracting with licensed conhan.n in
comment the project(Sec.7044.Business and Prefcnions Cade:)The Contractors U.
Ones e law does net apply to an owner of property wW Wilde Or Improves marts..and,
who contacts for such pmjeeu witha eonermae(s)Immune purmart to the Contractors
License Law.
0,1 am exempt undo Sec. .B k P C fm thismama
Ower Dau
WORKERS COMPENSATION DECLARATION
i Wmby anis,.unhr penalty of perjury oro of the following declanuou:
0 1 ha.eand will mNnuin•CW Tram ofConont mulfduum fo WorkcesCompen-
sation.as provided for by Section 37M of the labor Cod,%fu the perfotmmen of that
work for which this Permit is maned.
0 1 have and will maintain Workers Compensauan Insurance.as required by Section
3700.E the labor Code.far the Performance of the work for which this permit Is Issued.
My Worke��rsLdC�ampLe�usedon I�ns�uUE�n-�n-tt�eamiv ted Policynumberra�ams:
r"Ont yZ[r Polity Nm.: WORKERS'CERTIFl COMPENSATION
INSURANCE WORKERS'
COMPENSATION INSURANCE
[This section neM at be completed time permit isfrronc hundred dollen(5100)
or less)
1 anify met in we performance of the work for which this permit is Issued.I small not
employ any person in my moneran as to become abject In the WORen'Coultmostimn
Laws of Califomia.Date
Applicant
NOTICE TO APPUCANT:IL spur making this Cer iftcau of Exemption,you should
become subject in the Worker'.Compensation pmvlsmons of the Labor Code.you bun
.,Q forthwith comply with such provision or this Permit shall be named reoke d.
Z ti CONSTRUCTION LENDING AGENCY
[•n IWmby diem that gem it a convection lending.Semy for the perfurmmce of
a,r7 me work for which this permit it issued(Sec.3097.Civ.C.)
aQ Landers Name
=z lander's Addross
U0 I cenify mut I have rad this appliati n W state ren the Above ichor euun is
F coerce,.I agree a comply with ail city and county ordinances and mu laws m1ming in
p U building comwcuon.and hereby mtherim repmenumves of this city to enter upon the
W ebovccramimed property for lupecuon purposes.
(We)agree m tow,indemnify and kan
keep hnless the City of Cupertino against
,s rrA liabilities,judgments,costs and expenses which may In my way acerae against aid City
U in co of the g sting of tis permit.
UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURC• ECL • 5.
-7/2//-.5 Re-roofs
Signe arc fApplicaaVConlmcmr Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will we applicant or forum building 0(mmastsmm or handle beaudous material
as defined by the Cupertino Muniel I Code.Chapter 9.11.and the Health and Safety
Code,Smtie.2553z(a)7 All roofs shall be inspected prior to any roofing material being installed.
CYa o
Will the applicant or future buil' acuPant tee equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit heam.u'air conaminsnts u ncd by IW Bay Area Air Quality Management all new materials for inspection.
District?
0 Yea
a huadoua materials requirements under Chapter 6.95 of the Califon
Safety ode,Secuomg5N15.g5533md25534.Iundcawd mulfmu huilding
sm
cuereM ve a tenant,that It it my raponslbilhy m nmdfy the occupat of the
re m onts n Iprior to aCcnllncouorOca acy. Signature of Applicant Date
nor um.rimde e., � All roof coverings to be Class"B" or better