05030081 CITY OF CUPERTINO 77�77 A '
BUILDING DIVISION PERMIT IXONTRAC'I'OR m'INF MaTToiV '�
BUILDING ADDRESS: TAYLOR WOODROW HOMES PERMIT No.O 5 O 30 O 81
10280 PARK GREEN LN it 851
OWNERS NAME: PERMIT ISSUE DATE
IlkTAYLOR WOODROW HOMES 2300 CAMINO 05
g; SANITARY NO. CONTROL NO.
(925) 365-3100
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
0 o PLT T
taco LICENSED CONTRACTOR'S DECLARATION Job Description
Jul 1 hereby affirm that 1 Am licensed under provisions of Chapter 9(commencing
NN Section 7MG,of Division 3 of tiro Buuacu mod Profesuom Cade.and my Ilcerse is
n3 mmllsemeandefin _ NEW CONDO. (2052 ' -LIV. SPACE)
��? Licence �« DiSARAGE 359 '
Date "a COMncmr'
A2 HRECTSDECl LA AT N
ssl
n D-51 (BMR UNIT)
W
to
C Lis d Pont ioml
Oat I am exempt
from
DECLARATION
i I 1 by eRrm Nei I em escmpt from du ContnnoYa Ucac Law for the '
coo toll g mason.(Section 7031.3,Business and Professions Code:My city or county
$ which requires a permit in construct,All hnproe.demulith.or repair any structure
_2Z~' Prior a its uumca.Alto requires the applicant fertrch Permit An file a signed SUNAMN
that M is licensed purtranuo the prowaimosa theconvacmr's Uamc LAW(Ch.pw9 Sq.Ft.Floor Area Valuation
y $
(comm long with Section 7000)of Division 3 of time Business and Professions Coio)or $248539
A. — that he u&•-rept therefrom and the basis for the Alleged aemp0on.My violmlon of
Section 7031.5 by Any Applicant fora permit subjects the applicant to a civil penalty of APN Number Occupancy Type
am more dun Ove hundred dollars(SSW).
❑1,as ownar of the property,Or my employees with wages as their tole ampsmadon.
will do the Work.and the structure is Out Intended a offered for Wit(SN.704.Business Required Inspections
slid PmfasiMs Code The ComMcter's LiamUw don cot apply m an owner of q P
property who builds or Improves thereon,and who does such wort himself or through his
own employees,provided thatsuch improvements are not intended or offered for sale.if,
however,the Wilding or improvement is sold within ON year of completion•the owner
builder will have the Wrden of proving Out W did out Wild Or improve for purpose of
sok.).
❑1,as owner of the property,am exclusively convecting with licensed contractors m
construct the project(Sec.704.Business and Profcalam Code)The Convacmh LI-
cam Law does not pply to an owner of property who Wilds or Improves themon.and,
who contracts for such piceeu with acontnctar(s)licensed pursuant in the Contractor's
License Law,
❑I am exempt under Sec. .B!P C for this mason
OwnerDau
WORKERS COMPENSATION DECLARATION
10 1 hereby aiBnn under penalty of pedury oro of the following declarations:
❑I have and will maintain aCeAOam of consent in selfdnsum fm Worker's Compere
sauan,As provided for by Section 37M of the Labor Code.for the performance of the
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the UWr Code,for the performance of the work for which this permit is issued.
My Worker's am nsado.lmursnce carica and Poliq number art' `
CA. Policy No.: LL
CERT •ICATEOF JIEMMONFRO ORKERS'
COMP• SAIGON INSURANCE
(Thusaran sed not W complexed If the permit lalmore hunded dollars(SIM)
or less)
I certify that in the performance of ted work for which this Permit is issued,I Nall nes
employ any person in my mamrso As to become subject to theworkeW Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If.after making this CeNOate of Exemption,)w shoVld
became subject m the Worker's Compendium provisions of the UWr Code.you mus
OZ
forthwith amply with such provinces Or this permit Nall k damed scvokcd.
z TR
CONSUCTION LENDING AGENCY
y
r Ihereby.M.that there is.consuucUN lendingaFncy for the perfurnmeeof
IX 7 the work for which this permit Is issued(Sec.3097.Civ.C.)
WQcl. Lenders Name
=z Lender's Address
V Q 1 coldly that I have rad this Applia0on and suss that the above WermNun u
U.E COMM 1&gra m comply with all City and county aNimuwea cab state Isco relating In
0O Wilding construction,and hemby authoria en
upretYtives of Nu city m color upon the
{T.1 aWa-mentioned property fm inspection purposes
(We)agree m save,indemnify and kap harmless IN City of Cupertino against
Vi liabilities,judgments,cow And e.pensa which may In any vnyacmuc agAlmt stud City
V J'. is emtsequence of the Sterling of this permit.
w� AP DERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
UR ATI S.
Re-roofs
SIs piianvcoommor Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant Or future Wilding occupant store or handle hvardaa material
As deeded by the Cupertino Muni c 1 Code,Chapter 9.13,and the Wants And Safety
Code,Section 35533(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes u
Will the applicant or future bull ng occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it havardnns Air comarNnanu a lied by the Bay Area All Quality Management all new materials for inspection.
District?
❑Yes
I have mad the haymdem materials requirements under Chapter 6.95 of the Califon
ria Health&SafelyCode,S.M.35505.25533 and 25534.1 understand that ifthe Wilding
of c nlly a nano that h u my rnponslhillty m notify the amupAnl of Ne
require n h' met ofacemacamofocc Amy. Signature of Applicant Date
mer a Ihodoed. a, Ca/16 All roof coverings to be Class "B"or better
a