05030088 CITY OF CUPERTINO ,,
BUILDING DIVISIONATIA
PERMIT y CC)kV'�1=12ACTOIt TNFOXiMI T' '71911 is
BUILDING ADDRESS: TAYLOR WOODROW HOMES FtaUvi ND'05030088
OWNER'S NAME: PERMIT ISSUE DATE
TAYLOR WOODROW HOMES 2300 CAMINO RAMON, 91F 10C 07/20/2005
E; SANITARY NO. CONTROL NO.
(925) 365-3100
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BO EO PLUMB
MECH
O
+5+0oLICENSED CONTRACTOR'S DECLARATION Job Description
with 9.11.700Mo�IA.i..7 of the Buuneuunder
aM Profrsiluna,,cition,of LCopter 9 de end mylkemeih
n nmluoreemeeBc $ NEW CONDO. (1742 ' -LIV. SPACE)
z Lken IJc.
i Dam canlrura c ARAGE
515 '
ARCHI7HCI'S DECLARAT N C-35
k 1 u n my Ma ublic mcv
3 o nsed feaaland
OWNER-BUILDER DECLARATION
hereby aRrm that 1a.1. exempt from the Contractor's :My c Law for Ibe
1O w nguasan.(section 703 1.5, r.alnraand w.dcmliCode:My city or county
$m which mqutmu•P.also re emarthe alter.W prow,h pc
m it i Ile a sig ed munum
_Z> that M its Tensed pursuant
to the the applicant the
pnmit m cense signed uemmenl
< tiwW is licensed Pursuant to the provisions of the ConumtorY llceve law(ChaPtn9 Sq.Ft.Floor Area Valuation
lexicon eneingwilh Scaion70D0)NDivaion3oftie Baalnmmd Profevions Code)ur $217333
But k u exempt therefrom sad the Weis far the alleged eaempdon.My vloat m of "'
Section 7831.5 by arty applicant for a permit subject,tht applicant to a civil penally of APN Number Occupancy Type
nes,...dun Bw hundred doll.($.30)) -
❑1,as owner of the property.or my employes with wgu a Web sale compensation.
willda We woh.and the muaum isnmimmided oroRamd Imitate(Sec.78th,Bud= Required Inspections
and Profession,Code:The Cmrncmh License law des not apply toC an owner of q p
property who b W Ida car impr caw;thermn.and who deet such work hMalf or through his
own employees.provided that such impmvemmas are not intended aro@sad forsak.if.
however,the Wilding or improvement is mid within one yea of mmplWm,the owner- ,
Wiider will have the human of proving that W did not Wild or Improve fa purpose of
ak.).
❑1,a carer of We property am exclusively convening wish licensed convaclms in
construct the projea(Sec.7044,Business and Professions Code:)The Convacm/a IJ-
cave Law docs not pply m an mann of property who builds or improm thereon,sad,
who mntrscts for such prokcts with aeantrmmr(s)liunad pursuant to the Committees
License Law.
0 1 me exempt under See. .B A P C far this moon
OwnerDECLARDam
WORKER'S COMPENSATION ATION
I hemby a m under pealty of perjury om of the following declarations:
❑I haft and will malnule a CW ficole of Consent loml6insum forWorkersComPcn-
a tion,as provided for by Section 3700 of the labor Cade,for the performance of the
work for which this permit is issued.
❑I have and will maintain Worker's Compensation Insvmce,as required by Section
3700 or the Inbar Code,for the performance of tht work for which this permit is Issued.
My Worker's Compensation Insurance artier and Policy number am:
tinier. !t•-•il Policy No.:
C •
IFI A OFIX MMON FROM ORKERS'
COMPENS ION INSURANCE
(This=am nod an,W completed If the permil Is fm my hundred dollars($101)
or kat.)
1 unify that In the performance of the work for which this permit is Issme.I shall not
employ any poison in any manor m as W become subject a the Worle r'Compensation
Laws of California.Dam
Appliunl
NOTICE TO APPLICANT:IL after making this CeniOcale of Exemption,you should
become subject in the Worker's Compensation provisions of the laher Code,you must
.JO forthwith comply with such provisions or this permit hall W deemed revoked.
„Z„ CONSTRUCTION LENDING AGENCY
[r4 I hereby affirm that them is a construction lending agency[or des Performance of
tYi 7 Ile wok fur which Nis permit a iamd(Sec.3097,Civ.C.I
QLrder's Name
z Landefa Address
U Q I certify that I have rad this application and sum that the above Information is
W E~' corma 1 agree to comply with all city and county eminences and tam laws relating to ,
QU building convection,and hereby sunbeam mprexnt,tim of this city to enter upon the
W�L. shove-meMuned property fm Inspection PurpoPurposes.,I (We)agree to saw.indemnify and keep harmless the City of Cupertino against
�y y liabilities,judgments,costs and expenses which may In my way game against two City
U z in can f the granting of this permiL
A A DERSTANDS AND WILL COMPLY WITH ANON-POINT Issued by: Date
URCERE LATIONS.
Re-roofs
Ignmurs IlunvConusamr
Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
ill the applicant or foam build' oocupan 1 handle harardoa material
nth by the Cupertino tom Code.CMpmr 9.12.me the Health and Safety
can.Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
[:3y. o
Win the aPplicmt car mlum m{aecupmt a"aqulpment car tkwim which If a roof is installed without first obtaining an inspection,I agree to remove
it haardna aircmuminsnua fncd by the Bry Ansa Air(Nalily Management all new materials for inspection.
Dimon
❑Yes
I have mW the baammu materials requirement,underCWPtcr6.93of dm Califon
naxm COM.Satims 25505,23533 and 25334.I undertone lhmifthc budding .
I have a tenant,hast It a my rupmaibility m.odry the occupant of the
be w m xmetprimmlaaanamf.CcnineamafGeca Signature of Applicant Date
O armthariacdagenl Dam All roof coverings to be Class"B" or better
l