05030090 CITY
BUI D�c DPERToNNO PERMIT �COAITRA.0 R�IVFOATiON
JW51 ,4.E res- > k• a�,�,'si , 2.A Es..�a ?�
BUILDINGADDRESS: TAYLOR WOODROW HOMES FhKMIrND'05030090
OWNER'S NAME: PERMIT USUB DATE
10 TAYLOR hjQODROW
INWE: SANITARY NO. CONTROL NO.
(925) 365-3100
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
3 o j LICENSED CONTRACTOR'S DECLARATION MJb Description
r��m 1 MrebY affirm rm 1 in licensed under per isiou o
of Chapter 9(Commencing P
with Section 70010Of Division Sof the Budnumand Protestlom Code.and my license Is
nZ1 in roll forte and affect. 2lo N W CONDO. (17421 -LIV. SPACE)
LlcenseC Lk.N
Date cSDEC GE 515 '
ARCHI7EC1'S DEC RA ON D-41
undenta
as
b used. pMlie
Lie nal
OWNER-BUILDER m the Can clo
1 he y.(Sinn that 1 1. eumm from the COntrsmml 6iemse Law for IW
y� ON
O OC Ilowi n.permit
tc(Section 71131.6. t,Enormous nu and ere.desimm Cotic:My city s county
1! LL tits Ism a e,ai re construct,the appliun.cant
improve,dPermit 1.or e a sig ed URCrocm
Y:ZSn primwits luuance,asart tot he ileisionsnl for snhpennitw cense signed Comment
< man Wnecemed pursuant to the a Division(the ConuacwrsdProrelor U.(Chap=Code)or Sq.Ft.Floor Area Valuation
$C (romeI,eleepttheref.andthDivlsiofrof ft theWmlsiressandon.AnymCndc)or .$217333
Nat he s exempt Nemrrom and the bole for the dlegctl exemption.My violation of
Seellon 7031.5 by any applicant for a permit subjects the applicant w a civil Penalty Of APN Number - Occupancy Type
Int more than five hundred Colima($300).
❑1,u awmr of Ne propmy,a mY unploycer wise cages u tie'v ole nmpcvation.
will do the work and destructors,1.nothandedorortered inside(Sm.7094.Business Required Inspections
and Protestations,Code:no O nmcme.License Law does not apply w e ns an owner or q P
property who buildsorimproves Corton,and who docssuch work himselfor through his
own employees.provided Na such improvemenuam mtimmummd aoQered for We If,
however,the Wilding or impmvtmem u mid within ore year of completion,the owner.
Wilder will love the burden Of proving met W did not build On Improve for purpose of
sale.).
❑1.as Owner of the property,am exclusively contracting with licensed contractors to
mmlmct the project(Sec.7044,Eusiwa and Professions Cade:)The Coniruwri LI-
cense law docs em apply to an Owner Of property wW Wilda Or Impmva menton.and.
who commeu for such pmjem with a anuaetot(s)Ila and permit%he tW Contactors
License Law.
❑1 am exempt under Sec. .B k P C for this reason
Owner Dam
WORKERS COMPENSATION DECLARATION
lip 1 hereby affirm under penalty of perjury ooc Of On following dmemo tiom:
0 1ltave and will maintain a Quortae niceness,to self-insure for Worker's COmpm-
sati,n,as provided for by Section 37M of the Labor Code,for the performance of me
work for which Nb Permit is Issued.
❑1 have and will maintain Wake's Compensation Inagana.as required by Section
3700 of the labor Code,for the performance of me work for which this permit u isocd.
My W a e Comp11ew.`don Imsunna artier and Policy number am._7�V
Cartier.o�l� -k3('. �` � Policy No.:y^.1,.. i
CERTIFlCATE O• (EMPIION FROM WORKERS'
COMPENSATION INSURANCE
(This and.O ctatW.copludiftiepermit%afaomWndmddORas(SIM)
or lest)
1 certify mel in We performance of the work for which this permit is hand.I shall not
employ any person in any merrier an as to become object to the Workers'Compemati,n
Laws of Califomin Dae
Applicant
NOTICE TO APPLICANT.If,after making this Cenirtate of Exemption,you mould
Weome subjcm to the Workers Compensation provisions Of me Later Code,you mug
.J O forthwith comply with such provision or this permit shall W doomed tevel a t.
zCONSTRUCTION LENDING AGENCY
IWreby drum mat mart iaaeomuuctinn kndingagenry for ft pMamince Of
Ni
the work for which this permit is used(Sm.3097.Civ.C.)
aQ Lenders Nurse
7 z Lind
eex Address
U Q 1 Certify that l have mad this application and stem ma me gave Information is
ly F corms.I agree to comply with all city and county ordinances and mon swat mining to -
O� Wilding
construction,aid Monty summers,representatives of mise city nester upon the
property for Inspection purposes.
(We)agree to sive,indemnify ad keep harmless de,City of Cupertino against
,,.y imbllitles.judgments,toss and expenses which may in any way accrue against old City
V Fh�v�d
ERRSTANDS ANDOf WILLWILL COMPLY WITH ALL NON.POIM' Issued by: Date
EG rmit
TIONS.
Re-roofs
'seVCnuulor DaHAZARDOUS MATERIALS DISCLOSURE Type of Roof
W applicant or future building occupant stem m handle hampom mategdy Oe Cupertino Munic I Code.Chapter 9.12.and Ole Health and Sdetyyn 23532(,)7 All roofs shall be inspected prior to any roofing material being installed.
athe applicant or foto,,Wi ng Oecupont tau equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
nes a",
r conumiu u Inca by the Bay Ara Air Qvi ily Mamgemenl all new materials for inspection.
District?
❑yes u
ed the h,akrws malerialsrcquimmena under Chapwr6.95 of lW Califor- '
nia Homm titm ciy Code,Sccd, 25305,23533 ord 25534.1 understand that lfte Wilding
d not ntly h a"Art.that It s my responsibility w molly mo occupant of the
e. wNe,nCeninam,r e, Y. Signature of Applicant Date
Ow unu%hodzcdasem Dam All roof coverings to be Class"B"or better
a