05090032 CITY OF CUPERTINO ,��us.:�a
BUILDING DIVISION PERMIT cONTItAGTORINFORMATIO �.
BUILDING ADDRESS: TAYLOR WOODROW HOMES PERMIT ND.0 5 0 9 0 0 3 2
10280 PARK GREEN LN it 839
OWNER'S NAME: PERMTr ISSUE DATE
TAYLOR WOODROW HOMES 2300 CAMINO 11/02/2005
SANrfARY NO. CONTROL NO.
(925) 365-3100
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG EIPCf PLUMB MECH
0 0 0 0
100 LICENSED CONRACIOWS DECLARATION
iu C sh 1 bunchy amm Nm Hundred I aunder provldu oof Chapter 9(mmmencin6 Job Description
U wiSeclwn]OOIB of DiviaianJof Ne Budnuv and Profesrium Code.and myf Grim is
+�d Inrnnfnree&odeBem �ayog� Q REVISION--MOMENT FRAMES/STEEL PLANS
= Licenacla/ys� I"'a DENO NEW PERMIT ISSUED/ORIG. #05030079
-Fgp Date 1f—a,. CHRAA C` SDECLARATION
1 a I understand my plana shall Is used as Public records
)yes
Sorin Liucnscd Pmfcssional
OWNER-BUILDER DECLARATION
f I hereby aIE.that I am acmpt from tW Contractor's License Law for Ne
o O following reaW n.(Section 703I.5.BYFMSs and Professions Code:Any city of county
3 which requires a permit he construct,alter.improve.demolish,or repair any sructum
prior w its issuance.also requires be applicant for such pcmtit in Ole a signed statement
<
has heuliccmcdpursuanttothe provisions ofthe ComrxmrsLicense Law(Chapter 9 Sq.Ft. Floor Area Valuatiol$214
eFo (commencing wish Section 7000)of Division 3 of the Business and Professions Code)or
y
that W is aempt dam(rom and the bub for the alleged ucmpdon.Any violation of
Section 7031.5 by any applicant for a permit subjects the appli=L w a civil penalty of APN Number Occupancy Type
am mons Nan five hundred dollars(s500). 36940017 . 00
❑I.uownefof Nepmpeny,mmyemployeeswiNwagaudtebwlecomprnsauon,
will do Ne wart and the¢wctuse b nos intended ureRered formic(Sec.]0a4,Business
and Professions Code:The Contm,ar's License Law does trot apply w an Owner of Required Inspections
pmpeny who Wildismimprow dureon,and whodaessuch workhimselforNmugh his
awaemployar.pmvided that such improwfncnts are notintende0 moResed for sale If,
however.the Wilding or imp anneent is sold within ane year of compkuo t.the ownu-
builder will have Ne When of paving that he did not Wild or improve for purpose of
sale.).
❑1.as owner of the pmperY•am aclusivelY cenhamNg with lieensed rnmracwn an
construct the project(Sec.704x.Busineas and Profcarions Code:)The Conuanor's Li.
cove law dna oro apply to an ownm of property he Wilds or improves Nemo.,and.
who contracts for such projects wish a conuardor(s)limned pursuant in tW Commcar's
License Law.
lamum,nurdusee .B&PCfor Nbmason
Owner Data—
WORKERS
ateWORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty o(petj r,one,of she following desluauons:
1 haw and will maintain a Certificate of Conant w self-teem for WorWr'a Compen-
sation,az provided fn by Seetion 3700 of the Labor Code,for the Performance of the
wort for which his Permit is issued.
❑1 have and will maintain Worker's Compeuation Insurance,as rebound by Section
3700.(the LaWr Cade.for Nc pctiumnmce.f the work for which Nbp.1,u issued. '
My Worker's Comperimad pries aW Policy n6872020 b
Cartier. �S1Z�TO OYYI O Policy No.:6�0
'CERTIFICATE OF f'.S(EMPnON FROM WORKERS'
COMPENSATION INSURANCE
(Onus sectlau need nut uncompleted tribe Pettit It franc hundred dollars(SIM)
or bass)
1 certify Not in the Performance of the work for which this permit is issued,l shall not
employ any person in any manstefso as to become subject in Ne Worker'Compensation
Laws of California.Da¢
Appllcmn
NOTICE TO APPLICANT:If.afar making this Certificate of Examined.you should
become subject to the Worker's Compensation provisions of Ne Labor Code,you mesa
.J O forthwith comply wild such provisions or this permsh
it all W deemed unused.
Z�
CONSTRUCTION LENDING AGENCY
[--� 1 hereby"rim Nu Nem u a construction lending agency fm the performance,of
CL
be work for which this Permit Is issued(Sec.3097.Civ.C.)
Lcndn's Nation
a z Undoes Address
1 ccnify,that 1 haw mad this application and sew Nu the&hove information is
{I. F correct.I agree he comply with all city and county oNInLLLYs and state laws missing to
pU Wilding construction.and hereby swhonne represcntauwa or Nu city w enter upon do
od
r [17 labili memioninoms,property for inspection hichriapurposes.
(We)agree to saw,indemnify add keep harmless the City of Cupertino against
H Iimuna,JWgmc theeosumd.,pordwas may in any w'+Y+came agaiutsaid City
V z A APPLICANT
of the UNDERSTANDS
or Nu permit
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE��ATIONS.
s gnmblFo'Appli/� Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Ne applicant or future Wilding aceupamta ore or handle haardous material
as defined by Ne Cupenino Municipal Cade.Chapter 9.12,and Ne Health and Safety
,joiCod.Schen sss3z(a)]
Yes All roofs shall be inspected prior to any roofing material being installed.
❑ �No
If a roof is installed without first obtainingan inspection,I agree to remove
Will Nu applicanteoor(bum Wilding by ft
use cyuipmemiildevices which g
itict? air cmuminmts u dcfinc0 by Ow B&y Ara AJ,Quality Management all new materials for inspection.
District?
❑Ya EV-9
1 hawread the Wa (mmatefialsmquimmenuunder Chapwr6.95ofN Califm.
nb HeaIN&Safety Cade,Smdmts 25505.25533 and 25334.1 understand thmifda Wilding
docs not currently haw a want thas it u my mspoicaddlity w Maury the tempest of Ne
mqudc ca whichmuttWme ri n smmeeafacururecawafCe-pony. Signature of Applicant Date
All roof coverings to be Class"B"or better
Owner car
avNomted agent Daw' g