05090034 CITY OF CUPERTINO " �'�'%'*' `"° '
7777777777
BUILDING DIVISIONPERMIT CONTRACTOR INFORMATION p
BUILDING ADDRESS: TAYLOR WOODROW HOMES PERMIT NO.05090034
10280 PARK REEN LN ft R40
OWNER'S NAME: PERMIT ISSUE DATE
TAYLOR WOODROW HOMES 2300 CAMI
E: SANITARY NO. CONTROL NO.
(925) 365-3100
1ARCHITECTIENGiNEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION Iph D0SCr1pClOn
U C I mmby affirm Nn 1 am Iimnsed under provisions of Chapter 9(commencing
bth Sectwn7000)af Divimm 3ofdte BusneuaM Prafessio Cocie,andmylicenseis
sfullforceanderrect. (j REVISION-MOMENT FRAMES/STEEL PLANS
p vvf� Licensea Lu.g
' qq Dau - —Conuan NO NEW PERMIT ISSUED/ORIG. #05030080
s 'Y ARCHITECTS DECLARATION
vsi V I undmaand my plants mall be used a public records
n
±�IyLicensed Pndcssianel
CI3 dud Ica.BUILemoup ER DECUBATION
T: I hereby aRrtn that i 1. ,Bump.from Ibo Canuactors :My,Law fou IW
CIC following mown.(Seise RD L5,Business end Ptofevtian Cade:Any city or county
$ which requirm a rami.no,i.dao alar,improsu h Permit
I cart.sig any tausustructure
-P6 priartoiss issuaas.also requiter We provisions
for Conumfmitm Bin a,Law(sutemcm
�.,.A that he is licensed pursuant the pro•iaoro err dm conua,mra Lia<me law tchapter9 Sq.F[. Floor Area Valuatiol 214
(commencingwith Scctian7000)of Divhion3or Ne Businmand Professions CM)ur
y;. Nat M u comp,themfmm and the anis for We alleged aemptian.My violauan of
Schon 7031.5 by any applicant for a permit subj,cu the applicant in.civil penalty of APN Number Occupancy Type
not more than riw hundred dollars(5500). 36940017 . 0 0
O 1,u owner of the property,or my employee with wages as their Who compenudon,
will de,the waft.red WeaWerom is net WanGA IXaBCnd fmall,(S,L.7 .Bud».. eG I
Required Re ns
and Pm(miorm Cade:The Contractors License Law Ban ret apply to an owner of q Inspections -
property who builds or im p roan tiureon,and who does such work himself or though his
ownmployeer,providedtharsuchimprowmanuartnatinr,W oroQe+d(orale IL
how,cm.the Wilding or improsemmt u mid within one year of oompiedon,rhe Owner.
builder will have time Wfaen of proving that he,did net Wild in improve for purpose or
au.).
❑1.at awns,of the portion'..elusively cosseting with licensed mnuamors in
construct the project(Sec.7p ,Business and Professions Cade:)Time Contractors U.
cone law does not apply an m owner of property who Wilds or improsa Burton,and,
who mntracu fm such projects with a commis s(s)bemused pursuant in she Contractors
Lkens Law.
❑I am exempt under See ,B h PC for this moon
0. Dao
WORKERS COMPENSATION DECLARATION
I hereby affirm under perW ty car perjury nee of the fallowing decimation:
I bow and will maintain aCertifiau or Consent to elf-inure for Wuhdm
s Copes-
-tion,-provided for by Stores 7]00 of the Inbar Cie,for the performance of the
woh for wNeh Nis Permit is issued.
❑I Nee and will maintain Workers Compensation Insurance,as required by Saxon
1700 of the labor Cade,for the porpmom oto of the work foewhich this permit is issued.
My Wohers Comp, atian urarMs Beier and P.1k number ar
Cartier. Policy No.:
Comp
CER FirsTEOFEXEMPITONFRD R[ERS'
COMPENSATION INSURANCE
(This action net not W completed If cos permit is formic hund.d dollars($itu)
or Ire.)
1 certify,dot in the performance of the wort for which this permit is issued.1 shall not
employ any person in my mmmrw az M axome subject in the Wmken'Comperwtion
Lxwa of California.Dau
Applicant
NOTICE TD APPLICANT:IC afwr making this Certificate or Exemption,you aboard
dsome subject in thin Warteh Compensation provisions of IW Labor Cods.you most
r O forthwith comply with such provisions or this Permit shall W deemed rewkcd.
z" CONSfRUCOON LENDING AGENCY
h
E I herebyich thi W.there u s ed(Secti30lending agency for the Pcrfurmanc,of
ate Lc work rte which this permit u issued(Sec.]097,Civ.C.)
W.Q Lenders Name
Lenders Address '
U Q I certify that 1 bars mad this application and sum,that th,aWv,information is
correct.I agree to wurs comply with all city and county ordiand ruts laws relating to
0Wilding communication.and hemaymium.reprusenutives of thin city tomer urns the
Vabove-mentioned property for inspection purposes.
17y (Wc)ages to un.indemnify and keep hannim the City of Cupertino against
f4 Iiabilides.jdgmcnu.com and eapenu which may In any way aarnM against said City
L)Zin COMNumm of the granting of itis permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCEREG ONS.
c /A Dam
C' Re-roofs
Signature of ApplicmUCon oar Dau
HAZARDOUS MATERIALS DISCLOSURE Type Of Roof
Will theapplicantorfuture Wilding attvpantstmemh Mlch MftWmaterial
az dcfitud by the Cupeniw idle Muniripal GMC.Chapter 9.12,and the Health and Safety
❑Ya
otic,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
W,B the applicant atmture Wilding acsupant umequipmcntordevi=which If a roof is installed without first obtaining an inspection,I agree to remove
mi,havxrdirm air comaminanu n&road by the Bay Ana Air Quality Management all new materials for inspection.
Diauict?
❑Ym
I have mad the harardmts materials requirtmm aunderChapter695ortheCalifm-
maHcal"Safety Cade.Satiate 25505,25533 ad 255X.I understood thin if the Wilding
dors trot currendy bass•Mount.that it in my nesrwmibility to unify the occupant of doe
reyuirtmcnuwhich mu. .xmet prsa .tri man«tor,aNrcaM mraapanry. S ignature of Applicant Date
j
Owner err authorisd a,.,., �Dau'� All roof coverings to be Class"B"or better
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