05100168 CITY OFCUPERTINO
BUILDING DIVISION PERMIT CONTRACfORANF�ORMATIOIV .
BUILDING ADDRESS: TAYLOR WOODROW HOMES PERMIT NO.05100168
10280 PARK GRN BLVD B
RS NAME: PERMITISSUEDATE
TAYLOR WOODROW HOMES 2300 CAMINO RAMON STE 10 02/01/2006
PHONE: SANITARY NO. CONTROL NO.
(925) 365-3100
ARCHITECrIENGWEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
O O O O
�Op LICENSED CONTRACT'OR'S DECLARATION
mF I krcby affirm that l am licensed under provisions or Chapter 9(commencing Job Description
2w with Sermon 7")of Division 3 of the Business and Profusion,Code.and my liceucu
n« In full f....nd effect o TRUSS CALLS
j Liccnx i Lic.M Lo
Dak �f tT o�cnmmewr o Tt;N HOUSE ONLY-NO NEW PERMIT
ARCHITECT'S DECLARATto
5y C I undersand my plans shall k used as public mcmms '
1.0
g y Licensed Pnsfessieaal
OWNER-BUILDER DECLARATION
Contractors
ON -\\�
O C 1 herchy affirm Nat I a1.exempt from the Cssions Ys Liccnx Law for the
OC O following reason.(Section II131.5,Business and Profession,Code:Any city or county
S$ which requires a permit to eommuct,alter,impmw.demolish,or repair any structure
_Z< prior to its issuance,also requires the applicant for such Permit to Glc a signed statement
that he is licensed pursuant to the provisions or the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area \ a ation
x~$ (commencing with Section 7800)of Division 3 of NC Business and Professions Caale)or
that ha is exempt therefrom and Ile buis for she alleged exempmon.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more Nan five hundred dollars(5500). 3 AI)N�l�t[Iber 0 0 Occupancy Type
othe wort,Ute propeuctur myemploym withwaguudle(ec.7044,Bsseon, 6C�4o UZ
will Pr Re work,end the he Con es not intended icerea Law ed for oleppl y W in Bulinus
and Profwion,Code:The C sthstoon, ndwho law dao not apply if an owner of Required Inspections
property who Wildsro or in,Prows thereon,andwho doessuch work Mroffe orthough his
own employcui provided than such improwmeno arc nein.of c oro@ren.for tworm-
however,the building or improvement is hath within one year of completion.the owner-
builder will have the Wrdrm of proving that he did out build or improve for puryox of
salt.).
❑1,as owner of the property,am exclusively contracting with licensed comracmrs to
con,troct the project(Sec.703a,Business and Profesdmn,Code:)The Cortmxmr's li- .
come law docs not apply m an owner of prof who builds or improves dameon.and
who contracts for such projects with a contractor(s)licensed pursuant an the Contractor's
License law.
❑1 am exempt undo Sec. .B dk P C for this mason
Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a cudficutc of coucat to self-insure for Workers Coot
sation,u provided for by Section 37W of the Iakr Code.far the performance of the
work for which this Permit I,issued.
❑1 have and will maintain Worker's Compensation Insurance.as required by Section
3700 of the labor Code,for the performance of the wok for which this permit is issued.
My Work s Compewtion luunntt�cta�rrier�and Polity number arc:
Carrier. M Ce,w'1 45oIPTIONS'NOM WORKERS* S
CFAIyFl CO OF COMPENSATION
NFROM WORKERS'
COMPENSATION INSURANCE ,
mus it.need not k completed if the permit is forone hundred dollars(5100)
m less.)
1 terrify Nat in the performance of the work for which this permit is issued,I shall not
employ any person in any manner so as In become subject to tic Workers'Compensation
Laws of califomia.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Eacreption,you should
became subject k the Worker's Compensation provisions of the labra Code,you mut
.,O forthwith comply with such prnvisions or this Permit Nall k dccmcn.rooked.
Z� CONSTRUCTION LENDING AGENCY
PIhereby affirm the there is a cortsuuction lending agency for the x9mmmer.f
a 7 the work for which this permit is issued(Sec.309'1,Civ.C.)
W Q lenders Name
6,
J Z Undoes Address
J Q 1 ttnethat I law mad this application and sink Nn the ahemfor
inmation is
W fir correct.I agree
ct comply with all city and county ordinances and auk laws relating to
Q V akwe-gcansurd pmKnd hereby authorirereprexnutiws or this City mcnkr upon plc
akvcmrnudgm propc costs
for inspection purposes.
H C (We)ague a saw,indemnify and keep ham leu Ne City of Cupertino against
h
liabilities,judgments,costs ndexpemeswhich may in any way attic againstsaid City
V 2 i uenee o("'I"
c granting of 's permit
APPLI NT UNDERSTANDS ND WILL COMPLY WITH AliJL NON-POINT Issued by: Date Z t.v6
SOURC REGULA7iON
/ 1
IL to Re-roofs c�
Sign roof ApplicanUCom sc r Date
HAZARD US MATERIALS DISCLOSURE Type of Roof
Will dk applicant or forme building occupant Wore or handle halaseloos material
defimcd by the Cupertino Munid Code.Chapter 9.12.and the Health and Safety
,.screen 25532(.)? Code.
roofs shall be inspected prior to any roofing material being installed.
❑arch u
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
'mit harardouh it conmminants u cImed by the Bay Area Air Quality Management all new materials for inspection.
District?
E)ym
I have read the h reaNsws materials ayuircmenu under Chapter 6.95 of plc Califon
nits Hcrt b.SaretyCod'.Secdcm25505,25533am125534.1 undcraand thaifde building
d tit amenity new a tet w '
tenant itmy responsibility ihilisy comfy the eacupant of the
y irtm tswnmp ahtk t o is,uanrcnnccn;Grak mforWan y. Signature of Applicant Date
er mr,mtharix Gent I UD All roof coverings to be Class "B"or better