05100169 CITY OF CUPERTINO
BUILDING DIVISION PERMITCONTRACTOR INFORMATIONf
a
BUILDING ADDRESS: TAYLOR WOODROW HOMES PUMITNO-05100169
10280 PARK GRN BLD C
.R'S NAME: PERMIT ISSUE DATE
TAYLOR WOODROW HOMES 2300 CAMINO RAMON STE 10C 02/01/2006
PHONE: SANITARY NO. CONTROL NO.
(925) 365-3100
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
v00 LICENSED CONTRACTOR'S DECLARATION Job Description
w 1 hereby affirm Nat 1 am licensed under provisions of Chapter 9(Commencing
with Section 70(10)of Division 7 of the Business and Professions Code,and my licwc is
no�'n inmufnrco andI C y TRUSS CALLS
j Z Liccmc I Lic.N
o DaN h Contractor o W IN HOUSE ONLY-NO NEW PERMIT
ARCHITECTS DECLARAT
z I understand my plans shall W used as public meorth
Ir
g a t; Licensed Professional �f
^ S OWNER-BUILDER DECLARATION
4 i m I hereby affirm Wan 1 am exempt from dm Comerse tots License Law for the \/
e,4 following mason.(Section TIO L5,Business and Pmrevsions Code:Any city or County
$ which requires a penin w construct.ebea improve,demolish,nr repair any sto clure
_I6 prior us its issuance.also requires the applicant for such permit to file a signed statement
FFO that he is licensed pmmant to We provisions of We Coronaries License Law(chapter 9 Sq.Ft. Floor Area Valuation 0
$ (commencing with Section 7000)of Division 3 of the Business and Professions Cndc)or
— than be is exempt therefrom and We beau for the alleged exemption.Any violation or
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of NN NOccupancy yypumber Occu Type
not more then five hundred dollars($500)
4 002 . 00
1,as owner of the property,in my employees with wages as thew sole Compensation.
will do We work.and the a=,..u not intended Or oManod formic(Sec.70tH.BusiM..
and Pmfesdons Code:The Convector's Lt...law does not apply to an owner of Required Inspections
property who Wilda or improves thereon,end who doessuchwmk himself ar Wmugh bis
ownemploycea.provided WestsuchimpmvemenuartnminkM aroReredforsalaif,
however,the building or improvement is told within one year .of comple ion.We owner
builder will have the burden of proving that M did not Wild or improve for purpose of
axle.).
O 1,as owner of the property,am aelusively convecting with licensed Convenors no ,
convect the project(Sea 7000.Business and Professions Code:)The Convectors Li.
cense taw does not apply to an owner of property who Wilds or improves thereon,and.
who conmcu for such projects with a contactor(a)licensed Fursaem to the Canuactots
License Law.
rl lamexempiumic,See. ,B&PCforthumabm
Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury ram of the fallowing declarations
❑Iban and will moimain a Certifiemc of Cnnsem w Wir-imumforWorkarsCompen-
sanion,as provided for by Section 3700 of the labor Cade,fee the performance of the
work for which this permit is issued.
❑1 have and will maintain Workers Compensation Insurance,as required by Section
37W of We labor Code,for the performance of the wort for which this permit is burned.
My Wartets Compnuation Insurantt aria and Policy numher art:
Cartier:i^l N%W I C.<.n I* Poliq Na.: tR-{"3t0k3S
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Ttusection need not be corople LI ifthe permit u formic hundred dollars(5100)
or Ices.)
I certify dint in We performance of We work for which Nis permit u issued.l shall not
employ any person in any instinct an at in Mcome subject in the Wartrri Campuuadon
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Cenifiase of Esemption,you should
become subject to Ne Woher's Compensation provisions of ted Labor Code,you moa
.J z forthwith Comply with such pmvisiom or this Permit shall he deemed mated.
zCONSTRUCTION LENDING AGENCY
C4 I W r which thi Nat Vert I,.Comwc.3M7,nding agency for the perfurmamx of
FL Le work for which this permit is issued(Sec.7(197.Civ.CJ
QLenders Name
=z I<nders Address
U C) 1 certify that 1 have mad this application and sum Nat the above information u
D, F corccL 1 slime to comply with all city and county onlinarvxs and state laws misting to
OV d p
Wiidingeonsuuction.and hertbyamharite repcumbaivrsor this city tome,upon the
LU ab.n.nitriduneroperly for inapectian pmposes.
gL (We)agree to aave,indemnify and keep hamlless We City of Cupertino against
h Iiabilitia,judgments.costs and expenses which may in any way aamc against said City
U z i race of ' Yraming of Wis permit.
APPLICA UNDERSTANDS A WILL COMPLY WITH ALL NON-POINT Issued by: Date
SPURCE R GU DNS
y 1 D� Re-roofs
Signmure ApplicaHU=RDOUS MA 1S DISCLOSURE Date Type of Roof
VIII the applicant or future Wilding occupant more or handle husmolous material
defined by Ne Cupertino Munich I Codc.Chapter 9.12.and the H.10 and Safety
c.Section 25532(a)7 Yu All roofs shall be inspected prior to any roofing material being installed.
Will Urea Taal 0r future bis' If a roof is installed without first obtainingan inspection,I agree to remove
pp mg occupant use equipment or Wviccs which P $
emit hvardous airernuminanuu fined by Ne Bay Area Air Quality Management all new materials for inspection.
District'
❑Ya
I have read the hvadnus male ialsmquiremems underChapser 6.93of the Califor
hisFMml,&Safety GadC.$CC6ans 25505.255JJ end 25534.1 undcrsNnd thuif Nc Wilding
curently have s mnanx two it is my responsibility to notify We acupant of the
neymi¢ ntswhichm he r issuanaroccnirarcar y. Signature of Applicant Date
ow r m autho and agent 3 p J All roof coverings to be Class "B"or better