05100170 CITY OF CU
- a+'•'_ """
BUILDING DIVISION PERMIT xONTRACTOR;INFORMATION
9ai .aAe.2' .m•qs max_. It,—<. %i3�-'
BUILDING ADDRESS: TAYLOR WOODROW HOMES PERMIT NO'05100170
10280 PARK
ER'S NAME: PERMIT ISSUE DATE
TAYLOR WOODROW HOMES 2300 CAMINO RAMON STE 100 02/01/2006
PHONE: SANTIARY NO. CONTROL NO.
(925) 365-3100
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�Op LICENSED CONTRACTORS DECLARATION Job Description
e hereby affirm that 1 am Bayed under and
Prol ns of Chapter 9(commencing p
with Sccuon 7IXM))Of Di'ion3of the Business and Pmfcuioos DOde.and mylicense it
in(ullforeeendaIT Loa`�lrrro TRUSS CALCS
j y License CI Lie.s
g�th Dam S�ComraemrfM46 ,, woes IN HOUSE ONLY-NO NEW PERMIT
ARCHITECTS DECLARATI V
' U 1 understand my plans shall be used as public records \�
g G t; Licensed Ptofessionel
g OWNER-BUILDER DECLARATION
.� X 1 hereby affirm Not I am exempt from Ik ConumerOr's License Law for the
00 following mason.(Section 703 1.5,Business and Professions Cole:Any city or county
t$E which requites a permit to consumer,altar.Improw,dcmoliab,m repair any structure
yzi prion,,its issuance,a15ooxpimstW applicant for such permit to file a signed statement
<
that In is licensed pursuant to tk provisions of rhe Contracturs Li¢nse law(Chap¢r 9 Sq.FL Floor Area Valuation 0
i1- (commencing with Section 7000)of Division 3 of NC Business and Profusions Code)or
.- that he is exempt therefrom and the basis for the alleged exemption Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant in a civil penalty of APN Number Occupancy Type
not muse Nan live hundred d011srn(S500k 36940002 . 00 p y YP
❑1.u owner of the property,Or my employees with wages as then to compensation,
will do the work,and the structure is not intended or offered for sale(See.70M,Business
and Professions Code:The Contractor's License law doe,rust apply m an owner of Required Inspections
property who bis ilds tar ire W mons tha neon,and who does such work hiracelf or through rough hu
own employcu.provided that such improvements are not intended mortared for sale.if,
however,the building or improvement is sold within one year of completion,the owner.
builder wi0 have the burden of proving that k did not Wild or improve for purpose of
sale I.
❑1,u owner of the pmpeny,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)Tire Contractor's U. .
cerise law docs net apply m am owns of propartir who Wilds or improve thereon.and,
who concocts for mW projects with a conmactor(s)licensed pursuant us the Contractor's
License law,
I
am exempt under see. ,Bg:P C for this moon
Dare
WORKER'S COMPENSATION DECLARATION
1 Mosby all under Porosity of perjury one of the following declarations:
❑1 ban and will maintain a Certificate of Consent to self-insure for Worker's Compan-
sation,as pmvidcd for by Section 3700 of the labor Code,for Ne performance of the
work for which this permit is issued.
❑1 Nye and will maintain Worker's Compensation Insurance,a required by section
3700 of she Labor Code.for the performance of the work for which Nis permit is issued.
My Wo�es Compensation Insuran¢carrier and policy number . \?v�
Caniw. ! ,R.f'�Cr✓s -�pMR.Policy No,
CERTIFICATE OF EXEM MON FROM WORKERS'
COMPENSATION INSURANCE
Min seviur reed notbceanplerod ifthc permit is fare=hundred dollars(5100)
or Mss.)
I unify ths in the per(mmanee of the work for which this Permit u issued.I shall not
employ any person in any manner an as as became subject in the Worism'Compensation
Laws of calitc nn.Dare
Applicant
NOTICE TO APPLICANT:If,after making this Cenifmale of Exemption,you should
beComc subject In the Worker's Compensation provisions of the labor Code,you muss
.J z forthwith comply with such Provisions or this Noun shall k deemed mwkcd.
Z O CONSTRUCTION LENDING AGENCY
I-+ I hereby aRrm dot them iso consuuctmo kndingagency for the perfoorn.of
7. the work for which this permit is issued(Sec.3097,Civ.C.)
CLender's Name .
=z lender's Address
U Q 1 certify that 1 have mad this application and sum that the above information is
L4 P anorak I agrce Io comply with all city and county ordinances and rum laws relating to
C)(:j building construction.and hereby authono,rcprescmarins ofthis city to enter upon lk
>"4 awn tmenuoneA propc costs
for and
impaction purposes
(We)agree to save,indemnify and keep harmless the City of Cupertino against
Fw py liabilities,judgments,costa end expense sub's„may in any way attmc against said City
U Z me eorthegrantingof this
PLICA UNDER ANDS N ILL COMPLY WITH ALL NON-POINT Issued by: Date
URGE R G LATI ^��
2 � Re-roofs
Signs. fA"IlexansConuncmr Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will ft applicant or future building Occupant some or W ndle bvarduus manorial
e defined by the Cupertino Muni tai Code.Chapter 9.12,and 1W Health and Safety
C.Section yes
15532(a)?)7
❑ All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit havaMnus air contaminants as4fiined by de Bay Area Air Quality Managcmcnt all new materials for inspection.
District' A
❑Yes Nu
1 have road the hateardousmaterin,rcquiremanu under Chapmr6.95 of thc Cali(o1-
aHealth@ Safctyccia,Sccumu25505,25533 and 25534.1 understood thatifthe Wilding
Jrcr n c=,Ii,hast a meant,th it is my responsibility m notift occ
fy upant of the
aim ntswni I lwicmancemfaCenifenoofO paney Signature of Applicant Date
0 0
Ow r ur anthorned agent D,no All roof coverings to be Class"B”or better