0503003300
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CITY OFCUPERTINO
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BUILDING DIVISION PERMIT
BUILDING ADDRESS:
TAYLOR WOODROW HOMES
PERMIT "°.05030033
OWNER'S NAME:
PERMIT ISSUE DATE
TAYLOR
,JE:
SANITARY NO. CONTROL NO.
(925)365-3100
ARCHMICNENGINEER:
BUILDING PERMIT INFO
BLDO ELECTO PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
et 1 am licensed umkr provons of Chapter 9 (commencing
1 hereby Mr. Nisi
wid Section 70IXB of Dlvtsios 7 of ds Businessand PrefcaJunsCode, and my license Is
in full farce and effect.10
NEW CONDO 1691 SQ FT LIVING
License CI Lk. X
Dote Con" 0
2 SQ. FT. GARAGE
ARCHITECTS DELLA ATI N
ants my plana NJI M used u puNie rt..
Lk d P si
OWNER -BUILDER DECLARATION
exempt scum the peamoss Co License Law for the
I y affirm Nel 1 MCXCPIfrom
1. erns Code: MY city of count'
g rima". 7(171.0. Business ad
elan hnprove, or mash +uumura
Permit t remove. de
which Acquires a permit re ares
the h permit t d
prior bits iensedpahumgo the theApplicantfor eachpermits Blea Law (Chapter
Canusesr+Licerase law (Chapsr9
Sq. Ft. Floor Area
Vale@x030
Nalkklicenscd puauants llN provisions mftirc
(Cmnmexin8 with Section 7000)af Division 7 of Ne BuYnesa and Rofeuiav Cade) w
that he is asempl Ncafrom ad she basis far the alleged earmp fon. My viulWnn of
APN Number
Occupancy Type
Section 7071.5 by any applicant for a permit subjects the applicant s a Civil Penalty of
at mare thus five hundred dollus ($500),
36940017. 0 0
❑ 1. u owner of Ne Property, or my employees WN wegas as tiro"v axle compemthon,
Required Inspections
will do de work, and Na+wctum is not intended or offered far We(Set. 1044, Buss•...
and Profession, Cade: The Contreemra Lkm m law dace rot apply s an owes of
q P
property who but lds or improves demon, and wha does such work himself or through his
own emplaycea, provided that such Improvements ase not Intended aroffemd fatale. If.
however, the building or Improvement is mid within one Year of completion, the owner -
builder will lova the burden of proving that In, did not build or improve for purpose of
❑ 1, as owner of the property, am exclusively contacting with licensed conaactas to
convect the project (Sec. 7044, Business and Profeasions Cade:) The Comsater's Li.
came Law dues not apply N an owner of propwy who builds or improv demean, ad
who contacts for such projects with a contractor(s) licensed pursuant N the Connator's
License law.
❑ 1 am exempt under Sec. . B As P C for this ransom
Owner Das
WORKER'S COMPENSATION DECLARATION
I hereby'Man wader Penalty of perjury arc of de following declaationse
❑ I".ad will mmnulna Cemifiossaf Consentmself-InarcfanWorker'aCompcn-
ation, as provided for by Section 7700 of the Labor Code, In, the performa sm of the
wank far which this Permit Ice lased.
❑ 1 have ad will mainuin Workers Compensation Issuvana. as "used by S.Ctiom
77M of Ne Lac, Code, for the peYanmace of the work far which this permit is issued.
My Wark a ompensafion insurance rimer ad Polity number �-7 � D
Cartier. Polity No.:
'
CE TIFIC KERS
OMPE SATION INSURANCE
COMPENSATION INSURANCfi
(This sectinm aced atkcampleted lithe permit tslartme hundred d.R. ($100)
of ICa6)
I certify Not In the perfarmanco of the work fm which this permit is brand. I shall not
employ any person in my manor a as N become abject In dvtWorkFW Compensation
Law& of Callimnia. Des
Applicant
NOTICE TO APPLICANT: If, after making this Cenifieale of Exemption, you should
become abject be the Worker's Compcns.tlon previsions of she Labnr Code. you must
forthwith amply with such provisions or this permit shall be deemed mated.
CONSTRUCTION LENDING AGENCY
I Manby affirm Na then is • conrawtion lending agency far the performance of
the work for which this permit B Issued (Set- 7097, Cih, C.)
Land,ts Name
Lemdefs Addaue
I Cavity Nn 1 have read this application and sus NY the show infoommus U
correct. l A&= as comply with W city ad county ordinances and am Is" rearing N
Wilding convection. ad hereby aothanim mpretentstiv of this city a anter upon N,
stove-memaned property for Inspection Purposes
(W,) agree N ave, Indemnify and keep harmless use City of Cupertino agdmt
liabilities, judgments, cote ad expenses which may In any way erne 6211"Y aid City
in fthefantin2 of this Pcnnil
ICA DERSTANDS AND WILL COMPLY WITH ALL ON -POINT
Issued by: Date
SOURCE REG A S.
Re -roofs
Type of Roof
+7P
12nYthrc of liesn NDOU °i
NA2ARDOUS MATERIALsmaomor URE
II Nc 1pplicantanfuturc bol reg occupant Yore orhandle hasudou+mesrial
fined by de Cupertino Manic Cad,. Chapter 9. 12, ad Ne Health And safety
eau,, section 75572(.)7
All roofs shall be inspected prior to any roofing material being installed.
❑Yes No
If a roof is installed without first obtaining an inspection, I agree to remove
Will Ne applicant or fuwm k'Idin2 occupant use equipment or devkee which
emit hmammos air contsmilts u fined by de Bay Arca Air Quality MansgemC"I
all new materials for inspection.
Diaic17
❑ yes u
ve and the hmamnuamaterials rayuirom me under chapsr695ofde C+lifor.
A' Id, & Jely Cade. Sections 25505,75577 ad 2553/. l undeuuM that ifthe building
ocs rot c fitly M. a Yma4 that It is my responsibility An no" try the oecupaI rate
roman hmh kms pdorsiswace ofa CcruliclanaOcap �v.,
Signature of Applicant Date
All roof coverings to be Class "B" or better
ar.mnaYtcu a tnl Date
IbAnIpe'
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