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CITY OF CUPERTINO
CONTRAIN '•Q MATI 1�i
BUILDING DIVISION PERMIT
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BUILDINGADDRESS:
TAYLOR WOODROW HOMES
PBRMrTN0.05030036
OWNER'S NAME:
PERMIT ISSUE DATE
TAYLOR WOOD
E;
SANITARY NO. CONTROL NO.
925)365-3100
ARCHITECTMNGINEER:
BUILDING PERMIT INFO
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Eta PLUMS
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LICENSED CONTRACTOR'S DECLARATION
Job Description
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hereby grim Nat 1 un licensed under provisions or Chapter 9 (eommcneing
with Section 7") of Division 3 of the Business and Profession Code, and my Ilcense is
in fell forceandeffect.
NEW CONDO 1691 SQ FT LIVING
In�yl
Li 'no cl cumgracto
X-502 SQ. FT. GARAGE
ARCHITECTS DECLA A O
on nd my plan hall h ued s w
Lused ssiorIff
OWNER -BUILDER DECLARATION
I h by a1Tnce that I am uempl from the Convectors License Law for the
Ilowi n uon. (Section 71313, Business and Professlone Cade: My city or county
' rtquims a pcmN to earulmac4 eller. impmw, demnlW, m rtpalr anY aWetare
Tar RICA
Itscensed'C.a1Wnt Toa
Sq. Ft. Floor Area
4.9111030
Val$9111030
Law(Chartelll
Hom Ire
to provisionso Contractor'slaw(Cha
deommencccnsed PSesuant toNe pro vision of the
exe apt e)ur
a Business and Code) or
(commencing with Section m 3 of me
egad on. MProfesvi
Nu be b exempt therefrom old Ue bub far Ne alleged Gumption. My violation of
that and basis f
APN Number
Occupancy Type
Section 7031.5 by any applicant fora permit subjects dee applicant to a crwl penalty of
not more Nan Rw hundred dollars ($500).
36940017.00
❑ I, se owner of be property, or my employees with wages As their =to compensation.
Required Inspections
e
will do the work and the Announce isma intended ora@rcd for sale(Sec. IDM, Business
and Profusion Cade: The Commuctora Liam Law does Am apply to an owner of
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property who bui Ids or improv°. thereon, and who does such work himsel f or through his
awn employees, provided that such Improvements arc not Intended oroaeed forum. if.
'
however, the building or Improvement Is sold within one year o(completion, the owner.
Wilder will have the burden of proving that be did not build or improve for purpose of
Mk.).
❑ I, As most of me Property, am adutivelY convening with licensed contractors to
construct the project (Sec. 70M, Business and Promsdans Code) The Comnctors LI -
came law does not apply to an owner of property who Wilda or improve Norton. and.
.he conON for such pmjecu wide a connYtor(s) licensed pursuant M the Contractor.
Llame Law.
❑ I un exempt under Sec, . B k P C for this reason
Owner Data
WORKERS COMPENSATION DECLARATION
1 hereby of roo under Penury of perjury ane of Ne folican g decimations:
❑ I Mw and will maintain a Cenincom of Conant to self-iuum for WoftesCompen.
nation, As provided for by Section 3700 of the Labor Cade, for the performance of the
wmk for which this permit Is issoed.
1 haw and will maintain Workcra Compensation Insurance, at rtyalmd by Section
3700 of the Labor Cade, for the part... a of the work for which Ni. permit Is issued.
My Worker'. Compensation Insurance artier and Policy number am: D
Cartier. Policy No.:
T FICATEO^ XEMPnONMOM 0 KERS'
COMPS SATION INSURANCE
(This semen need natbecmnpleted if dee permit iaforonehundmd dollar ($100)
or Ws.)
1 aunty that In the porformann, of the wart for which this Permit is broad.1 Nall not
employ any peran In any manner an As m become subject to dee Workers' ComMnadon
Laws of California. Dam
Applicant
NOTICE TO APPLICANT: If, after making this CcniOam of Exemption, you should
become subject to me Worker'. Compensation provisions of the paler Cade, you am
foMwuh comply with such prevision or this Permit Ndl N deemed revoked.
CONSTRUCTION LENDING AGENCY
• construction lending agency for the performance: of
1 hereby hi that Vert w
work for wch this permIit b ssad (Sec.. 300 97, Civ. Cd
AM, which
"
Lender's Name
� Ianmaderl Addma
1 unify that 1 haus rad this application and.ute that the show information is
'
cancan I agne to comply with all city and county ominancea and sum laws relating or
building convection, and hereby authorion representatives of this city In anter upon the
shove -mentioned property for Inspection purposes.
(We) agree to on, indemnify and keep harmless the City of Cupertino against
liabilities, judgments. costs and expeava which may in any way scene again., said City
In con¢ me granting of this permit.
U ERSTANDS AND WILL COMPLY WITH AL NO POINT
Issued by: Date
OURCER S. Q'(
Re -roofs
Type of Roof
S' name Ppl1C HAZARD_ OUS MATERIALS DISCLOSURE Date
IltWappeantarho Wed" goceuputuamorlu"dmhvaNaamaterind
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used by the Cupertino Mumct Code. Clupur 9.13, runs the Health and Safety
Code. Section 25532(x)?
All roofs shall be inspected prior to any roofing material being installed.
❑ Ya a
If a roof is installed without first obtaining an inspection, I agree to remove
Will 11mapplicant or tutu¢ bar' ing acupam osc eyuipmem or devise which
emit Instances air conuorromu coned by Na B y Area Air Quality Management
all new materials for inspection.
Gimlet?
❑ Ya
I haw mad the hastmaus materials requirements under Chapter 6.93 of the Califor.
25515,25533 and 25534, 1 whearesed that if dee Wilding
et It is my responsihility to nmy accupan, of Ne
a
c a�y.
SEF
Signature of Applicant Date
Ie
All roof coverings to be Class "B" or better