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CITY OF CUPERTINO-
-7
BUILDING DIVISION PERMIT
CONTRACTURINFO,RMATION
BUILDING ADDRESS:
10281 TORRE AVE A94
TAYLOR WOODROW HOMES
PP"MITNo'05030041
OWNER'S NAME:
PERMIT ISSUE DATE
TAYLOR WOODROW
EWE:
SANITARY NO. CONTROL NO,
(925)365-3100
ARCHITECLENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
o
lb Description
1 homeyrcby ". that 1 am licensed under provisions of Chapter 9 (commencing
with Section 90K) of Di ision 3 of me Business and Professions Conn, and my license is
in full force and e(fecL q
NEW CONDO. (19381 -LIV. SPACE)
License 1 + Lk.N
Dam Comranmr
ARAGE 5681
ARCHITECT'S DECLARATI
B-24 (BMR UNIT)
my Ian u c levo
L' Pro nu
OWNER -BUILDER DECLARATION
CRhy al'Bfin that I am exempt fresh the L'onuactoes License Law for HIe
wing moan. (Section 703 1.5. Btest ness and Pro(eNau Code: My city er county
which requires a Permit to crnurum, alter, improve, demolish, nr repair any a"Amin
prior to its Issuance, also require+the applicant forsuch permit to file a signed statement
that h Is licensed pursuant m the provisions ofthe Conuacmh License Law (ChaPmr9
Sq. Ft. Floor Area
Valuation
(commencing with Section 7000) of Division 3 of the Business and Profession Code) or
$241650
that he is exempt therefromand me bub for the alleged Assumption. Any violation of
APN Number
Occupancy Type
Station 7031.5 by airy applicant for a permit subjects the Applicant in a civil penalty of
not more Nan five hundred dollars ISM
❑ I,uewneiof Nepmpeny,omyemployctswiNmpsumebsolecampemdm.
Required Inspections
W III dP Ise work and th<awcwm b Ins Intended orortered (or We (Sa.70a, Bualrcu
Law demes l apply in an mon, of
Arm ProfessCommittees ieu Code: The Cotters Uuos na
property who builds orimpreves thereon. and who douanch work himselfor Waugh bit
own employees, provided mat such improvements arc not Intsnded oro0ered forok. if.
however, the building or improvement is mid within one year of completion, me owner.
builder will have me burden of proving that be did not build or improve for purpose of
sale.).
❑ 1, as owner of the property, am exclusively contracting with licensed contrulma he
construct the project (Sec. 7044, Business am Profudons Cade:) The Couxclo's U-
'
covin Law doss not apply in an earner of property who builds or improves theme. and
who comets for such projects with aeonmcar(s) Ikensed pursuant in the Cs m doloes
License Law.
❑ Iamexemptunder See .Bh PCfarmismawn
Owner Dam
WORKER'S COMPENSATION DECLARATION
T hereby affirm under penalty of perjury one of to following declarations:
❑ I haw and will maintain a CwOuts of Consent mself-usum for Workers Compen.
.it... as provided for by Section 3700 of the labor Cade, for me perfommma, of the
work for which mix permit is issued.
(3 1 have and will maintain Workers Compmrsuion Iwnue, u required by Section
3700 of me labor Code. for the Performance of tis work forwhich orb permit is Mooed.
My Worker+Cmmpcuetion luunna artier and Policy numhr are: y(�'/''�
CAnne- Policy No.: Q ��i�axa-/
CERTIFlCA Ol5 'EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thisanti on need not he complemJ i f me permit is for one hundred dollars ($100)
Mrs.)
1 unify met in me perfomance of me work for which this permit is limited, ) "I no
employ anypcnen in any manner an As in become subject he ilts Werken'Compewmon
Laws of Califooda. Dam
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject to the Workers Compensation provisions of me labor Conn, you mal
foMwith comply with such provisions or thi+permit shall be deemed invoked.
CONSTRUCTION LENDING AGENCY
1 hereby grim that them is a construction lending agency for the performance of
the work for which this mmit 4 Issued (Sec. 3097, Civ. C.)
Landers Name
Lenders Addma
I awry vel1 have mad this application and sum mat the above information is
correct. I agree in comply with all city and county ordinances and sal¢ laws relating m
building construction. and hereby sumodm representatives of this city to inner upon me
above-mendoned property (or Inspection purposes.
(We) agrte to ova, indemnify and kaD bamku me City of Cupertino against
WbilWes, judgments, costs and expenaa which may In any way we= against said City
to con race of ren "it orthb ParmiL
DERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Dale
SOURCE RE ONS
-7/2 t;S
(
Re -roofs
Type Of Roof
S' nuurc of
RDOU pplianUConDam
HAZARDOUS MATERIALS DISCLOSURE
mill ' acupant mom or handle material
Iby
t Healloa
theappliCupant no Muni
As tined by dw Cupertino Municl Code, Chapter 9.13. aM Ore Health and Safety
Cak. Section 33331()7
All roofs shall be inspected prior to any roofing material being installed.
❑Yu o
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant sur future buil inP ar:upanl use cyuipmenI ordevices which
emit haaaMno airconrsmtunts u recd by tbe Bay Area Atm Qualiny Management
all new materials for inspection.
Olxuim7
❑ Yea
I havemad the hasrdoammdals Rgoimwnts unnnr ChapRr495 of W Califoo
rah Heal ctyCann,Sectiw 15503.33333 esu 35534.1wucrstsrW muifW building
J of c Jy haw a moat. mat It b mY mapauihilttY a nadfY the oaup t of me
aim nie rn0amara
Signature of Applicant Date
All roof coverings tG be Class "B" or better
own
anomiad ngcot Dae