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INFORMATIONN
BUILDING DIVISION PERMIT
,CONTRACTOR
BUILDING ADDRESS:
TAYLOR WOODROW HOMES
PERMIT No. 05030042
OWNER'S NAME:
FERMITISUBDATE
TAYLOR WOODR
E:
SANITARY NO. CONTROL NO.
925)365-3100
ARCHITEC (ENGINEER:
BUILDING PERMIT INFO
BLDG ELEG7 PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
lob Description
P
1 hareby Affirm that I am Iloemcd under provi ions of Chapter 9 (commencing
with Section 7") of Division 3 of rite Business And Pmfegolom Code, and my license h
�b(�
NEW CONDO. (1938' -LIV. SPACE)
Lfenrame,ndercat.
License IJe.N
Date cmuselar o
ARAGE 568'
ARCHITECTS DECLARA
A-4 (ORIG. )
U rmn r wnha public award,
KCKCd hlflanel
OW NE. BUILDER DECLARATION
IeBirm mm 1 am esempt from the Law for ft
My
femm.mh :
Code: My Nty ter county
. altar. and u c my
g moon. (Sadat RD IS,
alter, bnpmsu demolish. Ile
re cotes t, w. sig any tWment
which requires A Permite.
a
wits Iensedpdsu requitetW Applicant for Conch eritt Ole•eLAW(ned sukment
aim don
Lkcnmlaw(CMprer9
License
Sq. F[. Floor Area
Valuation
utuacturn
of tractor's
of the eBuinessa
thuWtscecnwit pursuanttoof Division Cade) or
Section 7M) of Division3 of tetege
$241650
eadmidon.Any vi
Net he ts anmpt uteafrom end the buffs fa the alleged enmptim. Any violation of
that he is
APN Number
Occupancy Type
Section 7031.3 by Any applicant for a permit subjecu the applicant m a civil penalty of
not more man Ow, hundred dollars (;3001
❑ I, as owner of the property, army employees with wages as Meir mle eampensallm.
Required Inspections
wmdo me work. and tht,new. lsnaumended conflicted mre.le(Sec. 7044. Busms,
end Profession. Cade: The Commodes License Law data not apply m an owmr of
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property w ho builds or improves doemon, endwho does such wank himse If or through his
awn employees, provided that such improvements ate not intended oroRered rorgoh, if.
however. me building or improvement i,sold within am year of ccmpletion, the owner.
bullder will ltsw me harden of proving that M did not Wild a Improve fa purpose of
,
Ask.).
❑ 1. As awmr of the property am excluaiwly contracting with licensed mnuectan m
contract dC project (Sec. RHC. Business and PmfeeVOm L'adc) The CmV,Cbes U.
cemt Law dans ml apply m an owner of property who Wild, or improws Neaten. and.
who contracts for such prokcu wim a com sesoRU licrmacd pursuant m de Cnnuacters
Lkes. Law.
❑ 1 em emmpt under Sec. . B & P C for this reams
OWN, Dau
WORKERS COMPENSATION DECLARATION
I hereby affirm under Mostly of perjury ore of the following dalantiom:
❑ I have and will maintain aCmlfteaaaf Ctement W self-irm. for WoekersCampen-
saner, As provided for by Section 37(10 of me Labor Code, for the performance of the
work for which this permit is issued.
❑ I have and will maintain Waker's Compensation Insurance, u required by Section
3700 of me Inbar Cade, far the pcAarmana of the wark for which mu permit Is igomd.
My Workers Comlcmadon Imursme arms and Policy nuumhrr AN:
Cartier. policy No.:S2llLL—LL2Q1.L
CERT�PnON FROM WORKERS'
COMPENSATION INSURANCE
mda sectio mrd not W complemd if tie permit is farms hundred 4o0. ($100)
or kis)
1 comfy that in the perfomame of the work for which anis Permit Is issued. I shall not
employ any person In my member an as W become subject to IN Werlecre Compensa0on
Laws of CAlifomh. Dau
Applicant
NOTICE TO APPLICANT: If. after making this CertlDaa of Eremption, you should
become subject m the Worker's Compensation provisions of the Latter Code, you must
forthwith comply with such provisions m this Perch shall be deemed revoked.
LENDING AGENCY
1 hareby afi rte mat mere Is • comuuctinn lending agency for tha perfurmanm or
the work for which this permit is issued (Sea. 3097. Cie Cd
Name
Lenders Address
1 certify mat I haw read this application and mu that the Above information ts
coma I aper m comply with all city and county estimates and sum laws totaling in
Wilding construction, and hareby southern repamntadsws of this city An A= upon the
AWw-mentiomd Property for impemime purymeL
A.
(We) ager an taw, indemnify and keep hatmlw the City of Cupertino against
lisbilides, judgments. cants And expenses which may in Any my accsa Against gold City
Iaa of me gstom" of mea MemiL
LICA UNDERBTANOS AND WILL COMPLY WITH ALL N N -POINT
Issued by: Dale
S CER IONS
m
Re -roofs
Type of Roof
Signature of pplleanVComeaemr AN
HAZARDOUS MATERIALS DISCLOSURE
III tire applicant or future building occupant or handle haramous material
dcMcd by the Cupertino Municl Code, Chapter 9.12. and the Health and Safety
Code, Section 25532(a)?
All roofs shall he inspected prior to any roofing material being installed.
Yu u
If a roof is installed without first obtaining an inspection, I agree to remove
WIII OSC applicant or forum Wilding occupied tax equipment or devices which
..It hamm�m eircomeramants a fimd by me Bay Area Air QuWtY Management
all new materials for inspection.
District?
❑Yes o
I �(c mad the hvardmn materials requirements undcrChapur6.93 afthe Collier.
nk Health&$sfmy Cade,Secndm25M.Zss33mu M53 .Iundcw ditamt Wudm{
not cumhsly have A tenant, mat' r mibility m nodry me occupant nr me
enydam mivhkh tRWm rforwLsshan r, eaten 0ofOcca a.
Signature of Applicant Date
All roof coverings to be Class "B" or better
O hranthomadegent Da