05030045�O ypzzFy�
n�
ON
�
lop
=iy
2?tt 0
s5=
CITY OF CUPERTINOx�
COI>Yi'RACTiCIR RMATIUN
BUILDING DIVISION PERMIT
,
:3 Ime$ett
BUILDING ADDRESS:
TAYLOR WOODROW HOMES
PE wmiiNO. 05030045
OWNER'S NAME:
PERMIT ISSUE DATE
TAYLOR
E:
SANITARY NO. CONTROL NO.
(925)365-3100
ARCHITEC (ENGINEER:
BUILDING PERMIT INFO
BLDO ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
o P
1 hereby sin. that I em licensed under provisions of chapter 9 (commmehas
with Section 7000) of lvi.ion 3 of the Business ad Professions Code, and my liccivm is
infull farce and effett LO
NEW CONDO. (19381 -LIV. SPACE)
Linen s LIC.N
Dam Comra
1
ARAGE 568
B — 18
ARCHITECTS DECLAll 1
I un rel my plenuhall M acid a Public
Il'ented Inner
OWNER �BUILDER DECLARATION
Lew for to
ereby affirm Net 1 em aempt rma the ComracrCo
: My.
owing mason. (Sr uu1 7(131.5, Business and caions Code: Any city or county
Improve. mash any structure
which requires • permit m eonarocL altee impmw,
h permit t fl
prior m its issuance, also requira thevisio nnl for each panni' m ices signed statement
de Conudear'Wcenee law (Chapter
Sq. Ft. Floor Area
Valuation
dust tschigwdpuruam roihepmvlalonsaf
(car Seaton7o00) of Division of Nc Business andon.Myl Cade)m
$241650
Net M u eamp'tiert(rom and Ue esu for IM alleged Bampton. My WWWon of
he I. eastern
APN Number
Occupancy Type
Section 7031.5 by any sppham for a permit subjects the applicaet On a civil penalty of
not mom Nan fin hundred dollen ($500).
0 I, a owner of the property, Or my employees with wages a theiraole compensation.
Re uired Inspections
will dothewortadhim structure lt not intended mothered Intake (See.7aa,Business
end Professions code: The COnttmror& Liame ns Law denut apply m an owes of
9 P
property who builds orimpraves t oscon,andwhodoesamle workhimselfm through his
own employes, provided tha'ach improvements artoat hmnd moQered fmsauif.
however, the building or Improvemrtnt is sold within ore )ear orwmpledon, the owner.
bulkier will have to burden of proving that M did not Mild Or improv for pulp. of
W.J.
0 1. as Owner of the property, am escholvely contracting with licensed contracmn to
construct the project (Sec. 7044. Business and Professions Code:) The COOM ot'a U -
cc= law doss not apply to an owner of property who Milds or improv thereon, and,
who contracts for much projects with a contncmrD) licensed puma, m Ne Contractor.
License law.
❑ I as esempt under Sec . B d P C for Nis mawn
Owner Dam
WORKER'S COMPENSATION DECLARATION
I hereby aRirm under penalty of perjury am of am following declinations:
'
01 ham and will mainWn a Canna oof Consent in self -insure for Workers Compen.
salon, as provided for by Section 3700 of Ne labor Code. res the performame of the
work for which this permit is issued.
1 have And will maintain Worker'! Compensation InsuMW. as ImIYIRd by Section
3700 of The Low, Code, for the performmme of the work for which this permit is issued.
My Worker's Compensation Insurance carder and Policy number art:
Cartier: Policy Na.:
CERTIFICATSOP EMPTION FRO ORKERS'
COMPENSATION INSURANCE
(Thu section coed at Mcompleed if the permit 4raromhundued do11m0100)
or Ica)
I certify that in the performance of that work for which this permit is sound. I shall not
employ any peon In my manna As in become subject to the Worker' Compensation
Law& of cahromu. Dam
Applianl
NOTICE TO APPLICANT: If. aper making this Ccri fiam of Em minion, you should
become subject to the Workers Compensation provisions of the labor Code, you must
forthwith comply with such provisions or Nis permit shell M demand revoked.
CONSTRUCTION ON LENDING AGENCY
ac of
1 heherebyichi dust thereon is.. . cec. lending Agencyfor Ne perfurmoc
S(Soc. ]00 97. Civ. C.)
' the work fur which this permit u issuedd (Sec.
Lenders Name
Lenders Mdrta
i 1 cedify that I hoe reed this applicator, ad mum that the Also. informWun i.
' corrett I agree to comply with all city ad county ordinances ad tum Is. relang in
building construction, ad hereby authodm representatives of this city to enter upon Ne
ahaw-m uldOned property for Inspection purposes.
(We) agree to ave, indemnify ad keep hannle s the City of Cupertino against
Iiabilitica judamenti adeapenw which may In anyway acerae against sold City
in c a f the {rating of this permit
a U DERSfANOS AND WILL COMPLY WITH A NO POINT
Issued by: Date
SOURCE LATIONS.
a%f
Re -roofs
Type of Roof
Sill pplicsoContra Dam
HAZARDOUS MATERIALS DISCLOSURE
the applicant or future building occupam seam orhandle hazardous memdsi
As ed by the Cupertino Municf I Calc. Chapter 9.13, ad dram Health ad Safety
Ode,Sectron 11531(a)7
All roofs shall be inspected prior to any roofing material being installed.
0Y. o
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment at devices which
emit havandans aircanmetinants u de0md by the Bay Area Air Quality Management
all new materials for inspection.
DLA let?
❑ Ya u
I have read the hvaaws mamriau rcquimments cider Clupmr 695 of the Callon.
nia Heel efmyCodc, Sectimts 73505.]5533 a1155M. 1 understand Nu if Ne building
c lly haw a tenan Nat It It my responsibility in neiify the occupant of the
requlrem hisOaMmetpriurmia0amar,certinamaraaPrmy.
SignatureofApplicant Date
All roof coverings to be Class "B" or better
ownerauthotvcdegent Da