05030052CITY OF CUPERTINO�'�>ix''w°`,
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BUILDING DIVISION PERMIT
ORRMATTON ,
BUILDING ADDRESS:
TAYLOR WOODROW HOMES
PERMITNO.05030052
10281 TORRE AVE ff 813
OWNER'S NAME:
PERMIT ISSUE DATE
TAYLOR WOODROW HOMES
2300 CAMINO
2005
E:
SANITARY NO. CONTROL NO.
(925)365-3100
ARCHITECGENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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LICENSED CONTRAC'TOR'S DECLARATION
lob Description
1 beneby +Rimm that I Am licensed under provWmu of Chapter 9 (Commencing
with Section 7000) of Div er 3 of the Bus. and Prof oor Com.aMmyliceveis
in full fora end effect.
NEW CONDO 1691 SQ FT LIVING
LkensuCl a tie.«
D Cmnlranm
502 SQ. FT. GARAGE
ARCHRECTSDECLA A 0
I ts sex m e W sad u public race
Lice feaumnal
OWNER -BUILDER DECLARATION
I heneby .Ilion that I em emmpl from We Liven¢ Law far the
nor Code: MY city of county
following name. IIoosm Rugitus and ProfessionsCodes:
permit t improve. de lire sig structure
which requires a peanll le eller, Improve, deermit
Mires the t A ed
tpflor At hat heitsissuummauerc to the preisio of for such mmor's Tense La (Chapter
that he is licensed pursuant to the of the Idccmclaw(Chapmr9
Sq. Ft. Floor Area
�,�a
ValUiihli 030
eBu,inmh
of Divisor
(commencing with Section of Division 3 of the Professions CAN) or
f cted a sompl o vi
that he u eampl therafmm end dx bMts for the ellcged emmption. My violation of
a and
APN Number
Occupancy Type
Section 7031.5 by any applicant for a permit subjmu the applicant m A evil penalty of
An, mane than five handled dmIsm (M).
36940017.00
C I. u Moor of Ire popery, m my uvployces with wages u Back NO compewdon.
Required Inspections
will do Bra work. and the.wnura u not intendedmrmlfarad reruk(Sec. 7044. Business
and Profassimu Code: The Canmcmrs Liana Lew door not apply m an MAA or
9 P
property who bulldsmrimpmves lhercon, andwho doessuch work Mmselfmr Waugh his
own employees, pmvidad that such Improvements are not Intended monered forsele. If,
however. the building ler Improvement is sold within one year of completion, Clue owner.
builder will have Bra burden of proving that he did not build m impose for pulp. of
ark.).
❑ I, u Mocr of dM propen, Am aseluivclY cont sted., with licensed cremscmn m
construct the project (Esc. 7044, Business and Professions Code:) The Commem's Li -
,mm Law docs not apply m An Moor of pmpeny who builds or impmwa the... and
who contracts for such projects with a eormactor(s) licenmd pursuant m the Can0men't
License Lew.
❑ I Am exempt under Sec. . B k P C for this ream -
Owner Data
WORKERS COMPENSATION DECLARATION
I haleby affusn under penalty or perjury ane of the following declarations:
❑ Ihaveand will mainuina CertiOamof Comentloulf-InsumrmrWorkeraCompen-
satian, As provided for by Section 37M of the Labra Code, for But performance of the
work for which this permit Is Ismed.
❑ 1 have and will maintain Walker's Compenradon Immarve, As required by Section
3700 of Ire Labor Code. for the performance of Lha work for which this permit is issued.
My Workeefa�Compe>nsation Insurance artier uW Policy number me _
(' No.: '�D
Caricr,'[�IZa-.1{. ��rl�i Policy id¢�!
CERTIFICATE OF �P IoN PROM WORKERS'
COMPENSATION INSURANCE
(This section need not bccompleled If the permit laferonc hundred dollars ($100)
lir leas.)
I modify that in the performance of the work for which this Permit u issued. I shall am
employ any person in my ma umrso ns m become subject m the Workclf COMPCMdm
taws of California. Data
Applicant
NOTICE TO APPLICANT: If, after making this Ceninca o of Eacmption, you should
become subject m the Worker. Compensation previsions or Are Labor Codc, you sour
comply with such provisions or this Nonit shell be dccmcd ..ked.
CONSTRUCTION LENDING AGENCY
1 hereby afrine the, Bt . ora CO.dnn lenall, agency for six perform. of
the work for which Thu permit u issued (Sec. 3097, Civ, C.)
Name
Lender's Addmas
1 cenify that I have need this application AM sum that the Above Infmmedun u
conect. I agree to comply with all city and county ordinauee end sum laws relating m
building construction, and hereby au horise represenudves of this city to enter upon ft
above-mentienM property far Inspection purpOma
(We) agree to save, indemnify and kap harmless IN City of Cupertino against
Ilabi a enu,cawmdeapeores which may in Anyway actrate against said City
1 onseq. Ne20. Zofthispermie
APPLICANT UJIDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE REGU TIONS.
7
1
Re -roofs
Type of Roof
Signature of HOAZeRDOUS MATERIALS DISCLOSURE Da
dII the Applicant or future building Occupant More orhendle Incautious mauerial
red by Bm Cupertino Munici Me. Chapter 9.13. and the Health and Safety
CAN. Section 25532(+)7
All roofs shall be inspected prior to any roofing material being installed.
❑Yu
If a roof is installed without first obtaining an inspection, I agree to remove
Will the appram or rmum building occupied use equipment m devices which
emit halardAN air Contend.. u u Bud by the Bay Arca Air Quality Management
all new materials for inspection.
Dlstricl7
❑Yes u
I have mad IN hvardous materials ropercmenuundcrChapmrd.95 of the Celifor.
nieHalth&Salet Code. Secdoor 25505,25533 W7.5534. I undmosed mutilate building
does Aly ve a mean. Bon II k my mspouihility b notify Utc asupant of W
M men ism Am mein Issuance Ora Cerdncam m Occup
Signature of Applicant Date
yr.
All roof coverings to be Class "B" or better
Own or narized;gp
u