050300530
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CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
CONTRACT will"'ORMATIQ.:
BUILDING ADDRESS:
109.R1 TORRE AVE # R14
TAYLOR WOODROW HOMES
PERMIT NO. 05030053
OWNER'S NAME:
PERMIT ISSUE DATE
TAYLOR WOODROW HOMES
2300
E:
SANITARY NO. CONTROL NO.
925)365-3100
ARCHITECTIENGINEER:
BUILDING PERMIT INFO
'
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hereby affirm an 1 w limmed under pmviuons of Chapter 9 (mmme slag
with Secdon 7011) of DIA.lon Sof the Buainnaend Profmd... Cade. and mylicwe le
ie fall force and arfecl.
NEW CONDO 1691 SQ FT LIVING
Limansa Lic gg502
Dew L -t cwt
SQ. FT. GARAGE
ARCHITECT'S ❑ TI
r3
Ian cadre una ah upublic ds
icevcd Prosumal
OWNER -BUILDER DECLARATION
License Lew for the
rehy vHirtn Net 1 am1. exempt from the Conics,
ions Code: Any city or county
owing reason. 7(131.5,Bnslnca.and o
which nvlussu a .Trent ere de
ac cnr swcL Blur, imprnt ve&srepair any m ctum
he moltt ermol
prior o its I Issuance, fen memo toMeuiLaw mat
alman,
Ft. Floor Area
Vali$Qiibrl 0 3 0
9
(CMpwr9
ensed p to he pro inions of dre Com (Chapter
that he urchng a�J punumt m he provisions o(Ne Conumosand
Sq.
Porclaw
(commencing with Section 7000) 3 of Code) Or
Busiegad
al exmand on. My
that u ts exempt NeOlrom and Ne berets far the alleged eacmpdon. MY Moladon of
W basis f
APN Number
Occupancy Type
Section 7031.5 by my applicant for a permit subjects the applicant w•CIAI penalty of
not mom than rise hundred dolun ($5W),
36940017.00
0 1, as owner of de property, or my employees wilds wages as their sole compensation,
Required Inspections
will do Nc work and derstum. bsommuaded oraRenA retail. (Sm. 7014, Business
and Professions Cade: The Conmcmes License Law dao Out apply m an owner of
9 P
property who build. Or i mprow thueen. and who does mach work hese If orthrough his
awn employees, provided rhusoch improvements K rmtineted oraRend Waste. If.
however, the building a Wpmvemmt Is sold within arc year of emadvion. the owner.
Wilds will have the burden of proving Nat he did ret build or improve for purpose of
sale.).
0 I, as Owner of the property, am exclusively contracting with licensed contncmn to
covtmct to project (Sec. 701 Business and Pmfessiohu Code:) The Comment's Lt.
come law dao not pply an an owner of property who builds or Importer, demon, ad,
-
who contracts for such pmjecu with a conuamer(s) licensed punuenf m the comors oes
Lkense law.
0 l em exempt under Sec ,B At PC for this Ounce
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby arm under penalty of perjury ane of the following decleratev:
0 1 have and will maintain a Cendhemeof Covent N self -tenure far Workeea Compen.
sulon, as provided for by Section 3700 of the Labor Code. for the performance of fle
work for which this permit is heated
'
0 1 have and will maintain Workers Compensation Insurance, u required by Section
3700 of she Labor Cade, for the performance of she work for which this permit is Issued.
My Workers compensation Insurance carrier and Policy number am: y�
Carrier. Polley No0.: �ba/
CERTIFIGTE OF EMPfION FROM WORKERS
COMPENSATION INSURANCE
(Thu mcdon reed net becompleed If the permit Is forone hundred dollen ($100)
ser lest)
I certify that in the perfunnance of the work for which Ni. Permit is Issued, i shell caw
employ any Worm in any mannerm Or w become subject to the Workem Compensation
U. of California. Data
Applicant
NOTICE TO APPLICANT: IL after making this Cenificau of Exemption. you should
became subject In the Workmen Compensation provisions of the Labor Code, you mtm
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hemby affirm that than its covtrvcfinn lending agency rot the performance of
the work for which this permit Is issued (Sec. 3097, Civ. C.)
Lendces Name
Latexes Mdten
I certify that I have mad this application and sum that de above Inform Won is
correct. I agree to comply with all city and county ordinances and sure law relating w
building mr3lomEen, and hereby authorize representatives of this city to enter open the
above-mentioned property for inspection purposes.
(We) agree w save, itecmnify and kap hermless the City of Cupertino against
j liabilities,judgments.COW, and expenses which may In any soy amme against said City
in can co the granting of this permit.
' NDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE L ONS
Re -roofs
Type of Roof
-7
_lot
gnmum o "C HtrAZARDOUS MATERIALS DISCLOSURE Data
I the applicant or fuwm Wilding occupant 4me or handle harm ous material
u Road by the Cupertino Merle Code, Chapter 9.11. and she Health and Safety
Cole. Smeon 15531()7
All roofs shall be inspected to any roofing material being installed.
0y.
prior
If a roof is installed without first obtaining an inspection, I agree to remove
Will dte applkant or future building acupant use equipment or devices which
mit havardnus.1,.ontaminants u cd by the Bey Arra At, Quality Management
all new materials for inspection.
Diseict7
0 Yee
I have read the hmardmismucria4 mquimmentsuadm uper6.95 afthe Califor.
25534.1md dNuifdc building
dg,ctyC:.=I,mh25.K15.25533e
d t cu t hove a unset. doh u my responsibility w hotly the occupant Of the
mym la ch ube reef pri�rw issuanm ora ccrtidcaw or ^y,
Signature of Applicant Date
..NDue
All roof coverings to be Class "B" or better
ner m orirade ant