05030054z
ZmZC
n�
z
L
5D
lag
_Z1�
E�C
IF!
O
U
CITY OF CUPERTINO
'7
BUILDING DIVISION PERNIIT
�
kc, ONTRAOTOR INFURMATIEQN..-,
BUILDING ADDRESS:
10281 TORRE AVE ft R11;
TAYLOR WOODROW HOMES
PER'"THO'05030054
OWNER'S NAME:
FERMIT ISSUE DATE
TAYLOR WOODROW HOMES
2300
E:
SANITARY NO. CONTROL NO.
925)365-3100
ARCHITEC17ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 Mmby affirm leu 1 Am licensed undo provisionsof Chapter 9 (...In{
with Secdon 70[10) ofDiA.i.A Sof the Busin era and Pmfesimu Code, and my hear. is
aenect.
NEW CONDO 1691 SQ FT LIVING
c�"mwrr-'
2 SQ. FT. GARAGE
ARCHITP-CPS DECLAR 10
9un
do d. mu shall be umd u public re
anted P u anal
OWNER -BUILDER DECLARATION
1 impeby Affirm that I am comp, from site Co meroh License Law for the
mllowi ear. (Section NO 1.5, Business and Professions Code: My city or county
,
whmquim • pminit m cnt 4 almr, impmw, demalLsh, v mpatr my siromuro
p wmiu Wu .al requimsdeapplicmlformchlcrmitmaleasi{nmisutcmcnt
Contractor's Have Law (Chapter 9
Sq. Ft. Floor Area
Val$0111030
Mut he is licensed pormenlm the prevision of the
(commenting with Semon 7000) of Division 3 of the Busumb; and Pmfosions Code) or
that he Is exempt tircmfrom and dm but& for also alleged eeempdon. Any violation of
APN Number
Occupancy Type
Section 7031.5 by any Applicant for a permit subjects the applicant to a civil penalty of
am roam than five hundred dollars (ssoo).
36940017.00
❑ I, u owner of the pmpmy, or my omployces with wages u dab mle eompenudon,
Required Inspections
e
will de We work, end theaWCWR is not Intended or offered forsam(Sm. 7044, BudrWa
ncmrs License, Low dons not apply be an owner of
and Pmfemfons Cade: The Caa
q p
property who but Ida or improves Mmeon. and who does s uch work himseIf or through his
awn employee, provided thatsuch improvements Am not intended mallard fantasia. If,
however. the building or improvement Is mid within one year of completion. the owner.
builder will have the Women of proving Wt M did not brim or, improve fm mrpam of
Aske.).
❑ 1, M owner of the properly. Am exclusively conhaming with bounced mnummn m
container ore project (See. 70ad, Bureau and Profemans ems:) The Conteacmrs U -
cram taw data not apply to an owner of property who builds or improves maroon, and
who contracts for each projects with a comacher(s) licensed pursuant no dm Conuaemes
License Lew.
❑ i am exempt under Sec. . B k P C far Nis moon
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury ons of the following declarations:
C3 Ihlw end wilt maintain aCemante of Consent to mif-imuR for Wadmra Gompen.
same, As provided fm by Section 3700 of the labor Code. for the performance of the
work for which this permit is issued.
❑ 1 Mw and will maintain Workers Compensation Norma, As required by Semon
3700 of the labor Code, for the perfomana of the work for which this permit is Issued.
'My Worker. Cmam mdan IIImRnm abler and Policy Mumbo sm.:--ss...�
Carrier. Policy Na.: �/-_(1Lg2
CERTIFICATE OFEK MP170N FROM WORKERS'
COMPENSATION INSURANCE
(Thueaudon need rot becampleted If the permit Is future hundred dollars (510[0
or las.)
1 artify that in the performance of do work for which this permit is issued, I shall not
employ any person in my manncrm As m baome abject he the Workere' CompenmMan
Laws of Calffemia. Data
Applicant
NOTICE TO APPLICANT: If. after making the CeNOate of Exemption, you Mould
become subject to one Workers Compensation provisions of the LAWr Code, you mug
forthwith comply with each provisions or this permit shall W accrued anodes.
CONSTRUCTION LENDING AGENCY
1hor that thcrc Issed(m..construction0 lending for the performance or
whalum
.)
the work for which this permit is issued (Sac. 3097, Civ. Cd
Tondos
Lendeh Add.
I I certify that I haw rad this application and sum Net me above information IA
' coma I agree to comply with all city ad county ordinances and fuse caws muting to
building construction, and hereby mthodm mpmaenu lm of this city to color upon the
Dove -mentioned property for inspection pupal
(We) agree m rove, indemnify and kap hamlets the City of Cupertino against
i Ilabillda. judgments, cusu and expense which may In my wry Accra against said City
t Inca f the jmaling of this Permit
A U DERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
EOUE RE TI NS.
-t
Re -roofs
Type of Roof
Signature pl uconuactor paw
HAZARDOUS MATERIALS DISCLOSURE
Il Me4pplicator(umm buildi gacupaurame rbeadlehaurdousmatedal
Oncd by rhe Cupertino Municlp ode. Chapter 9.13, and the Health and Safety
Cale, Sau.n 33533(.)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 detapplicant m ramm W at occupant ute equipment or devices which
mit harudous it, mommine u red by the Bay Ams Air Quality Management
all new materials for inspection.
Dismin7
❑Ya
11haveriothehuardmsmsmdaumquimmenuundcr Chapwr6.95orthe Califor•
of yCodn,Semans35305,35333and35534AunderstamthgifMm building
at,
ora not cu In. mnant, that It Is my rcepomihiltty m notify Mmwpm of Mte
mar Me issuance of eama�e ytr
r
Signature of Applicant Date
05
All roof coverings to be Class "B" or better
amD,I
woe hadvcd agent .