05030055CITY OFCUPERTINO
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'CONPRAGTORINF,
BUILDING DIVISION PERMIT
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BUILDING ADDRESS:
TAYLOR WOODROW HOMES
PERMIT N0.05030055
OWNER'S NAME:
PERMIT ISSUE DATE
TAYLOR WOODROW HOMES
2300 CAMINO RAMON STE 1U
07/20/2005
E:
SANITARY NO. CONTROL NO.
(925)365-3100
ARCHITEC (ENGINEER:
BUILDING PERMIT INFO
BLDGO ELECTO PLUMB MECHO
LICENSED CONTRACTOR'S DECLARATION
Job Description
P
1 hereby affirm Net 1 Am licensed under provisions of Chapter 9 (commencing
.fill Section 7M) of Division 3.f the Buelneu and FafeYlam, Code, anal my license ie
in full force and effect
NEW CONDO 1691 SQ FT LIVING
License ° c rgnner�
S Q . FT. GARAGE
ARCNIIECTS DECLA A N
plan I be use
pdilanisll.OWNERBUILDHR
DECLARATION
aRtrm that 1 am exempt from the Canuacrars Ucase Lew for the
(Setion 7031.5, Business a d Professions, Code: Any city Or County
which requires • Permit to commonest, after, hnpaw. demolW, or repair any structure
prior in its issuance. ales requires the applicant farsuch permit In file a signed statement
ComracmrsLlanselaw(Chepror9
Sq. Ft. Floor Area
Va �Lbd030
Nn he is licensed pumantmtheprovisinnsofthc
(commencing with Section 7") of Division 5 of the Buslinam and PreleseionsCMe) or
Nat he is exempt therefrom and the bub for the alleged exemption. Any violation of
APN Number
Occupancy Type
Section 7031.5 by tory simulation for a permit subjects the applicant in • civil pcnsily of
Am more dun Ow bombast daNn ($5007.
36940017.00
.
❑ Lu the prapertl'•ormyamployxs withwagesuthetrwle
Required Inspections
W.Bustion,
will me work.and forulapplyir 7001, ss
The C mmercI.
Pr Nasion
water of
Code: The Casterton Licence Law data not apply lf an racer of
Yd Professions , License
q P
W through his
ertywho WlMsorcd
thmesthlinprend nteras .at hummahimselfar
awn employees, provided Nat such Tmprowmems tae not Intended mo0erttl fm Yro.IL
am
however. the building or Improwmat is sold within year of ampletion. Neose
or
Wilder will ham the Writes of proving Nu he tlitl noten build or improv purpose for puof
,
❑ 1, as Owner of the property am exclusively contracting with licensed antrecers to
consumer the project (Sec, 7040, Business end Professions Code:) The Contncts's Lb
came law does nor apply to an mater of property who build, or imprwea thereon, and
who contracts for such projects with a eonvscmr(s)11censed pursuant to the Canlnclan
License Law.
❑ I em exempt now See . B St P C for Nb mason
Owner Date
WORKER'S COMPENSATION DECLARATION
10 i hereby Niru under penalty of perjury one of the following decimations:
❑ Thaw and will mainWnaCertlliata o(Commlto self -inure for Worker's Compeer
Ydon. Y provided for by Section 3700 of the labor Cade, for the performance of the
work for which this Permit is issued.
❑ I have and will maintain Workers Compensation INurYa. As required by Section
3700 of the Labor Code, for the performance of the work for which this permit is Issued.
My Workers ComMosaBon Insurance carrier And Policy number am: y p T
Cartier. PAI�I7 PolicyNo.: tit O�•�M /
CMMONMOMWORKERS'
ERTIFl F Ef
COMPENSATION INSURANCE
fni n section read not be completed HOW permit is forum hundred dollars (SIM)
nrlesx)
I anify that In the performance of the work for which this permit Is issued, l shall not
employ any person in any mannerY ss an become subject to the Workers' Compensation
laws of California. Dam
Applicant
NOTICE TO APPLICANT: If, After making this CaiOaro of Exemption, you should
become subject to the Worker's Compensation previsions of Ne Iabm Code. You muss
forthwith comply with such pmvisho. or this permit shall be deemed revoked.
ON LBNDING AGENCY
CONSTRUCTION
13 a c Agency for the Performance of
1 herebyich thi that there is a mNuec.
30 7, Ch,
the doh for which this permit s issced (Sm. 7097, Civ. C.)
lenders Name
Lenders Addmu
1 certify Out 1 larva read this Application and Ataro that the above information is
camera 1 agree to comply with all city and county aNlnances and bas laws mlatin{ to
building construction, and hereby Ythadrn epesenudws of this City in error upon the
aWw-matiunea property for impaction purymes.
/47
(We) Agme in Yw, indemnify And keep h,rmroas the City of Cupertino agalnsl
liabilities, judgments, cess and expenses which may in my soy exame, Against Wit City
msf Ne gremlins of this permit.
NT NDERSTANDS AND WILL COMPLY WITH ALL NOWPOINf
Issued by: Date
SOURCE U 10
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Re -roofs
Type Of ROOF
gmlure ApplicanUCamrscror DAro
HAZARDOUS MATERIALS DISCLOSURE
iIlIc,pPIkAdtm(uture Wil'sx upanlatammhendlehuudousmatmfal
As need by the Cupertino Munich Code. c ince, 1, 11, and the Health and Safety
Code, Section 35533(.)?
All roofs shall be inspected prior to any roofing material being installed.
❑secs u
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipmem or devices which
mit InOu dnN air calemins m u food by do Bay Area Air Quality Managencnl
all new materials for inspection.
District?❑
Ya u
1 have read the hneardous matarlals requirements under Chapter 6.95 of the Califon
nAHcmlN ly Cadc, Scedons 25505,23533 and 24530.1 understood this iflhc Wilding
ly haw A renal, met it b my reapanslbillly a rmdfy the upset of the
ichmHiemelpdalmlHYYMCafaGCrdBgglp a
Signature Of Applicant Date
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All roof coverings to be Class "B" or better
d,<d acenr Dae