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CITY OF CUPERTINOit
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BUILDING DIVISION PERMIT
CONTRACTOR INFORM&ION:4
BUILDING ADDRESS:
TAYLOR WOODROW HOMES
PERMIT NO. 05030057
OWNER'S NAME:
PERMIT ISSUE DATE
TAYLOR
4,7'12
E:
SANITARY CONTROL NO.
(925)365-3100
ARCHITECOENGINEER:
BUILDING PERMIT INFO
BLDG ELECTO PLUMB MECH
O
LICENSED CONTRACTOR'S DECLARATION
Job Descri tion
1 hereby mint that 1 am licensed under provision of Chapter 9 (commercial
p
with Section 70(11) of Division 3 of Ne Business and Professions Code, and my license k
mfull to= and affect. 0,
NEW CONDO 1691 SQ FT LIVING
License I Lk.g
Dae Gamna;a
2 SQ. FT. GARAGE
ARCHITECTS DECLARA
un nJ If. all t used m public s
erred Sinn
OWNER -BUILDER DECLARATION
I krehy, affirm that 1 am1. exempt from than CatiOnSC d License Law for the
following Raaam. IID L3, Business and alum Cade: My city Orstructure county
which Rquirm t improve. d ri sig W
patnit re eamman akr, improve de
permit
t e a ed oncou
uarequires the applicant for such permit m file a signed atsmmem
s permit
dash d its i licensed o(the (Chapter
(commis licensed pursuant toes
pursuant
Sq. Ft. Floor Area
- Val ipg030
Code)
(commencingwith of Division 3 o he exeand Cedo) or
hereiro7000)MDiasisf alleged pton. Mynvi
del k u exempt therefrom and the bmb for the alleged exemption. My violation of
APN Number
Occupancy Type
Section 7031.5 by any applicant for a permit subjects fee applicant e a civil penalty of
not mom than It hundred dollars ($511117.
36940017.00
❑ 1. ss m m ar W papa p, es ter uoplayean w en w.gu m that role emnam+than.
Required Inspections
ME do the work mud that smaome ismat Intended m offered for sale (See 7044. Band.
and Professors, Code: The Conuaaa's License Law don not apply a an owner of
property who Wilda orimproves Beeson. and whodoessuchwork himselforthrough his
own employes, provided that such improvements am, not Intended w Gffcmd for We. If,
however, the building or improvement Is mid within can yea of completion, the owner-
bullder, will have the burden of proving that he did not Wild or improve fm purpose of
role.).
❑ 1, as owner of that property, am exclmlvely connecting with Bemused nmhmm us to
construct the project (Sec. 7W4, Business and Prefeasions Code:) The Comrmrofl LF
cense Law dean not apply to an Owner of property who Wilds or Improve; Neeson, and,
who contracts for such pmJeeo with a conu.ctar(s) licensed pursuant to the eonnrmtoes
License Law.
Ism exempt under Sec. , B k P C for this Rama
Owner Data,
WORKER'S COMPENSATION DECLARATION
10 I hereby aflinn under penally of perjury one of the following decimation:
❑ I have and will maintain a Ceniftnm of Gment a self-InsuR for WorkeYs Compen.
cation, m provided for by Section 3700 of the Labor Code. for the performance of the
wank for which this permit u issued.
❑ 1 have and will maintain Workce3 Compensation Wum noc, as required by Section
3700 of the Labor Code. for the performance of than warts for which this permit is issued.
My Workcr's1rompimmulon Insurance carrier and Policy number me;
Grrier. Policy No.: do-17[�O
FROM WORKERS'
COFFPON
COMPENSATION INSURANCE
(ThI;seNan aced nut W compleuN if the permit is foram hundred dollan($100)
or kat)
I certify del In the performance of the work for which this permit is issued, I shall not
employ any person In any manmrm as e become mbjml to theworkere Compensation
Laws of California. Data
Applkmt
NOTICE TO APPLICANT. If. after making his Ccaieme of Exemption. you should
become subject to One Worker's Compensation provisions of the ISWr Code, you mum
forthwith comply with such provisions "is permit shall k dmmcd Rvekcd.
CONSTRUCTION LENDING AGENCY
I thereby shim that Nem is a construction lending agency for NC Performance of
the work for which this permit Is issmd (Sec. 3097, Civ. C.)
'
Lenders Name
Lender's Address
I century that I have read this application and Ne that Ne AWW InfermWun Is
current. 1 agree to comply with all city and county ardinanes and stale laws mlating to
building constmction, and hereby authorme mpmmnuNv of this city to cner upon the
above-mentioned Property for impectian purposes
(We) agree in save, indemnify and keep harmless the City of CuPenina against
Iiebi' u. costs and expenses which may in any way aocne gahu, said City
me APPLICANT of DERSTANDS ANDof WILLWILL COMPLY WITH ALL NON-P01I
Issued by: Date
SO ERE LA NS.
Re -roofs
Signat pplicartwonuacer I Data
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
bull the applicant or in, Wild ln occupantaomorhatdkhemrdaexmaeaal
as defined by the Cupertino Mumapal ads. Ch.per 9.13. and the Health and Safety
Code, Section 35533(a)7 ,
All roofs shall be inspected prior to any roofing material being installed.
❑ Yet
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future Wilding moup of on equipment or dcvicn which
it hmandnm air conuminanu m ncd by that Bay AM Air Quality Management
all new materials for inspection.
DimktT
❑ Yex
the hanNnus m auriels mquimmcmm under Chaper 6.95 of the cal i for
N Sar Cade,5cNom355D5,35533and35534.1unknwdthuifthe Wilding
does mol ev y have • enem, d l It Is my responsibility a anddo upset of the
men hich R melpriorwismenceof.Gnifts" m cy.
Signature of Applicant Date
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All roof coverings to be Class "B" or better
owner owed agent Dae
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