05030059CITY OFCUPERTINO
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BUILDING DIVISION PERMITCONT
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BUILDING ADDRESS:
10281 TORRE AVE if R21
TAYLOR WOODROW HOMES
PERMIT NO. 05030059
OWNER'S NAME:
FERMrf ISSUE DATE
TAYLOR WOODROW HOMES
2300 CAMINO RAMON, STE 101
07/2n/900S
E;
SANITARY NO. CONTROL NO.
(925)365-3100
ARCHITECf/BNGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
Job Description
1 Wrathy a(fim that l are licensed under provisions of Chapur 9 (commencing
wi0Sa0oa701K1)af Divi6io of the Burin mWPmfeWom CDdc.uidmylicenmb
In fan force mde@ct.
NEW CONDO 1691 SQ FT LIVING
Lhenheq tie.. I&0Q)SQ.
Dau Cumrutor
FT. GARAGE
ARCHITELTS DECLARATI N
u has shall bu used u puh1lC rceor
J
Licensed mrrui,n
OWNER BUILDER DECLARATION
herchy Inn that I em exempt from No Contractors License Law for the
czb
,
fall, ng . (Secdun 7031.5. Business and Professions Code: Any City ser county
which ernes a permit to construct, alter. improve, demolish, or repair any strumu e
prior no as issuance. him rcqunce the applicant for such permit to file -signed matomcnl
Sq. Ft. Floor Area
Val$ZID11030
than he b licensed pursuing to the provisions of ton, Contractor's Licame Law (Chain. 9
(commencing with Section 7000) of Civilian 3 of the Business and Profcatons Cade) a
that he b exempt therefrom and the basis for the alleged caumptim. My vinladart of
APN Number
Occupancy Type
Section 7031.5 by airy applicant for • permit subjects the applicant to a civil penalty of
am mase than Rvo hundred dollarsWOOL
36940017.00
C I, as owner of the property, a my employees with wage as their into compenuder,
Required Inspections
ec
will do the work. and the unuclum is not rounded or offered for We(See. 7061. Budrcas
had PmreaCounselorsice Law Next t apply to an Owner of
Cade: The Contrtors Lmro
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property, who builds a impraea theseon, and who dao such work himself or through his
own employees, provided amisuch Improvements ate notimended oroffemd pursue. IL
however, the building or improvement is held within one year of completion, the owner.
builder will have the burden of proving that M did trot build or improve fa purpose of
tile.).
❑ 1, u owner of the property, am escluively contracting with flamed convectors to
comtmet the project (Sec. 7044, Business and Proicssions Code:) The Convectors Lb
cense Law does not apply to an owner of property who builds or improves theuon. and,
who contracts for inch projects with a convactar(1) licensed pursuant m the Convectors
License Law.
❑ I am esempr undet Sec , B h P C for this mumn
owner Daa
WORKERS COMPENSATION DECLARATION
l hereby aBLrs under penalty of pesjury ON of the following declarations:
O 1 haveane will maraim a CeNRam ol'Consent bselFinsum forWarimesCompem
cation, u provided for by Section 3700 of the LOW Code, fa the performance of the
work for which this permit is imued.
❑ 1 have and will maintain Worker's Compensation Immance, u mquimd by Section
3700 of the Labor Code, for the pedonnmuc of the work for which this permit is lulled.
My Worker's Comp//ema�Non Imm�na artier and Policy number a.:
Policy
mnicr. `rry�C� PoIIry No.: D p�
CER73FICA OF
COMPENSATION INSURANCE
(Thlssection rued notbecornpleud If the pemtit Is fnronchundmd d,lba (31010
or less.)
I certify the, in the Performance of the work fa which this pemh is issued, l shall Na
employ anypcesen in my manerm as to became subject to BC WarkCli' L'alggpenYdM
Laws of Catlfomb. Dau
Applicant
NOTICE TO APPLICANT: IL after making this Ccniricam of Exemption, you should
Woman subject to the Workers Compensation provisions of the Leber Code, you mum
,
forthwith comply with such provisions or this permit shit[ be domed revoked.
CONSTRUCTION LENDING AGENCY
I hemby affirm that them Is a construction lending agency for the performance of
the work for which this permit is issued (Sec. 3097. Civ. C.)
'
Lenders Name
Lcmice.Add.
I ceNfy that 1 have mud this application rob sou that the above Information Is
covin 1 agree to comply with W city and county oNiwras and sum taw relating to
building construction, and hereby authors apresenhtivea or this city to enter upon the
,
above-mentioned property for inspection purpose&
(Wc) agree to save, indemnify and keep harmless the City of Cupertino against
liabilities, judgments, emu and expenses which may in any wry hecroe against said City
in co ucee of me BranI. 2 of thia permit.
AP UNDERSTANDS AND WILL COMPLY WITH ALJ. N NPO
Issued by:3 Date
SOURCE R • NT701j .
h t
/
Re -roofs
Type of Roof
gmaurcorA d nUContractor Data
HAZARDOUS MATERIALS DISCLOSURE
a applicant or raum Wilding ompant mac orhendic hueNous material
d by tie Cupertino hal mI l Cone. Chapter 9.11. and the Health and Safety
Cade. Section 255324)?
All roofs shall be inspected to any roofing material being installed.
❑ Yu u
prior
'ng
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or futum buil occ pan, use tlalpment or devices which
b hnardnm eircmuminmu u and by the Bry Arca Air Quality Management
all new materials for inspection.
Dimlet7
❑Yea o
I have med the huardom materiels mequimmenu under Chapur 6.95 of the Collor.
niaHeabh&S tyCode.Secama 35505.35533 and 8536.1 understand mu Irthe building
o y have a unapt. mat It b my rcsponsihaity to nodry me occupant of the
Dimmen ich a uxmetpdarmiamnaoracmr) tear eupmey.
Signature of Applicant Date
All roof coverings to be Class "B" or better
weer a odvcdagem ,to
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