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INFO tMATIN
BUILDING DIVISION PERMIT
ONTRA4TOR
BUILDING ADDRESS:
TAYLOR WOODROW HOMES
PERMIT NO. 05030060
10261 TORRE AVE 4 826
OWNER'S NAME:
PERMIT ISSUE DATE
TAYLOR WOODROW HOMES
2300 CAMINO PAMON. StE 10
005
E:
SANITARY NO. CONTROL NO.
(925)365-3100
ARCHITECOENGINEER:
BUILDING PERMIT INFO
BLDG PLUMB MECH
� O O �
LICENSED CONTRACTORS DECLARATION
Job Description
1 hereby of eon Nn I am licensed under provisions of Chapter 9 (Commencing
with Section 7") of Division 3 of Nc Business and Profeumm Code, and my license 4
in full fine and eB
NEW CONDO 1691 SQ FT LIVING
License CI - Ue. [
0 2 SQ. FT. GARAGE
Da '� ORnl4waor
ARCHTIECI•S DECI 10
tun inti 4nya sahaBY.o Mie
OW/
Licensed send
DECLARATION
OWNER.exempt
herchy aB]rm I em ,Bumps stem Po COnoacrors License Law for NC
](131], Baal•^.s site fhofcasium Calc: MY d1Y Or county
following mason. on
t
permlt to cmWuse alar, Improve. demolish, carte
permit sig any socromm
whish rite imu
n for a
psis NIts4nsedprsuantice. also n
ctor'it m64a, Lmv(ned Warpmr9
Sq. Ft. Floor Area
Val$ IDti030
that the provisiappon of Conrach
witpursuanttoNeofDialomofthe euutorWameLaw(Chapur9
(commencingheIsexempt tction Business Pm (MyvilationW
)th
mfmm[YI.
basisen30ldmeged
That W 4 exempt Nemlrom and the basis for the alleged exemption. My Notation of
pt
APN Number
Occupancy Type
Section 7031.5 by any applicant roe a permit subjects me applicant m a civil penalty of
Cut mile than five hundred damn ($500).
36940017. 0 0
D 1, as owner of the property, re my employees with wages as their sole eompenaadon,
Required Inspections
will do the work. and the structure ts not brocaded re offered for saic(Sec. 7044. Business
and PlefeYtiON Code: The ComVaemra LICCNd Law does not apply to an ewMr of
q P
property who builds orimproves •en.on, andwho doessuch work himselfor through his
Own employes, provided that such Improvements are maintained orOOered formic. If.
however. the building or improvement is sold within one )ear of mmpledon. IW owner.
builder will Tuve the burden of proving that he did ma Wild or Improve for purpose of
colo.).
D 1, as Owner of the property, am exclusively contracting with licensed contractions; to
commict de project (See. 7044, Business and Professions Code:) The Conusemr's Ll.
Cohen law does not apply to an owner of property who Wilds or Improv demon, and,
who contracts for such projects with a eommumor(s) licansed pursuant to Ne Conuacmrs
License Law.
D I am exempt under Sec. . B @ P C for this moon
(Tuner Dau
WORKER'S COMPENSATION DECLARATION
110 1 hereby affirm under penally of perjury one of Ne following declantiom:
D I haveond will maintain a CertiOate ofCnmeni.MWINmurelReWcrYsrsCOmpcn-
ution, as provided for by Section 3700 of the Later Code, for Ne performance of the
work for which this permit is Issued.
D I low and will maintain Workers Compensation Insurance, as requlmd by Section
37M of the Labor Code, for me perfomtance of that work for which this permit Is issued.
My Workers Compensation Insurance carrier and Policy number am:
Carrier. �c9`(_d,., f!�—, Policy No.: -N
CERTIFICATE OF�PI70N FROM WORKERS'
COMPENSATION INSURANCE
(This section nerd Out W confined time permit Is feral hundred dollar (SIM)
or less.)
1 ani% that in the performance of the wait for which this permit is Issued, I NJI not
employ any person in any manner an as m become subject m NC Workcn'Compensa0on
laws of California. Dau
Applicant
NOTICE TO APPLICANT: If, after making this Cenlncam of Exemption, you should
become subject m Ne Workers Compensation provisions of tha Later Code. you man
forthwith amply with such pmvisinm Or this Permit Mall W deemed revoked.
ON LENDING AGENCY
CONS...
1 hereby thi dor Vert is a c lending7.Ca[enry for Ne performance Of
mmSm.
rwich s 30
the work for which this permit 4 issued (Sm. 3077. Civ. Cd
'
sanders Name
-
LcMeH Address
I Certify that I have read Nis application and sum that the above infam.a0n I.
m n m 1 agree in comply with all city and county crdiwwes and sure laws relating he
Wilding construction, and hereby authorise mpre Mil s of this dry to tour upon the
move-mendoned Property for Impttlen part L
(We) agree in ave, indemnify and kap harmless Ne City of Cupertino against
liabilithu. judgments.emts and expo. which may In any way amus gam0 mid City
in eonse of th<Panin" of this Permit.
NDANAND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE R L ONS.
Re -roofs
Type of Roof
ignatur III _VCDam
HAZARDOUS MATERIALS DISCLOSURE
II the applicant or future Wilding eccupanumre or handle hvardous material
Red by the CupertinoMuniti Code, Chapter 9.13, and the Health and Safely
Code, Smile. 25532(x)?
All roofs shall be inspected prior to any roofing material being installed.
Dyes O
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or fuwrc build arupam use equlpmenl or devices which
It haaardnm air contaminants u d ed by IW Bay Area Air Quality Management
all new materials for inspection.
District?
DYce
1 have read the WraNms materials requirements under Chapati 6.95of de Califon
ria sty Code, Sautes 755(15,25533 and 35534, 1undtntnd that lfthe Wilding
I not by harp a unan4 Net It Is my msponslbillty in nodl'y drc occupant of the
on whit uat etpdormissuanceofaCcrdOcaueri panpy.
Signature of Applicant Date
All roof coverings to be Class "Bat or better
owner anthodmdogem Da
C_