05030069CITY OF CUPERTINO
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Cd%1'CRt1• TUIt INU1tMATiON"' �,
BUILDING DIVISION PERMIT
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BUILDING ADDRESS:
10281 TORRE AVE it 812
TAYLOR WOODROW HOMES
PERMIT NO. 05030069
OWNER'S NAME:
PERMIT ISSUE DATE
TAYLOR WOODROW HOMES
2300 CAMINO PAMON. STE 10
005
g;
SANITARY NO. CONTROL NO.
(925)365-3100
ARCHITECTIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MEOCH
LICENSED CONTRACTOR'S DECLARATION
Job Description
Job
1 hmeby a0irm Nn 1 am amounted under provisions of Chapin, 9 (commencing
with Section 7") of Division 3 of the Business W Professions Code, and my license Is
nmBfa eanOafea
NEW CONDO 1691 SQ FT LIVING
Lima Lic.N
nous contraca' Na
SQ. FT. GARAGE
ARCHITECTS DECLAR TIO!
i un m s shall d u public remods
icenod fessianal
OWNER -BUILDER DECLARATION
I hereby effort that 1 am exempt from tiro Contactors License Law for the
owing mason. (Section 7031.5, Business and Professions Code: My city or county
which requires a permit he cmufluci. alms, improve, dcmoltsh, m mPoll any Abortion
prior to its issuance. AIM rcgmires the applicant farsuch permit to file a signed sudemcm
Ft. Floor Area
Val '13030
that W is Insured pursuant to the provuiom of the Contractor's Uccea: Law (Charter 9
Sq.
(commencing with Section 7000) of Division 3 of the Business and Profeulons Code) or
that he is excu pt therefrom and the bait far the alleged examption. My violation of
AFN Number
Occupancy Type
Section 7031.5 by any applicant for s permit subjects the applicant in a civil penalty of
net mart than five hundred dollars (M).
36940017.00
❑ 1,uown"ofthe property, army employeeswith wages As deeirale campmambar,
Required Inspections
en"
will do the work, and Ha scutum isnotimmuded moffemA forsah(Sec. 7044, Business
and Professions Cade: The Connxeues Liaruo e law danot apply m an owof
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propenywho Wlldaorimprows Hereon, andwhodoessuch workhimselfor through his
awn employees, provided that such Improvements Are, not intended osoa"ed forsale. If.
however, He Wilding or improvement issold within aro year of completion. He awn"-
bulldtr. will haw Ha Wrden of proving that he did not amid or improve for purpose of
am.).
❑ 1. as Owner of she property em ucluiwly contractual with liamed commetors m
construct dm project (Sec. 700, Business and Profession Cade:) The Contretars Li.
cone law dsa not apply m m own" of propeny.whe Wilds art improve daemon. and
who Contracts for such pmjvm with acauxeror(s) licensed pursuant An He Caamine,
License law.
❑ I am exempt under S". . B k P C fm His moon
Owner Data
COMPENSATION DECLARATION
1 hereby aRm, under penalty of perjury Can of the following dedurnab es:
p1WORKERS
haw am will maintain acenlficate of Consent m self -insure for WorinersCompen-
maim. u provided for by Section 3700 of the Labor Code. for the performance of the
work for which His Permit is issued
❑ 1 have And will maintain Workers Compensation Insu Ona, As required by Section
3700 of the Labor Code, far the performance of the work for which this permit is lamed.
My Worker. Compensation lnmrana no i" and Policy number tae:
c ri Policy Na.: [DJT7
CE IMFICATEOF EMPrION FROM WORKERS'
COMPENSATION INSURANCE
Oban suction need net W Completed base pcmth is forane hundred dollars (SIM)
or leu)
I unify the, in the performance of the work nor which this permit is issued, I stall not
employ anypc.a in any manrmr so u m became subject to the Workso Compensation
Law s of California. Dam
Applicant
NOTICE TO APPLICANT: IL after making this Certifiau of Exemption, you should
become subject in He Worker's Compcumlon provWons of the labor Cade, you must
foMwide comply with such provisions or this permit Nall be domed remlead.
CONSTRUCTION LENDING AGENCY
1 hereby afBon W, Here is a ComwcOnn lending agency for the performance of
He wade fur which this permit is issued (Sac 3097, Civ. C.)
Lenders Name
I<Meri Addrea
1 cerdfy that 1 bow read His application and sum that the Above information is
tomo I agree in comply with all city and county Ordinance and sum laws missing in
Wilding construction, and hereby a thodne mprescr mivu areas city m cm" upon the
above-mentioned Property for inspection purposes.
(We) agree to an. indemnify and keep harmless the City of Cupertino against
liabilities, judgmcna, costs and expenses which may in any'w'ay accrue Against raid City
in cmateque,me of the granting of this Permit.
UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
OURCER TIONS.
Re -roofs
Type of Roof
"Z
,gnu Appliam/Conuacmr f Da
HAZARDOUS MATERIALS DISCLOSURE
Will theapplimat or forum Wil' goecupant atom m beadle harudoa nuamial
de0xed by use Cantos Muriel Code. Chapmr 9.12, And am Health and Safety
Cede, Section 255324)?
All roofs shall be inspected prior to any roofing material being installed.
❑Yos 0
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or Towns Wil ung aecupam use equipment"devices which
t haaardnus air con aminsnta u ncd by We Bay Arta Mr Qutliry Mansgeman,
all new materials for inspection.
District?
❑Yes
I hew read the haandousmaterials requirements under Chapmr695of dm Califor.
aretyCade, Scetimta 25305.25533 And 2550.1 understand thadif t e Wilding
does at fly have a tenant. that It Is my responsibility ro,wtify the t of He
dim Ah muaWmetpdarmmusnccar,CcniRa ora
Signature of Applicant Date
2. !
All roof coverings to be Class "B" or better
ow r authorirrdagr n am
a