05030082CITY OF CUPERTINO
;aCOfVTRA,CTQRINF,OILMATION: .
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
TAYLOR WOODROW HOMES
PERMIT No. 05030082
OWNER'S NAME:
PERMIT ISSUE DATE
TAYLOR WOODROW HOMES
230
E;
SANITARY NO. CONTROL NO.
925)365-3100
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTORS DECLARATION
' Job Description
n Hmed under pm thiom of Clup1m 9 (commencing
1 Iereby sf0rm Thal i ua
with Section 70M) a(DiriWa 3 ofthe Businras and Profession, Cade. and my licensets
in fall fora andeffeet—CG
NEW CONDO. (1742'-LIV. SPACE)
LlcenmC s Lle.N
5151
Dale �- Cmuuwr
RCHTmCI'S DECLA ATI N
May
A-3 (ORIG. )
I n yphns elWl be tlsspublic nichill
teemed esti at
OWNER.BUILDER DECLARATION
her=hy .171. the 1 em eumpt From the Contractors License Law for the
owing reason. (Seamon 7031.5. Besmear and Profesfiom Code: Any city at county
which re4uiros a permit to ansuaL alar. Improve. demolish, nr repair any lumture
prior to its issuanec. also requires the applicant for such permit to file a signed statement
Sq. Ft. Floor Area
Valuation
that he is Hamad pursuant to the provision, of the Continuities License Law (chapter 9
(commencing with Section 7000) of Division 3 of dec Business and Professions Code) or
$217333
that he U aumpt therefrom and the basis for the alleged assumption. Any Halation of
APN Number
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not team dun live boosted dollars (5500).
I, as owner of the property, or my employees with wag=s as their tole compensation.
00 ns Required Inspections
will do the work.. ad the structure is mmintended or offered for saki (See. 7W. Business
and Professions Code: The Contractors Lictout law dos not apply to an owner of
q P
property who Wi lds or impraua thereon. and who does such work himself or through his
mvn employes, provided the such improvements tae notimanded mattered intuit, ff.
however. the building or improveteenf is sold within am year of compution. the ounce.
builder will have the burden of proving that Is, did act build or Improve fm purpose of
ale.),
❑ 1, as owner of the property, am exclusively contracting with licensed commema to
contract Ne project (Sec. 704x, Business and Profueiom Code:) The Contractor's LI-
ec. law 4. at apply to an owner of property who builds or harrows, Nemo., and
who conmreca for such projects with aconuscmrtB licenaeC portion, to tie Cmtmc are
License law.
❑ i.muemptunder See .BBPCfmth3naasmn
Owner Dau
COMPENSATION DECLARATION
1 hammy affirm under penalty of perjury am of The following declam0ons:
ptuWORKER'S
wand will matain in • Cenifiau of Consent inself-inswe fm Worker, Compe.-
smlon, as provided for by Section 3700 of the labor Cade. for the performance of the
work for which this permit is ivued.
❑ I have and will maintain Workers Compensation Imunna, m required by Section
37W of the later Cade. far sic performance of the work for which this permit is issued.
My Worker�s �Compensation Insurance carrier and Policy number am: O�
Carrier. fcTfA�C, Ci �i.�Policy No.: [.M
CERTIFICATE OF FJCWMON Fl OM WORKERS'
COMPENSATION INSURANCE
(fhissectim recd nothecampleted Elie permit lsforam hundrrddollan (5100)
or Inas.)
I ossify that in the performance of the work for which this permit is Wood. I shall not
employ any parson in any manner an as to become subject to the Workers' Compensadon
Lowe of California. Data
App lam
NOTICE TO APPLICANT: IL afar making this certificate of Exemption, you should
became subject to tie Workers Compcnution provisional of the lahm Codd. you am
forthwith comply with such provisions or this permit shall W deemed mated.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that them is a consuoelan lending agency for the performance of
the work for which this permit Is issued (Sen. 3097, Civ. C.)
'
Lenders Name
.
Leaders Addres,
I certify that I haw rad this application and fume that IM above hafomrWun u
'
Canal. i agree to comply with ell city arta county ordinance, and tote laws miming to
building conatmction, and hereby audrarlm represemative, or this city to enter upon the
ahwe-mentioned property far Inspection purpm es.
(We) agree to save, indemnify and kap homeless tie City of Cupertino against
linbilities. judgments, amts and expemm which may in any way see= against said City
I of the games or this partalL
PPLICA NDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOU RE L TIONS.
—7
2 '
Re -roofs
Type of Roof
rgnuure f pplicanuConuacmr De
HAZARDOUS MATERIALS DISCLOSURE
ill the applicant or foam building occupant state or handle huardoes material
as dcBmd by the Cupertino Munlet Code, Chapter 9.13, and the Health and Safely
Cade, Smile. 2.5532(x)7
All roofs shall be inspected prior to any roofing material being installed.
❑Yon a
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or fumm bui mg ace "use equipment or devices which
horerdcus air contsmmmis ss recd by mha Bay ArmAi, Quality Management
all new materials for inspection.
DlsfricV
❑Yes collc
I the hassrdam materials requimerents order Chapter G95 of the Califon
ayCade, Satiate 25505.75533 ana125534. 1 underhand ft ifthe building
doa etc fly eanam. that it is my mspomibility to notify Ne ss ant of tae
no c It melpdmtulvuemcafaCcnilkaaof ,.pan .
Signature of Applicant Date
All roof coverings to be Class "B" or better
amaar=d engem as