05030084V.,
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CITY OF CUPERTINO
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BUILDING DIVISION PERMITZCOnRAC`I'QRINFO,RIVIATIQ
BUILDING ADDRESS:
10281 TORRE AVE 4� R22
TAYLOR WOODROW HOMES
P.W.TNO. 05030084
OWNER'S NAME:
PERMIT ISSUE DATE
TAYLOR WOODROW HOMES
2300 CAMI
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SANITARY NO. CONTROL NO.
(925)365-3100
ARCHITECDENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
lob Description
p
I hereby affirm that I sm Iieemed under provisions or Chapter 9 (commencing
wit Section 7010) of Division 3 of Ne Business mal PrafeWons Code, and my license u
mm�mmeindeffect. j .�� �
NEW CONDO. (1742'-LIV. SPACE)
Licen Lle.O "'V—') "L0
Da Conttunor o
GE 5151
ARCHI7ECYS DECLA A N
B-22 '
u den nJ q�ane Me11 Ie used u public nets
L' erred Pmf iontl
OWNER -BUILDER DECLARATION
rcby allbm that 1
tBusin from the CanuenCo License Law for to
].171.5. Business and Profmaluas Code My city ar counre
mg moan. 1.
which requires a permit re emurue4 plus. W prow, d . m repair any umctmt
permit i
prior mits iensedi alsonirequires the applicant for such permit tofiesSigned
the Conmcmri License taw (Chrpter9
Sq. FL Floor Area
Valuation
rmmil
tuWis licensed Pumuantmte provtsi.m of a(sutemem
(commencing with Section 7000) of Division 3 of the Ramona aand PmRuiana Code) m
$217333
Wt he ts.atmpl therefrom and to basis for de alleged exemption. My vloladon of
APN Number
Occupancy Type
Section 7031.5 by any applicant for a permit subjects On applicant m a civil penally of
not mom ten five hundred dollen (SSW).
❑ I, u owner of the properly, or my employeas with wages u their sole compensation,
Required Inspections
will do the work and the income is at intended at offered rental. (Sm. 7061. Business
and PraftWom Code: The Comacmes License Law dos at apply t an owner of
q P
property who builds or i mprowa thereon. and who dao such weak himself or trough his
awn empt.ytm. provided tat such improvements ase net inendcd or offered for sale If,
however, the building or improvement is sold within om year of completion, the awhor.
builder will have to burden of proving that he did an, build ar improve for purpose of
.to L
❑ 1, a owner of to property am uelusinly convening with licensed cvnuanan m
construct the project (Sec. 7046. Businm mod Pmfestloas Cade:) The Contracmr's U.
cenw Law doss not apply in an awns of property who WIIN or Improves neon, and,
who commune for Inch projects with a convtco (s) licensed pursuant m the Contractor's
License Law.
O l un exempt under See. . B & P C far this rcaron
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 hereby ane under penalty of perjury am of the fallowing dnelaredons:
have and will maintain a CtrdOcote ofConsenito self -insure for Worlwes Campcn.
..,Jan. u provided far by Scedan 3700 of the lab. Code, for the perfmman. of the
work for which this permit Is stencil.
❑ I have and will maintain Worker's Compensation insurance, as required by Section
3700.( the Labor Code, for to Pertarmance alt. work f. which this purl, is Wood.
My Worker's mpeoodon Imunnee mrtiu and Poliq number ort:
Gnitr. PoliNMO CORKERS'
MONMOMWORKERS'
CERTIFICATEPE
COMPENSATION
COMPENSATION INSURANCE
(Lbrb=a. need natbecompleted ifthe Permit Isforane hundmAdollan ($100)
or kis)
I Co ify that in the performance of dm work for which this permit Is Iced, l shall not
employ any person in any manner m as in bmsurm subject to to Workers' Compensation
Laws of California. Dat
Applicant
NOTICE TO APPLICANT. IL after making this CeniOcae of Exemption; you should
become subject a the Worker's Compensation provisions of to Lab. Code, you must
forOwit comply with inch provisions or this permh shell be d.cmcd revoked.
LENDING AGENCY
1 hereby affirm the, there is a construction lending agency for the perfarmmnce of
the work for which this permit ts bound (Sec. 3097. Civ. C.)
Name
Lander'.Addmn
I cenify vel 1 now and this application ask lute to the show information it
coned. I epee m Comply with all city and county on it uses and Iuu laws relating to
Wilding connotation, and hemby authorin epmonutim of this city W Coln upon de
s Wve-mcnuaned property far inspection pub».
(We) agree in save, indemnify and kap hareleas the City of Cupertino agalml
li is count and expenses which may In any My account again, Wit City
nc.nYque of &peeing of this Permit.
APP ANT ERSTANOS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
S C REG A NS.
sr"
Re-roofs
Type of Roof
ignition of Iicanr/Convanor tDete
HAZARDOUS MATERIALS DISCLOSURE
WIII the applicant or suture building occupun store or handle hanard.m material
as delimit by The Cupertino Muriel otic. Chapter 9. 12, and the Health and Safety
Cuda, Section 255320)7
All roofs shall be inspected prior to any roofing material being installed.
❑Yes o
If a roof IS Installed without fust obtaining an inspection, I agree to remove
Will the applicant or future building Occupant um equipment or devisee which
havardom air conuminmis u hod by the Day Area Air Quality Management
all new materials for inspection.
Dim'4
❑YCs u
A tehuardmm�dals q inmcnuundcrCMper6.93afIWGlifol-
ulicaith&Sd Ca .S cv.u2550l,25533m 25334.1umkrswdthniflW Wilding
d.a City w a =ML tet it u my MApomihiliry m nodfy to aceuPam of the
2q mcnuwhle mmnW tpd.lor.Conali.mi.fol"Pavily,
Signature of Applicant Date
All roof coverings to be Class "B" or better
own...int Date