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CITY OF CUPERTINOR
CON=TRA ORR�iN�i(SRM�ITIUN:
BUILDING DIVISION PERMIT
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BUILDING ADDRESS:
TAYLOR WOODROW HOMES
PERMIT No. 05060231
2
OWNER'S NAME:
PERMIT ISSUE DATE
TAYLOR WOODROW HOMES
2300 CAMIN
E;
SANITARY NO. CONTROL NO.
(925)365-3100
ARCHITEC (ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
lob Description
1 hereby affirm that 1 am licensed under previsions of Chapter 9 (commencing
with Section 701111) of Division 3 of the Business and Professions Code. and my license Is
in fullfomeode LREVISION--CALCS
("� cj
& HOLD DOWNS
License Cl Lk.0 `�
Data -? Conncmr o¢ -idea
NO NEW PERMIT ISSUED/ORIG. $05020006
ARCHITECTS DECLARATION
1 un andPlans all he It c
mcseJ ncssional If
OWNER -B LDER DECLARATION
I hereby affirm that I am exempt from the Comment is License Law for the
fallowing mason. (Section 7031.5, Business and Professions Code: My city at county
which requires a permit to construct, alar. Improve. demolish, or repair any structure
prior to its issuance, also mquires the applicant for such permit to Ole a signed statement
that he is licensed pursuant to the provision of the Conwcmrf License Law (Chapter 9
Sq. Ft. Floor Area
Valuatio¢115
(commencing with Section 7000) of Division 3 of the BtumC sand Professions Code) or
that he is exempt thcmfmm and the basis for ,rte alleged exemption. Any vloladon of
APN Number
Occupancy Type
Section 7031.5 by any applicant for a permit objects the applicant to a civil penalty of
oat mart the Ove hundred dollars (53001.
36940017.00
I, as owner of the property, or my employees with wages as them sale compeaadon,
Required Inspections
will do the work, and the structure is not intended or offered for sale 7044, Business
and ProCode: The CoThe ConwctorS LAcene Law does not apply m m owner of
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property who builds or improves, ,herwo. and who doessuch work himtel f or through his
awn employees, provided that such Improvements are net intended stuttered forsala IL
however, the building or improvement is old within one year of completion. the awro.
builder will have Ne harden of proving dual he did act build or improve far purpose of
sale.).
❑ 1, u owner of the Property, am exclusively Contracting with licensed canurctore to
construct the project (Sec. 7044, Business and Pmfesvoes Code:) The Contractors Li.
cone Law does not apply to an owner of property who hoods or improves thereon, and
who contracts for such projects with a cnuactor(s) licensed pursuant to the Contractor's
License Law.
❑ 1 am exempt under Sec. . B St P C for this mason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby effort under penalty of perjury an of the following declarations:
❑ l have and will maintain a Certificate ofConscm to self-InsumforWorker'sCompen-
satien, as provided for by Section 37M of the Labor Code. for the performance of the
work for which this permit is leaned.
❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section
37W of the labor Coda for the performance of the work for which this permit is issued.
My Worker' Compemau lnaunnCe camiccand Policy number am:
Carrier: -. e�m Policy No: �1 g- clg.2
CERTIFl ATE FEXEMPr10NPROM ORKERS'
COMPENSATION INSURANCE
Glia aec un need trot hecemplewd(fthe permit Is foronc hundred dollars ($]W)
or less.)
1 certify that in the performance Jof the work for which this permit is Issued. I shall not
employ any peIn any manner an as to become subject oda Workcrs' Compenadon
rson
Laws of California. Date
Applicant
NOTICE TO APPLICANT. IL after making this Cenificam of Exemption, you should
become subject m the Worker's Compensation provisions of the labor Code, you must
forthwith Comply with such provisions or this permit shall W deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performam:e of
the work for which this permit is issued (Sec. 3097, Civ. CJ
Lender's Nam
Leader's Address
I certify that I have read this application and slam that the above information is
comm. I agree to comply with all city and county eminences and mm laws mlalms to
building construction. and hereby authotine representatives of this city to enter upon the
above-mentioned property for Inspection purpetea
(We) agree to ave, indemnify and keep harmless the City of Cupertino against
liabilities, judgments, costs and expenses which may In ay way accrue against aid City
In consequence of the graining of this permit
NT UNDERSTANDS AND ILL COMPLY WITH ALL NON -POINT
Issued by: Date
RC REGULATIONS.
Re -roofs
Type Roof
Signmur o ppticanvConeacmr Getsof
HAZARDOUS ATERIALS DISCLOSURE
Will the applicant or future building occupant arum orhendle hazardous material
as dented by the Cupertino Municipal Code, Chapter 9.13, and the Health and Safely
coda, Section 25532(a)?
CI Yeso
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment or devices which
telt haoud us air contaminants Vented by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑Yes Nu
I have mad the hasomams mamrlalarequirements under Chapierd.95 of the Califor-
nia afety Cede, Sections 25305.35533 and 25534.1 understand thalifther building
J not cu Oy have a In 4 Nat it is my eponibillty o notify the eceupat of the
'menu meh mus Get cetera cemncate arOcCopm
Signature of Applicant Date
kra�D
All roof coverings to be Class "B" or better
saner ,mhadvad as=net ate