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CITY OF CUPERTINO
BUILDING DIVISION PERMIT
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BUILDING ADDRESS:
TAYLOR WOODROW HOMES
Pa""'NG'05060233
OWNER'S NAME:
PERMIT ISSUE DATE
TAYLOR WOODROW HOMES
2300
E:
SANITARY NO, CONTROL NO.
925)365-3100
ARCHITEC (ENGINEER:
BUILDING PERMIT INFO
BLDG ELECTPLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hemby ai0m that I an licensed under previsions of Chapter 9 (Commencing
with Section 70111) of Division 3 of the Business and Prafesswns Code. and my license is
in full force and eDeB t,r
REVISION --CALLS & HOLD DOWNS
NO NEW PERMIT ISSUED/ORIG. #05020006
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ARCH SDECLARA 1
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OWNER -B ILDER DECLARATION
I hereby affirm Nm 1 am mpt from the Conuamor's LI¢nse Law for the
following rtAson. (SCetiun 7031.5, Bmhrss and Professions Code: My city or county
which requires; a Permit to Construct. alter, Improve. demolish. or repair any atmewm
prior m its Women, also requires the, applicant for each permit to file aligned Ntemem
Luenw(Chap¢r 9
that t is licensed pursuant to we provisions of the Convector'sso la
Sq. Ft. Floor Area
Valuatio 115
(Commencing with Section 7(1 of Division 3 of the Business and Homers, Code) m
that he it exempt therefrom and the basis for the tlleged ourmptim. My MDIAIM Of
APN Number
Occupancy Type
Section 7031.5 by any applicant for a permB subjeelowe applicant in a civil penalty of
not mare than raw hundred dollars ($50%
36940017.00
0 Lasowtrufthe Property, mmyemployesswlth wage As thou solecompewdon,
e ns
Required Inspections
will do the wrokand the structure loco, intended morteud rorsa4(Sec. 7044. Budtrss
end Prefmions Code: TM Conmmors License Law does marl apply u an owner Of
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property who builds or improves thereon. and who docs such work himself or through his
own employees, pmvided that such improvemantsart not Intended molfend fmsaw. if.
however, the building or improvement Is sold within one your of completion. the Owner -
Wilder will haw the burden of proving that he did not build or improve for purpose of
sale.).
❑ 1. as owner of the property, am eaclwively contracting with licensed conuacmrs In
construct the project (Sec. 7044, Bnsinm aM Professions Code:) The Cmincmrs Li-
mnu law dors not pply in an owner of property who builds Or impress thereon, and
who Comment for such projects with a contnewr(s) licensed pursuant in the Conusomfa
License Law.
0 1 am exempt under Sec. . B & P C fm Nis recon
Owner Dau
WORKER'S COMPENSATION DECLARATION
I bereby of hen under penalty of perfury And of don following decluadonc
❑ Them and will mainuinaCenifimteof COnsentwrtlf-insarefm WmkerY Compen•
ration, an provided for by Section 3700 of we Inter Code. war the performance of we
work for which this Permit is issued
(2 I have and will maintain Workers Compensation Insurance, As required by Section
3700 of we Labor Codo, for we performance of the work for which this permit Is Wood.
My Workers Com ns wn Insurance cart.. and Policy number am: s�C�
Carrier. POIwY No.: �7_7 a.9! C)
CERTIFICATED EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Inds moden mad not An completed lithe permit is foram hundred dollars ($100)
or lost
I cenify that in the performance of the work for which this permit is issued. I shall not
employ any person in my matter an As in become subject In site Workers' Compensation
Laws of Califomh. Date
Applicant
NOTICE TO APPLICANT: If, after making this Ccri fcafc Of Exemption, you should
become subject to the Wormea Compensation provisions of the Labor Code, you must
foMwith Comply with such prvisimn or this permit shot] c decreed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that them is a construction lending agency for we perfi mance of
the vert for which this permit is issued (Sec. 3097, Civ. C.)
'
Lenders Name
L.wera Add.
1 Coldly that I love reed Ws application and cute that the aWw Information la
coma 1 agree in comply with all city and county on inenms and slow laws relating in
Wilding construction, and hereby Authorize rtpreconutiws of this city on now upon the
show -mentioned property for Inspection purposes.
(Wu) agree to core, indemnify and keep bamleu the City of Cupertino against
Iiabilidou, judgments. costs and expenses which may In any way amnw &gains said City
in conswumvic of we granting of this permit.
AND W LL COMPLY WITH ALL NON -POINT
Issued by: Date
MUNDERSTANDS
O E R ULATIONS.
Re -roofs
Type of Roof
o
Sian f ppliwnVCon—o r' ave
HAZARDOUS M RI DISCLOSURE
Will wcapplicamorfutum buil ng Occupant nom or handle himadous material
u defined by the Cupertino Muriel Code, Chapter 9.13, and we Health and Safety
Cnx.Sectionz553z(a)7
All roofs shall be inspected to any roofing material being installed.
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C3,
prior
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or forum Wilding occupant use equipment m devicns which
mlt hvardou air contemirnu xs�lileflnad by the Day Arm Air Quality Management
all new materials for inspection.
Disuiarf
❑ Yen 124,
I haw mW the hmsrmosmawdals requirements under Chapter6.95 of son Califor-
nia Safely CeAe. Soodow,255D5.25533 uu125534. 1 underswm lharifdte Wilding
d mart cu n0y haw a tenet we It h my responslhility u nosily tint amupant of the
qulremcn wtoh rIbemet rwB:evane.raccmnawofoccup cy.
Signature of Applicant Date
t, 1
roof coverings to be Class "B" or better
own r w,wml A Cot
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