05060234CITY OF CUPERTINO..-
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BUILDING DIVISION PER MIT
,ACTOlCiINFORM-ATION-
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BUILDING ADDRESS:
TAYLOR WOODROW HOMES
PERMIT No. 05060234
OWNER'S NAME:
PERMIT ISSUE DATE
TAYLOR WOODROW HOMES
2300 CAMINO
2005
B;
SANITARY NO. CONTROL NO.
(925)365-3100
ARCHITECTIENGINEER:
BUILDING PERMIT INFO
BO EO PLUMB MECH
O
LICENSED CONTRACTOR'S DECLARATION
Job Description
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1 hereby affirm that I atm licensed under provisions or Chapter 9 (coecin
wife Secdon 7") of D'rislon 7 of me Business and ProfeWuns Cade. Ami my license is
In full rome Mad eff
REVISION--CALCS & HOLD DOWNS
Lic-As
Licenseue.I
NO NEW PERMIT ISSUED/ORIG. #05020005
Dao: I err
ARCHITECTS DECLAR 1 N
l as ruand m lana I d ASpas Ic oris
License cUnrest
OWNER-B11LD CLARATION
I hereby affirm Net I em exempt from the Contractors License Law for the
following Mason. (Seedon 7117 1.5, Business and Profeuivas Code: My city or county
which requires a permit to construct, alto. Improve, demolish, or repair any coucturo
prior to its iswutce, also require, the applicant forauch permit to ftic aligned summcnl
is ConOacters license Law (Chapter 9
Sq. Ft. Floor Area
Valuatio 115
met he licensed pursuantao the provisions ofmb
(commencing wife Section 7000) of Division 7 of the Bwlnestand PMMUSMUCode) or
that he is exempt therefrom and Ne basis for the alleged exemption. Any violadan of
APN Number
Occupancy Type
Section 7071.5 by any applicant for permit subjects the applicantm a civil penalty of
mat muse man five hundred doll. (5500).
36940017.00
❑ 1, As owner of tic property, or my employ= with wages as Weir sole compensation,
Required Inspections
will do the wads. and me,amemen isnoinmuled manemed Waste (Sm. 7014. Busircu
awr of
Nd PmfcWON Cade: The CompCmYs Licence, Lao, does Mt apply le N M
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property who builds o improves Obscure, and who d= ouch work himself or through his
Own employ=, provided that Such improvements are not Intended aroRered forum. Ir,
however, the building or improvement is Sold within one year of completion, the owner.
builder will have me burden of proving that he did not build or improv for purpose of
SAM.).
O 1, as owner of me property, am esclunvely contracting with licensed cor msemrs to
constroet me pmjen (sec. 71144, Business and Podc cions code:) The Conmcmfe u.
cense raw does not pply m an owner of property who bell" or improves thereon. and,
who contracts for such pro ecu with aconuacmr(S) licensed purswnt m me Comtracu/e
License taw.
❑ I am exempt undo Sea .B k PC for this maven
Owner Due
WORKER'S COMPENSATION DECLARATION
110 1 hereby afarn under penalty of perjury ane of mb following declarations:
❑ Ihsm and will maintain a Certifemeof Consent to sel6insure for WorkCrs Comlmen.
cation, as provided for by Section 7700 of the labor Code, for the performenx of the
work for which this Permit Is issued. •
❑ I have and will maintain Worker's Compememan Tonna. as squired by Section
77M of the Labor Code, for tise performance of W work for which this Permit is iuwd.
My Warkefa Compensadon Insurance artier and Policy nu nk, Aree:,.vy.�T�
Cmrier: 31 (^saaiA Policy NO.:_J..�¢.(_L�=
CERTIPICATE OF EMFTION FROM WORKERS
COMPENSATION INSURANCE
(Ibusectiot reed not Ise completed if ds: Permit isroronchundred dollars ($100)
or less.)
T certify that in the performaece of the work far which this permit is issued. I shall not
employ any person In my manor Hl is to become subject to the Workerif ComtsmotBM
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If. after making this Cenineau of Exemption, you should
become subject m the Worker's Compensation provisions or me lobo cede, you mum
forthwith comply with such provisions or mu Permit Nall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby afnrm that mem is a construction lending agency fa, me performance of
the w.m for whim this permit 4 issued (Sea ver, Civ. c.)
'
f.endcr'S Name
Lenders Address
1 I cenVy that I ban read this application AM Som feet me above mr(MOSIMM is
correct, I gree te comply with all city and county ordinances and Sum taws miming m
building construction, and hereby Sumerian representatives of this city to enter upon Me
above-mendoxd property for IMNCUW Purposes.
(We) agree to un, indemnify and keep harmleu me City of Cupenino against
i liabilities, judgments, ensu and expenses which may In any way accrue against said City
I Inco sof fee grantifile this permit,
LICANT NDERSTANDS AND W L COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE REG LAMONS.
Re -roofs
Type of Roof
Signuu ApPliaanVCanugicmr Dam
HAZARDOUS ATERIAIS DISCLOSURE
tWIII
Ne applicant or future building oceupem uorc or hander hwArdow ma cral
As donned by the Cupertino Memel Me. Chapter 9.11. and the Health and! Safety
Cade. Seed. 15571(a)7
All roofs shall be inspected prior to any roofing material being installed.
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If a roof Is Installed without first obtaining an inspection, I agree to remove
Will the applicant or swam building Occupant use equipment car device, which
emit haurdaw oir contsminanty u nncd by the Bay Arca Air Quality Management
all new materials for inspection.
Dis0tct7
❑ Ya u
I have mad me haumms materials requircerenu under Chapter 6.95 of me Califor-
M-Henter&Salety Code. Seetiats25S05.25577 Mad i53M.l undcsswdfeulfine building
t comentlY haw a means At 1 MY M44MMihlI CY m notify Ne eve ant of Nc
wm entswhi Tuatx no uattecancerdrtamafoccuPy . /
Signature of Applicant . Date
All roof coverings to be Class "B" or better
ow rorauthofisdagent ohm