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CITY OF CUPERTINOt
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PERMIT
INFORMATION
BUILDING DIVISION
.+CONTRACTOR
BUaDING ADDRESS:
TAYLOR WOODROW HOMES
PERMIT N0. 05090029
10281 TORRE, AVE BID B
OWNER'S NAME:
PERMIT ISSUE DATE
TAYLOR WOODROW HOMES
2300 C
E:
SANITARY NO. CONTROL NO.
(925)365-3100
ARCHITECTIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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LICENSED CONTRACTORS DECLARATION
IU Description
OOSCIIP
thereby dant I am licensed under provisions of Chapter 9 (commencing
I heraffirm
with smile. 7") ofDivisian 3 of the Business and Prafcstiom Code, anal my license is
in fullfoneand,frec d 17K
REVISION -CABLE LAYOUT
oownse °iI - cmurracmr I
NO NEW PERMIT ISSUED/ORIG. #05020007
ARCHITECTS DECLARATION _
I understand my plans shall be used o public mcorda
Licensed Pmfc ummad
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Candaclaes Lieenm Law for the
fallowing reamn. (Sccuon 70113, Business and Nufe m m Code: Any city at County
which requires a Pamir to emmvueL alter, improve, demolish, or repair any structure
prior to its issuance. also requires the applicant for such permit m file a signed statement
that he is license) pursuant to the proviaom of we Contractor's License Law(Chapta 9
Sq. FL Floor Area
Valuation
(commencing with Section 7(00) Of Divism 3 of the Business and Professions Code) or
Q214n
that M B eanmpl therefrom and the boas for the alleged eaempuan. Any violatioof
Y
APN Number
Occupancy Type
P Y YP
Section TOL" by spy appli=t far a Pennell uWjecu the applkanl m a Civil pmuity of
five not mom thanve hundred dollars (e500h
❑ I. u Owrv:r of the propety, army employee with wages u Neo mle Compewdon,
Required Inspections
will do rhe work ane theswcure u rotintenaca or ortered forsele (Sec. ]M4, Btssneu
and Proremom Cade: The ConuacmYs License Law does net appy m in Owner of
pmpmy who builds or im proves thereon, and who dues such work himself ar through his
Own employees, provided dui such improvements art ret monocled esoQced forsale, If.
however. the building or improvements sold within one yur of cemplenion. the owner -
builder will have to burden of proving that he did ret Wild or improve for purpose of
cale.I.
❑ 1. as swan' of the propcny. am exclusively contmancling with deemual ronwmma in
comwct the Project (Sec. 7044. Business and Profesdom Cade:) The Comnemes Li-
cense!tawdadcotappyia owner MPmPemy'ahaballast orimproves thereon.and.
who aces for such projecu witha contractor(s) licensed pursuant the Canwcah
/
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az
I sm
Q ama Wunder See .B@PC (or Nis recon
y
Ow ne: j Dee
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WORKERS COMPENSATION DECLARATION
I hereby affum under peoalty of perjury none of the fallowing declarations:
have sad will msinuin a Certificate ofCasum nt us self -inure for WmrkeeaCompen-
carbon, as provided for by Section 3700 of the Labor Code, nor the peAonnmen, of the
woh for which this permit is issued.
❑ I love and will maimaln Wmkees Compensation Insu . u required by Section
3700 often Labor Code, for to performance ofde .,it forwhich this permit is issued.
'
My Worker' mpemauan Insurance earner and Policy n mbar ane:
Cartier. Policy No.:
ER IFlC IE OF KEMPIION FROM W0229
COMPENSATION INSURANCE
(TW; section need ork bre completed if de Permit is Intone hundred dollars (SIM)
or less)
1 certify that in NC performance of the wort for which this Permit is issued, l dull not
employ any person in any marumrm u no become subject in the Worker' Compemauon
laws of California. Dau
Applicun
NOTICE TO APPLICANT: If, after making Nu CcniBcam of Exemption. you should
bccam< subject to the Workca's Compensation provisions of the Labor Cade, you mean
forthwith comply with such Provisions; or this permit shall be asoma revoked.
CONSTRUCTION LENDING AGENCY
1 hcmhy.M. last there is. conswcumm lending agemy for the performance of
the work fur which than p .it b issued (So,. 3097, Cl, C.)
Undoes Name
Locates Address
,
I cetify, that 1 have rend this application and some than the above information is
Comet- I agree m comply with all city and County ordinances and sum laws relating m
building construction, and hereby authod¢ representatives of this city to enter upon dm
ahove-menudgm pmpeny farimpnomn puryOses
(We) agree m save. indemnify and trop harmless dm City of Cupertino agaiw
Costs ad osteinwhich may in any way eccnm against said City
incammalue ce of she
of lag granting of Nu permit.
A
APPLICANT
APPLICANT UNDERSTAN ND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE ATIO�
Re -roofs
-4L-2-01
Sig of Applicamt onion., ata
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applicant or future building occupant stare orhandle hues door material
u defined by dm Cupertino Municipal Cade. Chapter 9.12. and the Health and Safety
. Section 25532(a)T
❑res ,�j'No
All roofs shall be inspected prior to any roofing material being installed.
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Will future
6hucartm.
If a roof is installed without first obtainingan inspection, I agree to remove
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the applicant or building Occupant use equipment of devices which
air conuminams. &flood by the Bay Arca Air Quality Management
all new materials for inspection.
❑Yrs ,glN.
I have mad the harardeass ousmi-b mquimmenu underChapter6.95 of dxCaliu,-
nia He -huh @ Safety Code, Sections 25505,25533 andx5534.I understand thutifNe building
docs mol currendY have a mranmL that it u my respomibihly m noul'y the ozupam or the
mquine%hi neuabeme rm dmacOr.Ccmfigmmr aaamy.
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Signature of Applicant Date
All roof coverings to be Class "B" or better
owrmr�t fautbodsa;pent D,m .