05090030CITY OF CUPERTINO
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BuaDlrvc Dlvlslory PERMIT
CONTRACTORANFORMATI,OK�=
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BUILDING ADDRESS:
TAYLOR WOODROW HOMES
PEgmrt D. 05090030
OWNER'S NAME:
PERMTr ISSUE DATE
TAYLOR WOODROW H
2300
SANITARY NO. CONTROL NO.
(925)365-3100
ARCHffECTIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
lob Description
1 bemby affirm that 1 am licensed tither pmvidau of Chapter 9 (mmmcncin6
with Section 70M of Division 7 of the Business had Prafcuiaus Code. arW my license is
inrmlremeandaffect. b�d[� S6
REVISION --CABLE LAYOUT
Dole.a Co.x
1 - 1] Contractor
NO NEW PERMIT ISSUED/ORIG. #05020005
Te DECLARATION
As"I
tic
1 understand my plans Nvl Po used u public retorts
Licensed Pmfcuu nal
OWNER -BUILDER DECLARATION
1 hemby affirm that I am exempt from the ComassemYs Llcmm Law for the
following mason. (Section 713 I.5, Business and Professiau Cale: My city or county
which mcf.i. a Permit to manumct, aIle, unprove. de n.11O. ar RpWr say Slraclafe
prior al its issuance. Mau mGulml the applicant for such permit u, file a signed summenl
he islimmedparmanuothe the Conmcus'sLucveLaw (Chapm9
Sq. Ft. Floor Area
Valuation
that provisiouar
(commencing with Section 7000) 9Division 3 of the Business and Profeasions Cak) or
$ (]
that he Is exempt Ncmlrom and the basis for the alleged eaemptim My violas m of
APN Number
Occupancy Type
Schon 7071.5 by any applicants for a permit subjects the applicant m a civil penalty of
not mom Nan fin huMmd dollars (S300).
❑ 1, u owanr of the propenY• ar mY clsploYcu with wages u Ihev ante mmpewton,
Required Inspections
dathcwon and the 70 a4,
dams not apsee.
Owner of
and License Law doss not apply m rt owner of
and he Conumetuendns, Law
Cade: The
q p
Immo.and who tausuchwank nimmRmthrough his
property who ilsp menton.
em whobuilds improves
am i ata am ant tendedmpkded for ole IL
awnemployes.providedthateach improeld
however. ills al
i or improvemen u cold within arc War of mmPkeiaa the pose
of
Wilder will love the Wsdan of proving that h<did not Wild or improve for purpose of
ave th
ark.).
❑ 1. u awrcr of property celsexclusivelysinenal connecting with licensed cammumss
/
ct U.
Code:) Tho Cmrrw:mh nd
...La the es project (pec. n as. Bosuns asp Praproperty no ensWilds
Lime raw does ooh apply b an owner of propmywho Wiltls or improves Ibelsan, mtl
who canlaams for such projects with a eontracmrts) Iicmued parmant a the Contractors
e�
"kava Law.
❑lam ucmpt undo See .BBPC fm NU Ramo
v ,
\
Owrc Data
WORKERS COMPENSATION DECLARATION
1 hereby trials under penalty of perjury arc of the following declaimmet :
1 un and will maintain a Certificate of Consent w self -some for Workout Corpses.
.due, as provided far by Section 3700 .1 00 labor Code, for On performance of the
wast far which this permit is issued.
1 ban and will maintain WorWYs Compers"on Iosurnme. u required by Section
3700 a Ne labor Cade. far the perfaramce ofthe wort for which thusp.it is issued.
'
My Workers o pear tion lo nee artier and Poliq num er e:
S
Cartier. aT A Policy No.: 7��)Ar�
CEROFICATEOFE% PfIONFROM WORKERS'
COMPENSATION INSURANCE
(Thu semim head ors M completed time permit is forom hundred dollar ($100)
or less.)
1 ani(v that in the performance of the wark for which this permit is issued, I shall ant
employ any person in any manneran u m become subject to the WoHsrs' Compecard on
Laws of California. Data
Applicant
NOTICE TO APPLICANT: If, ager making thus Ccniftcam of Excmpsion. you should
become subject m Ne Workeh Compca pion provivons of the Labor Code you must
forthwith comply with such pmvivosu orthis permit shall W deemed revoked.
CONSTRUCTION LENDING AGENCY
aurum than the. u a cmtswcuon lending agency far the perfosmeme of
me woh fur which this ficanut u issued (see. 3097, Civ. C.)
Lenders Name
Landers Add.
1 unify thus 1 have mad this application and aum Thar the above lamm aura u
correct. I agree In comply with all city and county un)inmea and shale laws elating to
building contraction, and hemby mthori>e mpraenuuu of this city to cmcr upon lis
shove-mcnud and pm. ertycost for inspection purfacwhich a
(we) agree m an. indemnify and keep harmless the city of Cupsnino against
liebinsical judgments. costs and expenses which may in any way aeesm agvusssaid City
of thegrantor of thusD
A
APPLICANT
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
WILL
Issued by: Date
SOURCE REGU MS.
Re -roofs
—�
She^arum ofA pliaHAZARDO Dam
HAZARDOUS MATEIIIALS
Type of Roof
Will the applicant no forum Wilding plausuDISCLOSURE
or handle hmsim anmamvv
e. Chans.uom
u defined by the Cupertino Municipal Code. Chapter 9.II. and the Hevth and Safety
ale. section sss3z(t)7
❑Yusu
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment or dcvims which
If a roof is installed without first obtaining an inspection, I agree to remove
it bmardnus air mntamitwns as defined by the Bay Amo Air Quality Management
all new materials for inspection.
D tact?
❑Yn
I h& alsmquimmcrosunhr ChapmdthatifJan WilO.&
Nadm,sae.
Safet
his HcalthhSafcsy Cotle,Smuom 2)3U5.3333J aml23SJq.luMcnmhtl thuif Jan Wilting
25
dot ant cormmms
ly have a me, dal it IS my motion ability m natty Os occupant of the
Rm
quatole tial ac melp to IMuNm of a Catfcne of Occupancy
2MZOsGv/J//'-
C/
Signature of Applicant Date
4
All roof coverings to be Class "B" or better
. .
owner orauthomed agrnl Dam