05090031CITY OF CUPERTINO
Ii�k'ORMATION
BUILDING DIVISION PERMIT,CONTRACTOR
BUILDING ADDRESS:
TAYLOR WOODROW HOMES
PERMITNO. 05090031
10281 TORRE A
OWNER'S NAME:
PERN[T ISSUE DAIS
TAYLOR WOODROW HOMES
2300 CAMINO
SANITARY NO. CONTROL NO.
(925)365-3100
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
'BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
.is s of chapter 9 (commenting
I bmeby air..mat I am lima d under praon
with Salon 70fIU)af Don no3tf die BusineuaM Prafcssia��` 'C�ade.aM myliccnseu
in b0 force and affat. 6fi�l
REVISION--CABLE LAYOUR
1.icenx
Dam �it�C Lk.d r
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NO NEW PERMIT ISSUED/ORIG. #05020005
ECTS DE[
DIEC
ARCHITLARATION
1 understand my,im.,hall he usod as public retards
-
Licensed Pmfc amonal
OW NER-BUILDER DECLARATION
1 beo:hy alTirm Nat I em exempt from the Contractor's License Law for the
fallowing mato.. (Section 7031.5, Bull. and Professions Cole: Any city or County
which mquira a permit to Consw0. alw. improve. dcmoRN, or repair any iwclure
prior m its iuoae, also requires tiro applicant (orsuch permit to file a signed statement
Nat he is lkenaedpuswant m the provisiauo( the Cmurucmr's Liana. Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 7000) of Division 3 of me Business art Plefeudoes Codc) or
Q 214
at he u empt therefrom and the buil for the illcgcd uemption. Any violation of
Nx
APN Number Occupancy Type
Section 70315 by any applicant for a permit subjects the applicant to a civil penalty of
not more dun five hundred dollars (55007.
1, as owner of the Properly, or my employes with wages as dteu sole ennar ado..
88
will do the rk and t hemonturc u not intended o offered for sale (Sec.70a1, BasinGL
woam,
- Required Inspections
and PmfaaaColn: The collocates Liana taw data ant apply to an awnw of
_
pmpcnywW Wildsorimprovvthcreon,andwW daesswhwmkhimselr.r W.ughbu
.we employees, provided Nat such improvements are not intended ooaeted formic. IL
howe,w, the building or improvement is sold within one yes of Completion, the owner-
builder will have the Which of proving Nat M did on boil Or improve for purpose or
ale.).
0 1, as owner of tb< propen, am exclusively Contracting with Booed conuanon to
cautrat the Mica (Sec. 7044, Business sol Professions Cade:) The Cormamoes U.
cense Law docs not apply to an owner of properly who builds or improves Nemom, and
who contracts ro such projects win a eantraclar(s) licensed pursuant to the c.nlrames
License La-
aw.❑Ism aempt under See ,B@PCfor lis msson
0 1 am
Owner Dox
WORKERS COMPENSATON OECLfRAnN
I hereby am under penalty or perjury mill of the following decluatiau:
I ham and will ..low.. Ceri fsox of Conan to self-insure its, Wark,es CamPa-
\
wion, u provided for by Section 3700 of the labor Cade, for the penfannarue of the
work for which Nis Permit is issued.
❑ 1 have and will maintain W.rkees Compensvan Insurance, as required by Sc van
3700df eUWCode,rar0ex9ormmmoffte fwwhichthisKmiLuiumd.
'
My Worker' rep sauon rance amu and Polity numb rax:
Gnicr. 0 Policy No.:�
C ICATE O EXEMP ION FROM W RI ERS'
COMPENSATION INSURANCE
,
071dise Lina acd rolbecampkxd irthe permit is foram, hundred a.0ars(SIM)
ar less)
I ceodfr that in the Performance of the wart for which this permit is issued. I "I nor
employ any person in any manner art as as become subject to the Workers' Compensation
laws.f California. Date
Applicant
NOTICE TO APPLICANT. f. a0cr making this Celina¢ of Exemption, you should
become subject to the Worker, Compcmauao provuiolt of ne Labour Code, you most
forthwith comply with such provisions or this permit hall W deemed rewkad.
CONSTRUCTION LENDING AGENCY
1 hereby a(Rrm that there is a cosuuction lending agency for the performance of
the work for which this permit is issued (See. 3097. Civ, C.)
LemIces Name
Lender's Address
I certify that 1 have road this application and state this the above information is
cOnee6l agree to comply with all city and County nostrum; and sale Iawa relating to
building construction, and hereby authodx representatives of this city w enter upon the
shove-m,nuaned property for inspection purposes.
(We) agree to saw, indemnify and tramp harmless the City of Cupertino against
othesouand expenses which may in any way same againstsaid City
in
ro of the granting of this
APPLICANT
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
D WILL
Issued by: Date
SOURCEREOU ONS.
%.�/i5
Re-roofs
Signature of pplitanaCaARDO Date
x,kzAaDous MATERIALS DISCLOSURE
Type of Roof
Willy (roux Wilding ac handle
OSed the Health anmateriil
the Cupertino
a Municipal Cade. Chapter 9.13, end tie Health and Safely
haptsore, and
uihs,,arMus
Section
Sanyo. zss3z(a)7�
324)?
❑TaWill
All roofs shall be inspected prior to any roofing material being installed.
the applicant or future Wildingeceupnt uxequipmentor&vim which
If a roof is installed without first obtaining an inspection, I agree to remove
air communes s u defined by the Bay Area Air Quality Maagamcnt
all new materials for inspection.
DistricR
❑Yu MV.
Lhave r
eluarduus,15505Uxquiremcnsundcrdersta
Wilding
&Sefoy dduni6.95
nit Health@Safety Code.Satios35505, 25531 and25534.1 understand thuif nc Wilding
to
Joel Out currently haw a tenet. that illi my responsibility to mtify the osupant nr the—
nequiremen nb roma n m me af.ccruk.m.rOccop,ay.
Signature of Applicant Date
All roof coverings to be Class "B"
g Ur better
�
Owarr ar i thoriacd agent Dam