06010097C)
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CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
CONTRACTOR INFORM, NN ,
BUILDINGADDRESS:
TAYLOR WOODROW HOMES
PERMIT NO- 06010097
10281 TORRE AVE BLVD C D
M'S NAME:
PERMIT ISSUE DATE
TAYLOR WOODROW HOMES
2300 CAMINO RAMON STE 10C
02/03/2006
NE:
SANITARY NO. CONTROL NO.
(925)365-3100
ARCHIIEC (ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
o
Job Description
I hereby affirm not I am licortsed under provisions of Chapter 9 (commencing
p
with Section 7000) of Division 3 of the Business and Profen inns Code. nod my license is
m f[Ifome an deItea
REVISION--STEEL/OMENT FRAMES
License Li.. as ear Z GOn
Daa:
CONNECTION FOR BLDG C & D
TS DECI.y
DEC
As
ORIG. #05020005 NO NEW PERMIT ISSUED
ret
1 understand my plans shall h used ss public records
Mail W
s
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby aRren that I am exempt from the Contncmes License Law for the
following mason. (Section 703 1.5. Business and RofeMiom Cad: Any city or county
which requires a Permit in construct, alter, improve, demolish, or repair any structure
prior to its issuance. also requires the applicant for Such Permit to Bk a r iprod smtement
he is licensed Coturni Liccme Lia, (Chapter 9
Sq. Ft. Floor Area
Valuation
that pursuant to the provisions of the rs
(commencing with Section 7M) of Division 3 of the Business arM Pm(ecsionsCakl or
$214
Nat he is exempt Ourefrom and the bssu for the alleged exemption. Any violation of
APN Number
Occupancy Type
p y yP
Section 7031.5 by any applicant fm a Permit subjects the applicant m a civil penalty of
not mote than five hundred dollars ($5()0k
Q I, ssowner alike propany, army employees with wages ssthelrrokcomperundan,
will h tete Wad[, and the swaum k not immndcd maffemd (ordak (Scc.70aa, Baircu
'
Required Inspections
and Professors Cade: The Contracmrs Llcerue Law does MI apply to an owner or
propcoywh builds at improm thereogand wW does auchwork himself., through his
'
own employees. provided thatsuch improvements am not intended oraReted fortune. If,
however, Ne building or improvement is sold within one year of completion, the owner.
Wilder will have the Wrden of proving that he did act Wild or improv: for purpose of
salt.).
❑ 1, as of the y, comraamis with license. conuumrs t.
construct the p and Profeso
Sea.7 . B since, and C.ae:)The
toOdd,wner
meLatheproject(Sec.
of
.case law ones not apply to an owner of propeny.who sd or improves Cmitne and
Wilds ves Warner, nd
for such pmjCCL5 WIN 0C.nVILW1(5)114nSed panWnl b lh G.nllYelorS
Q �l
Lienee Laeta
Edetic Law.
\ v
I am exempt under Sec. B k P C for this mason
\\\\
er Date
�
WORKER'S COMPENSATION DECLARATION
I bemby affirm under penalty of perjury can of the following dealmatiom:
I ham and will maintain a Certificate of Consent to self-imure for WorkcraCompen-
ntion, as providrA for Try Section 1100 of the Labor Code, for the peRannantt of the
work for which this permit is issued.
❑ "have and will maintain Worker's Compensation Iuunntt, as required by Section
3700 of Ne Lahr Code, for tete perfo,mance of the work for which this permit b issued.
My Workkae,Compensation lmun�nyye,.�_ame�r end Policy attack,,rare:
Cari.1:A Awi�1.0-G"sN G `✓ MPoliry No.: L4`f-'Slot 3S
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
.
(Thu section need not be completed ifft Permit is Intent, hundred dollars ($10B
or bo )
I carinv Nat in the performance of the work for which this Permit is issued, I all not
anploy any person in any manncrso as to become subject to the Workers Compensation
Laws of California Data
Applicant
NOTICE TO APPLICANT: IL atter making this Certificate of Exemption. you should
become subject to the Worker's Comperuation previsions of the Labor Code, you must
forthwith comply with such Previsions or Nis Permit shall be deemed revoked.
CONSTRUCTION
ON L.ENDINGAOENCY
1hereby n. c
Neve iss 3 ten ding agerry for the perfurmantt of
chumpe ed(Sec.
work for which Nis permit is issue. (Sec. 3041, Civ. CJ
lender's Name
Lc
I,cnOeri Address
1 sanity that I have mad this application end arum Nat the above information is
core. I agree so comply with all city and county onlin awns and sum laws misting in
Wilding eonewnion, and hereby authorim mpicsentati rs of this City to enter upon the
alive-memidgmd Property for impaction purpose.
(We) agree to nae, indemnify and keep harmless On City of Cupertino against
liabili5Pq*nc judgments, and es which may in anyway attmc against said City
i
in q ace of Nc granting of this Permit.
of this
,APPLICA UNDERSTANDS A D ILL COMPLY WITH ALL NON -POINT
Issued by: Date
S CEtIS.,
R GULATI
Re -roofs
Signature ApplicanfCanuaemr Da
HAZARDOU MATERIALS DISCLOSURE
Type of Roof
YIINeapplicantorfuture (ding occupant now or handle hausedous material
as defined by the Cupertino Monte 1 Coae, Chapter 9.12, and the Health and Safety
le, station 25532(,)1
❑ Yu
All roofs shall be inspected prior to any roofing material being installed.
Will Nc applicant or future Wilding occupant use eyvipment or aevim which
If a roof is installed without first obtainingan inspection, I agree to remove
P g
it hazardous air comamim ss rued by Ili Bay Area Air Quality Management
all new materials for inspection.
District?
❑Yee a
1havemadthehv ousm=dalsrequimmenuunder. Chapmr&95ofthc Califor.
ni a Safcty Coda Secuom MM5. 533and2553a.lundcmm�dthmifNc Wilding
ans rat c mly hare iaum. that it Y reapomibility m notify, On occupant of the
I men whie m theme r i ance.f.carlihnmof0�upvmO
/ 777'
Signature of Applicant Date
All roof coverings to be Class "B" or better
Owan ,..mate cd .ban,
a,a