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CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
A'CONTRACTOR INFORMATION
BUILDING ADDRESS:
TAYLOR WOODROW HOMES
PERMIT N006010141
OWNER'S NAME:
PERMIT ISSUE DATE
TAYLOR
WE:
23
7/2006
SANITARY NO. CONTROL NO,
925)365-3100
ARCHITEC (ENGINEER:
BUILDING PERMIT INFO
'
BLDG ELECT PLUMB MECH
0
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 bereby &from that 1 am lieuresed under provisions of Chapter 9 (commencing
escrp
with Section 70(k)) of Division 3 of Nc Business and Professions Code. and my license is
in full fora and effm q.pg�
Licenses a Lk. p
REVISION --FAN COIL INSTALLATION IN
RNACES HAVC UNITS/ORIG. 405020006
Dam Coour wr_
A. shall use DECURATh
I undcrstanJ my plans shall E T., as Nublicrecur
NO NEW PERMIT ISSUED
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
following reason. (section 7W 1.3. Business and Professions Cale: Any city or county
which requires a permit to construct, alter, improve, demolish. or repair any structure
poor to Its Issuance, 21w regUirea the applicMt for such ricroit to file a signed statement
that he is licensed promotion Ia the provisions of the Conuactats Umnse Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 7") of Division 3 of the Business and Profession& Code) or
�w O
Nat W u exempt therefrom and Be basis for the alleged exemption. Any violation of
Y
Section 7031.5 by any applicant for a permit subjects the applicant in a civil penalty of
ApN Number
Occupancy Type
not more Nan five hundred dollars(S5Dy.
P y
1, as owner of tW property, in my employers with wages as their sole compensation,
will do Ne work. and Ne structure is not intended or offered for sale (Sea 7094, Business
and Profeuiom Code: The Conuanori Licerve law does nut apply in an owner of
369400t7. 60
Required Inspections
property who builds or improv Herron, and who docs such work himself or through his
own employees, provided that such improvements sue not intended orolfered formic. If.
however, Ne building or improvement is said within one year of completion. Ne owner-
-
builder will haw Me burden of Moving Net he did not Wild or improve for purpose of
sale.).
C
1, as owner of Ne prcc cny, am exclusively contracting with licenud contractors to
� a�
construct Ne pmject (Sec. 7W. Business and Professions Code:) The Conuacoh Li
came law Macs not apply o an owner of proyerty.who Wilds of improv thereon, and,
who contracts for such projects with a contractor(a) licensed pursuant in the Convenor's
License Law.
❑ I am exempt under Sec. , B B P C far this reaon
Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of Ne following declarations:
_
EI I have and will maintain a CeNftote of Consent oself-insure for WorkersCompeer-
sation, M Provided for by Section 3700 or the labor Cade, for me pertormance, of the
work for which this permit is issued.
❑ I have and will maintain Worker's Compensation Insurance, u required by Section
3700 of the Labor Code, for Ne performance of the work for which this permit is issued.
My Wor es Compensation lasufatrce carrier and Policy number are:
Carrier CMaJ^ %A>V-ALPolicy No.: �ifnl�
CERTIMCATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(ThH auction aced not W completed side permit is forone hundred dollars (SIM)
or less)
1 certify that in Ne performance of Ne work for which this Permit 0 issued, 1 shall not
employ any person in any manner so as to become subject to the Workers Compensation
Lava of California. Date
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption. you should
become subject to the Worker's Compensation provisions of the Labor Code, you must
foMwith comply with such proviomts or this permit shall W deemed rooked.
CONSTRUCTION LENDING AGENCY
I booby affirm that there Is a construction lending agency for Ne Nefformaare of
Me work fur which this permit 0 issued (Sec. 309'l, Civ. C.)
Lender's Name
1<nders Address
I mnify Net 1 have read this application and shote Net Ne aWw inf xonatiun is
correct. I gree in comply with all city and county orthtumes and some laws relating to
building construction, and hereby authorio representatives of this city in cnmr upon Ne
'
ahove-cs,judnedpmpeny for inspection purpowhich
(We) &gree to sane, indemnify arta kap harmless the City of Cupcnino against
ms.
Craning Which may in any Way aCCNC against said City
IiablllUes.cmcc
n encs o M e of thiscxpensicat
this permit.
Pe
NDERSntingrf
APPLICANT UNDERS7ANOS AN WILL C PLY WITH ALL NON -POINT
Issued by: Date �G L
RCE EGU ONS.
) Ola
Re -roofs �
Signa of Applicant/Contncm D,
HAZARDO S MATE is DISCLOSURE
Type of Roof -
Wi1ltWapplicantor(uoa din upant HrrIM Wndlc haYLMOaS material
az Meflned by Ne Cupertino Muni a] C . Ch&Nor 9.13, end Ne Health ,nil Safety
Code. Section 25532(a)7
❑ Yes
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future b�
np gby
If a roof is installed without first obtainingan inspection, I agree to remove
the Bay the Area Air Quality Management
all new materials for inspection.
District?
❑ Yci
d the haiardnusmaterials requirements under ChmacriS 95 rf hoc Califon
tyCodc.Smtiats25505.25333 and 253M.IundcrshoM Nvifdc Wilding
y haw a tenant. Nn it is y respo ' tyo noufy me acupont of Ne
aH"IM
eh pW met ri rlssnanceo ,BgateofOccupancy,
-ixe
Signature of Applicant Date
All roof coverings to be Class "B" or better
i agent te