06010148CITY OF CUPERTINO:^K'*'"
CONTRACTORINFOT2MATIQN
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
TAYLOR WOODROW HOMES
PERMrrNO.06010148
10281 TORRE AVE
NER'S NAME:
PERMIT ISSUE DATE
TAYOR WOODROW HOMES
2300 CAMINO RAMON STE 1 0
02/27/2006
NE:
SANITARY N0, CONTROL NO.
(925)365-3100
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONRIACTOWS DECLARATION
Job Description
1 hereby affirm at 1 am licensed under provisions of Chapter 9 (commencing
p
with Section 7") of Division 3 of tW Busi Ossand Profass(ans Code. and my It.. is
infull forocand effect.
REVISION --STRUCTURAL REVISION TO RFI
Lk. at
License mitis Contractor
Dte
Dale
NO NEW PERMIT ISSUED/ORIG. #05030100
ARCHITECTS DECLARATION
I understand my plans Stell W used as public records
Licensed Pmfessional
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
following reason. (Section 703 1.5, Business and Pmfessiom Code: Any city or county
. .
which requires a permit w crruwcl, alter. improve, demai'mh, m agoir any sWCWm
prior w its issuance, also requires the applicant for such pemil to file a signed statement
that W is beermmd pursuant to the provisions of the Contractor's acerae Law (Chapter 9
Sq. Ft. Floor Area
Valuation 0
(commencing with Section 70M) of Division 3 of the Business and Professions Code) or
that W or exempt Osterman and the basis for the alleged exemption My violation of
APN Number
Occupancy Type
p y yp
Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of
not mom man Bae hundred dollars (5500).
36940017.00
❑ 1, u ownm of me Dmpeny, or my employers wire wages u their sok wmpense0on,
will da the work and baswnure is not intended m offered formle (Sec. 706x, final.
Required Inspections
and Prefessions Code: The Contractors License Law docs not apply m an owner of
property who W1ldsor(mpowes lherton.and whodoenuchwark himselrar0mugh his
Own employees. provided mal such improvements an notimmmded oroff ned formic If.
however, the building or improvement is sold within one year of eomplcuon, the owner.
A
Wilder will have me Wrden of proving that W dm rest Wild or improve for wrpam or
Sala).
c
\
I, as owner of the property, am exclusively convecting with licensed contractors to
consumer the project (Sec. 7044, Business and Profmores Cade:) The Conlre =,. V
v
Cense Law does not apply to an owner of property who Wilda or improves Orman, and
who contracts for such projects wire. Cm uacmr(s) licensed pursuant w the Cmnwnae,
\�
License lsw.
I am exempts under Sea • B k P C for this mason
Dam
WORKER'S COMPENSATION DECLARATION
1 hereby &(film under penalty or perjury one of 0th following declantionc
❑ I Lew and will maintain a Ceruftaw of Consent o selr-insure for WorkcesCompcn-
sation, as prnv(dcn for by Section 3700 of the labor Cade. for the pcsfarmame of the
'
work for which this permit is issued.
❑ 1 have and will maintain Workers Compensation Insurance, as required by Section
37W ofthe Labor Code, for the performance ofthe work for which this permit is issued.
'
My Worker's Compensation btsurmce earner and Polity number am:
Carrier. Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
.
Olussection need not W completed iftW permit is foronc hundred dollar (SIM)
or less.)
1 ar ifv mot in the performance of the work for which this permit u issued. I shall not
enptoy any Notch in any manner an as In WCmrM subject to (W WofknS CohnpenWllon
Laws of Caliromia. Date
Applicant
NOTICE TO APPLICANT: If, after making mit Ccnificate of Exemption, you should
become subject in the Workers Compensation provision of IW Labor Cock, you muse
forthwith comply with such provisions or this permit &hall W deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency forme performance of
the work for which his permit 0 issued (Sec. 3097. Civ. C.)
L emicr's Name
tander's Address
I certify mat 1 have read Of. application and sure that the above information or
Comm 1 agree w comply with all city and county on it uMn and sum laws relating w
building consuuction, and hereby authorise representatives of Nis city to enter upon the
aWve.majudga pmpcny for an pUrmMwhich
(We) agree to save, indemnify and lump harmless the City of Cupertino against
exper
may
expcitseswhich maY in any way accme againstseid City
of thecostsend
Aconsequenceof the granting
incoitiesu consequence permit.
SNis
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE REGULATIONS.
Re -roofs
Signature orApplicaDate
HAZARDOUS
HAZARDOUS MATERIAL$ DISCLOSURE
Type of Roof
Will the applicant or future building accupaptr1,1or handle
Ibuthiommaterial
as defined by the25 Cupertino Municipal Code. (Sopwr 1, 11, and IW Health and Safety
odc.5ection 25532(x)?
❑res ON.
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment or devices which
If a roof is installed without first obtaining an inspection, I agree to remove
emit hammous air coneminan a as defined by the, Bay Area Air Quality Management
all new materials for inspection.
District?
❑Yes ❑Nu
1 have read the bonmdous materials re,eifemem under CmN,, 695 of the Califor-
niaHealth hSafety Code. Sections 25N)5. 25533 and 25534.1 understood oustt KOM Wilding
docs not cmren0y hate a wnanc that It is my responsibility w wdfy the ezupam or the
requirements which mum W met prior to issuance dl CCMFJCRte of Occupancy.
Signature of Applicant Date
All roof coverings to be Class "B" or better
Owner or authorind agent Dow