05020005CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
10 TR QT,0_R I`1F0RM>ATION,'';
BUILDING ADDRESS:
TAYLOR WOODROW HOMES
PEaM r N b 5 02 0 0 0 5
OWNER'S NAME:
PERMIT ISSUE DATE
2
NE:
i36c;-Il
00
SANITARY hlCONTROL NO,
ARC ITECffEN01NE
BUILDING PERMIT INFO
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LUMB MECH
BLDG ELECT PO O
i LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that 1 am Iimwud under pnevldmta of Chapter (commaelet
i with Section 7")of Division Sof the Business and Pmfcadans Cade. ams my lice—is
i flomfe^Iccleam rrect.
ONLY
Lka
�F,�O,,�U�;3N.,DATION
fc4%M*P PERMIT #05040091
Data CwurSm
ARCHITECTS DECLARATION
I command my plans Nall he used as public exa ds
- Licensed Professional
j OWNER -BUILDER DECLARATION
I hereby affirm that 1 em exempt room Ne Conlnemr's License Law for the
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> following mason. (Section 7031.5, Business and Pref edons Code: Any city or county
which .quires a permit to wmflract. alter. Improve. demnlub, or .,am any slrucmre
m prior m its Issuance, slant requires the applicant for such Permit to file a signed statement
e Cotirecmr''sUmmaLaw (Chapter 9
Sq. Ft. Floor Area
Valuation
that he I. licensed purmantmtheprovisionsnfthe
3 (commencing with Section 7000) of Division 3 of dm Business and Professions Crude) or
. that M u exempt merefram and the basis for de alleged asempedon. Any violnran of$1249397
APN Number
Occupancy Type
Section 7031.5 by any applicant for a permit subjects me applicant to a civil penalty at
mat mom than flue hundred dollars ($500).
❑I.amannerofLeproputy,mmyemployswithwgwuftbwtewmpcw m,
Required Inspections
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will do Ne work, and the sbumurs is an[ intended or offered for aale(S.C. 7044, Budreu
and Profeaeions Cade: The Conuamore License Law ds et apply m an ower of
p
property who builds ar improves thenen, end who ds such work himself or through his
awn employs, provided Me such Improvements art cel intended oraRered forsale, it.
however, Ne building or Improvement inlaid within one year of compledw, Ne owner -
builder will have the burden of proving that he did act build or improve for purpose of
ul. I.
❑ 1, as owner or me property am exclusively conuoning with licensed canuamort m
construct me pmjem (Sec. 7014, Business and Professions Code:) The Comanors LI-
cense Law ds not apply to an owner of property who builds or improv thereon, and,
who contracts; for such projects with a comm cmrfs) licensed pursuant to the Conleacmrs
License law.
❑ I ore exempt under Sec. . B & P C for this moon
Owns Date
WORKERS COMPENSATION DECLARATION
I hereby affirm under Penalty of perjury one of the fallowing declarations:
❑ 1 ham mail will maintain aCeNfresm of Consent to elf -ilium for WarkersCamper.
nation. an provided for by Section 3707 of the labor Cade, rte the performance of the
war for which this permit is issued.
1 have and will maintain Workers Compensation Insurance. as required by Section
00 or the Labor Code. for the performance of the work for which this Permit h issued.
a
My Workers Compensation Insutance caaiicrrwd Policy numberre:
Carrier, b-\6iLst-1 7 riytl 7-f't�r roomy No.: s&) A �I tQ<, Op�
1 L
IQ f L Qss
CERTIFICATE OF EXEMPTION FROM WORKERS'
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COMPENSATION INSURANCE
(Tb13 action reed not hecompleted trust permit is fmaehundrc4 dollaa(f 100)
ar mass)
1 certify that In the perfmmmco of the work for which this permit a ieaed, I shall not
employ any person in any manners, as b become subject to the Workers' Compenssdom
laws ar Califomfa. Data
Applicant
NOTICE TO APPLICANT: If, after making this Cenifmate of Exemption, you shwld
become subject .the Workers Compensation provisions of Me lahar Code, you mus
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w forthwith comply with such provisons or this Permit sedI he decreed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby thi that mart b a col nn lending agency for me Performance of
which (Sec.
Me Murk for which this permit 4lssurd (Sec. 3097. Or. C.)
ndeh Name
lander: AEd.ss
Le
-
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j I campy that I have read this application and state that the show information is
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comeck 1 agree in comply with all city and cowry on inaees and sum law mtsdng to
building construction, and hereby aumMinc representatives of this city to enter upon me
Q above-mentioned Property for iMPcction Purposes
(We) agree to ace, indemnify and keep harmless the City of Cupertino lgainsl
y ample against d Coy
Rabilllles udgments,cos, and expenses which may In my anan
In an of the gaming of this permit.
PLICANT NDERSTANOS AND ILL COMPLY WITH ALL NON -POINT
Issued by: Date
CER I.A 0 S. S
Re -roofs
Type of Roof
Signs a Appliesn onset r em
HAZARDOUSATERIA SCLOSURE
future building u, soomamdlc havraw matarial
Will fro applicant w am
u dented by the Cupenino Munic'pal Code. Ch ter 9.12. and me Health and Safely
Cade, Section 15532(a)7
All roofs shall be inspected prior to any roofing material being installed.
❑ Yu u
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building mcupant use equipment or devil which
mit hmodduus aI, conuminanb doled by the Bay Area Air Quality Management
all new materials for inspection.
DuuiaT
❑Yes u
I have mad the lo ardws materials requirementa underChapter6.95 ofine Cables.
as &SafatYCaM.. Smvmx755s)5 537 md2553d.l undenunC thvif me Wilding
not vacady haw a tenons N ii ts y reqs lohty u dairy me occupat oft e
to ulmm k5 whish meat ba awenc Is err ora ar.
Signature of Applicant Date
j/ L11'5 D
All roof coverings to be Class "B" or better
0 erraathodadage ate