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INFnORMATION
BUILDING DIVISION PERMIT
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BUILDING ADDRESS:
TAYLOR WOODROW HOMES
E ""'0502000F)
"""'05020006
OWNER'S NAME:
PERMIT f5611E DATE
0 6
NE:
112C OL NO.
SANITARY
S
ARCHIT'ECTyENGINBER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
j LICENSED CONTRACTOR'S DECLARATION
Description
I thereby Anton that 1 am licensed under Provisions of Chapter 9 (commencing
.lob
d with Section 7000)ofDivision 3 of the Budneu W Professhms Code. and my liceveu
i Lifmlr�wnderc11 Lic. em g ��p�^j
F UNDATION ONLY
MP PERMIT #05040088
Date con"'°arTP
ARCHITECTS DECLARATION
I understand my phis shall be used As public records
Licensed Prormusianel
3 OWNER -BUILDER DECLARATION
g I hereby alum that I exempt from Ne COai�. a License Law for the
C
0 703IS,Business and Profession Com: Any city or county
reason. I
Improve,
Z which requites a permit tar construct, altec impmsu dcermitt or mash
which re permit atroment
ed
prior At its Issuance. site requires ton Applicant for such permit file e,IgmJ statement
Comraclor'sLiense Law(Chapter 9
Sq. Ft. Floor Area
Valuation
n� that he is licensed pursuant to the provisions of the
(commencing with Staten ]000) of Division 3 of the Business and Professions Cade) or
Mass he Is exempt therefrom and the basis for the alleged exemption, Any violation at
1441758
APN Number
Occupancy Type
SCNW7031.5 by any applicant far a penult subjects Ne applicant to a civil penally Of
not matt JIN five hundred dollars MOO).
0 1, u mw of Uro pmpeny, m my employes wW cagesa thetr mle=penuow.
17.0 0 Required Inspections
will do the work, and Ina struclurt h ontinrendeE oroRnrtd fm sale (Sec.70u, Buata••0
and ponim ions Cada: The Comraamra U. Law dean sot apply m an owner or
propeny w ho builds or i m prow themon, and who does such wort himself or through his
own employees, provided IMI such improvements are not InmMed mattered rmsele Ir.
however, the building or improvement is mid within am year of completion, the Owmr.
Wilder will have Ute burden of proving that he did not build or Improve rte purpose of
sain.)
0 1. as Owner of the Property, and exclmively conuneting with lleaued conoacters to
construct the project (Sec. 70110, Business and pretensions CWeO The Cmrdrw 's Li.
cense law does not apply to an owner of property who builds or Improm thereon, and,
Who contracts for such projects with a conuac(af(n) licensed pursuant to Me, Communes
License law.
0 l am exempt under Sea ,B&PC for this Mason
Owner Data
WORKERS COMPENSATION DECLARATION
40 1 hereby &Mrm under penalty of perjury em or the following declaraliom:
0 I ham and will maintain aCerdfias of Covent An self-imurt fm WarkcYsCompen-
utian, an provided fm by Section 3700 of the labor Code, its the performance of the
w hich this permit I. issued.
rttew
40 Nvc and will maintain W Wke/s Compensation Imu anal. u requimd by Section
3 110 of be, Cade. for the performance of the wells for which this permit is Issued.
My Workot's Compensation Insurance carrier and Policy number art:
MVCG1Ab1Tcy
Carler.L-1F;r' No.:N&LON:t1D _
CERTIFICATE OF EXEMPTION FROM WORKERS
'
COMPENSATION INSURANCE
(This section need ambo completed ifthe permit Is rnromhundred dollars ($100)
or leu.)
1 eerily Nat In he performance of ire ..,it for which thin permit U issued. l shall am
employ any person in my ranter an As At became subject to tM Warkan' Compcwton
Laws of California. Data
Applicant
NOTICE TO APPLICANT: If. after making Nle Cenifleata of Exemption, you should
become subject 0 the Workm's Compevetion provisions of the labor Code. you must
'
? forthwith comply with such provisions or this permit shall W dimmad lowland.
CONSTRUCTION LENDING AGENCY
I hereby aflimM that there is a construction lending agency for the performance of
> the work for which this permit 6 issued (Sec. 3097, Civ. C.)
:1 Lendch Name
Lcrlms Address
I ceNly that I have rand this application and ass that the above information Is
cotrem I agree in comply with all city and county ardinancee and sum Laws relating to
building construction, and hemby mthorim Rpremmlatim of this city te corm upon the
L7 above-mendomd property for inspection puMpnses.
g (We) agree to saw, indemnify and keep harmless the City of Cupertino against
A Ilabilides,judgmenu, ems and expenses which may in my myaccrue gsimt said City
i; Inc uenm of the granting of this Permit.
PL NT UNDERSTANDS ApfD WILL COMPLY WITH ALL NON -POINT
Issued by: Date
URC REGUL 7jONS. L
�f J
Re -roofs
a of Roof
Type
sI&.. IrApplicanucomuucm Date
NAZARDO SMAT IS DISCLOSURE
Will the applicantor future buildin cupanumm or handle havardom material
As defined by the Cupenim Munici I Code. Chapter 9.11, and the Health and Safety
Cade, section 15532(.)7
All roofs shall be inspected prior to any roofing material being installed.
C Yea u
If a roof 15 Installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant um equipment or devices which
craft hanNnm air contaminans Jefrcd by the Bay Arta Air Quality Management
all new materials for Inspection. -
District?
0Yes Nu
I have real the hauNomm teriahtmNimmemu underChApter6.95 oftheCatifor.
ni Health&SunYCade.Swd=25505.25533 and 35534.1 unicameral thuiftite building
m currently hew: • IanmL that hp. my respomlN1ity m andfy is amapent or the
mquim cmA h muabc t ar ataameanceornmteyl
Signature of Applicant Date
S
All roof coverings to be Class "B" or better
er or authorised agent
Date