05020008CITY OFCUPERTINO>.,�o
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l�CONTRACTOR
BUILDING DIVISION PERMIT
TNF,,OWATIO
BUILDING ADDRESS:
TORRP ANTE 131D G
TAYLOR WOODROW HOMES
PERMITNQ05020008
. OWNER'S NAME:
PERMIT ISSUE DATE
NE:
SANITARY C OL NO.
e25- 3 cn5-
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
j LICENSEDCONTRACIOR'SOE.CLAKATION
JobDescrimon
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I MRby affirm Nal l •m IIceNCd aader prossim a a(Chaptel 9 (Wm .mem,
with Section lIXD)of Divitlav3efine Blleineraand Profcsdou Com.and mYlicensets
mrmlmhaad ea ']
FOUNDATION ONLY
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MP PERMIT #05040090
ARCHrfECTSDECLA ATION
I understand my plans shall be used as public record.
^ Licensed Professional
OWNER-BUILDERexemptDE DECLARATION
JC
g 1 hereby .meta that 1 exempt from the Cantnclars License Law for the
:
following maan.(Scetiun 7031.5, Business and Pro(essinns Cam: Any city or county
maxo 1.
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E which rectum a permit an construct. altar, improve, demolish, or repair any structure
^ prior to its issuance, also roqutms tie applicant for such Permit In rile asigned wicmctt
Ilan W is licensed pursuant to be, provisions of the Cmanatue, ULTM Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing wide Section 7000)of Division 3o( ate Business and Professions Cade) or
-
97
. that h ts exempt therefrom and the busts far the alleged eaempdon. My violation of
APN Number
Occupancy Type
Section 7031.5 by A" Applicant for a permit subjects the applicant In a civil penalty of
.at mole Nan five hundred dollar. ($500}
❑ I, u owner of the property. or my employees with wages as their sole cmnpenution,
0 Required Inspections
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will do the work and deeawmure I. an[ as@red for sale(Sec. IOM. Business
and Professions Code: Tho Co mamors License Law does nos apply m an .wirer or
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property whobuildaar improves thereon, and whodm.uch work himselfar Waugh his
own employes, provided that such improvements are not Intended oroacred for We. If.
however, the building or Improvement Is sold within one year of completion, the owner.
builder will lave to burden of proving do, he did on, build or Improve for purpose of
sale.).
❑ 1, as Owner of the property- am exclusively contracting with licensed contractors to
construct use project (Sea 7044, Business and Profusions Cade:) The Conlnctor'a LI-
come taw does nal apply to an moment of property who Wrists of ImproMa thCRM. and,
who cost.= for such projects with a cmoomor(A licensed pursuant to alae Contsactee,
License law.
❑ Iamesemplundes Sec .BBPCfathisrosson
Owner Data
WORKERS COMPENSATION DECLARATION
1 Wmby &arm under penalty of perjury one of tie following d•clarsda n:
❑ I ham and will mainain.Cenifiaa of Consent to self-Iuum fa Walkers Compen.
ation, u provided for by Scetion 37M of the LaWr Code, for the performance of the
w or or which this permrl is issued.
1 have and will maintain Wasker's Compelaadan Insurance, u required by Section
3700 of The Labor Cede, for the performance of the work for which this permit is issued.
,
My Worker, Compensation Immance artie"r anl�d Policy"umrsbxer am::`
,.,(�
Carrier:I..1 Irinj No.: a`�'••� 1 9JnGa9
1,
Lot
CEIFI TE OF EXEMPTION FROM WORKERS
OMPENSAT90N INSURANCE
(Tbtsaclia sed at be cur plead If use permit is faaa hundred dall.01M)
ser leas.)
I aNfy mal In the performance of the work for which this permit is lamed, I Nail not
employ any person in ay manor W as m become subject to the Walkcro' L'ampenaaa
Laws of California. Dau,
Applicant
NOTICE TO APPLICANT: IL after matin j this Cer illae of Eacmpt at. you Arnold
become subject to dee Worker's Compensation provisions of the Labor Coda, you must
'
y forthwith comply whit such provisions or this permit shall be darned raveled. '
y CONSTRUCnON LENDING AGENCY
Ihereby a per alert Iancausation7.Civlending agency for the Performance of
ich
the work for which Iles permit ts load (sec. ]09'1. Civ. C.)
Landers None
Ismer. Mame
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1 unify that 1 ham read We application and state that tie above infahmata Is
correct I agree in comply with all city and county ordinances and sus laws relNng to
construction, Wilding conaation, and hereby authorirepresentatives of mid city to enter upon the
4 above-mentioned property for inspection purposes.
(Wt) agree or am, indemnify and keep harmless the City of Cupertino eguut
Ilabllides.judgments. costs and carouser which may in my way acme against mid Citya17
,
In consegance of dee granting of this permit.
CANT UNDERSTANDS D WILL C MPLY WITH ALL NON-POINT
Issued by: Date
OUR EREG TIONS
Re-roofs
Type of Roof
sibof ApplimUCon xe ate
MATER A DISCLOSURE
HAZARDO
Will W appnan, or(utam Wilding. nl stere or handle hasrdaa material
at mond by the Cupertino Mad I Com. Charter 9.12. ad tie Health and Safety
Cone. Section 25532()7
All roofs shall be inspected prior to any roofing material being installed.
[3 Yes No
If a roof is installed without first obtaining an inspection, I agree to remove
9nn the applicant ormusm WOmng=open%amegaipmatordevices which
all haardous air com eta"Oil ncd by the Bay Arta Air Quality Management
all new materials for Inspection.
District?❑Yer
Nu
I have mW the hrardous materials requirements under Chapter 6.95 or the Califor.
n a safety Cade, Sections 25505,25533 and 25534.1 understand lhu lfW Wilding
m not c oily have a urnut that It my rtaponslbility m nduty the, accupenl of the
barren whichmysl-Wmetp'r naa.naoracwneataar c SryoS
Signature of Applicant Date
All roof coverings to be Class "B" or better
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