05030038 CITY OF CUPERTINO »sx 7ewa ,"^-�s3: rs" .r'+,z`''~:�',�.
BUILDING DIVISION PERMIT CONNN RA.CTOR Imo,NFORMATIOP s_
BUILDING ADDRESS: TAYLOR WOODROW HOMES PERMIT NO.05030038
OWNER'S NAME: PERMIT ISSUE DATE
TAYLOR WO
E: SANITARY NO. CONTROL NO.
(925) 365-3100
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
O O O O
aat Cij LICENSED CONTRACTOR'S DECLARATION Job Description
6t 1 W. m Nw
by affirm I licensed anchor o
er provisions of Chapter 9(commencing
with Section 70110)of Division Sof the Business seal Profession,Code,and my license is
infuilfo.ea"eff t. 1P NEW CONDO 1691 SQ FT LIVING
s 5 i u:on a c u hu. a
B ARCHTTECI'SDECLAR ION SQ. FT. GARAGE
1 plana shallWusedss uM1l' -
�IIICCC
`O Li cased ons
OWNER-BUILDER m Ce Conu ON
D 8 Leby s177m that I am exempt from slag Commmara License Law for the
g resson.(Section 7031.5,Business and Pmfe.i..Code:My city ser county
3 which requires a Permit in emuuun,Blur,ImPmv.demolish,or repair any ureem.
S^ prior in its issuance,aim requires du applicant for each permit to rile a signed statement 030
-�<
than the is ea
licensed pursuant ns o the Provision ofthe Concretizes Lae law(Chapter9 Sq.Ft.Floor Area Val$
$ (eommenrint with Section 7000)of Division 3 of the Business and Professions Code)or
-
Chad he is exempt therefrom and the basis for the Winged exemption.My violation of
Section 7031.5 by.ay applicant for a permit subjects the applicant In a civil penalty of APN Number Occupancy Type
aot mom then five hundred dollars($500). 36940017 . 00
❑I,as owner ofthe property,or my employees with wages as their sole compensation,
will do the work and the net..I not intended or offered for exist(Sec.7044,Bualmu Required Inspections
and Professional Code:The Contracu'a License law does ant apply m an seame ns,of q P
property who buiknor Improves thereon.and whom essuch work himselfor Waugh his
awn employms,provided that such improvements art net Intended oroEesW far We.If.
however,the Wilding or improvement la Bold within one year of completion,the owner.
builder will have the burden of proving that he did oat Wild or Improv for purpose of
talc.).
❑I.as owner of the prumrty,am exclusively contracting with licensed cantrenom be
construct the project(Sec.7044.Business and Pedimental;Code:)The Contracture U.
cense Law does not apply in an ower of property wlw Wilds or Improv,(homes.and.
who contracts for such projects with aeonusemr(t)licensed pursuant to the Conuacmh
License Law. -
❑lamexemptuntlersec. ,B&PCrarthi,muon
Owner Dau
WORKER'S COMPENSATION DECLARATION
1 Mmby a m under pestalty of perjuryone of the following dmlar0oase
❑I"a and will maintain a Ce Rata of Consent in self-imuro for Worices Compen.
nation,u provided for by Section 3700 of the labor Code for the performance of the
work for which this Permit is Island.
❑I haw and will maintain Worker's Compensation Imursom,an required by Section
3700 of the labor Code,for the performance of the work for which this permit ie Instead.
My Worker.Camp,..U.Insunnce carrier and Policy number see:
Cartier: Policy No.:
CERTIFICATEOFEKE ON FROM ORKFRS'
COMPENSATI NINSURANCE
rfhis settles need not W completed Ilion permit Is forone hundred dollars(SIM)
or less.)
I unify that in the perfmmanee of the work for which this Permit is Issued.I mail not
employ any person in any mannerso as be become subject to tiro Workers'Compensation
Laws of California.Dau
Applicant
NOTICE TO APPLICANT:IL afar making this CediTmm of Exemption,you should
become subject m the Worker',Compensation previsions of the Labor Code,you must
�z foMwith comply with such provision,or this permit shall W deemed revoked,
z'O CONSTRUCTION LENDING AGENCY
(-a Itoothy affim thstthe.sea construction landingagenry for the Performance of
D:> the work for which this permit 4 issued(Sec.3097,Civ.C.)
4 Q Lenders Name
7 z Lenders Address
U C 1 certify that I have read this application and sum that the show Information Is
IT.P comet.1 agree in comply with all city and county oNlnatu.s and mute laws relating to -
C f.) building construction,and hereby authodze representative of this City m enter upon the
447 abow-mentioned Property for Inspection Puryosest
(We)agree to uv,indemnify and keep humleu the City of Cupertino all
req li gmm�u,eases antlexpensn which may in my my secry a{alnsl aid City
C.) con see f Ne trantint of this Permit.
AP IC N NDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
URGE VIA}'ONS, Ing�/.21 I b Re-roofs
Signed. ppliddincinracmr D
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Ilthesppliesmarfn Wilds acevpant port w handle hxaaNam material
an defined by the Cupertino MunidChapter 9.13.and the Health and Safety
Code,Scotian 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Ye,
Will the applicant or future Wild' t occupant me equipmem m devices which If a roof is installed without first obtaining an inspection,I agree to remove
I haxem..air contamin.nu a ned by the Bay Arta Air Quality Management all new materials for inspection.
District?
❑Yes
I hive roul the haaaNeus materials requirements under Chspur 6.95 of tiro Califon
safclycedc,Sccdme25503,25533 and 25534.1 undcrsund thatif u c building
does trot c ntly hens a umnt that It Is my responsibility m runty he mcupan of the
M ' menu h tpkneuis ance.f.CrniOcauofocc may. Signature of Applicant Date
tj own moria"agent Da All roof coverings to be Class"B"or better