05030048 CITY OF CUPERTINOx�,t-, .,{, � .: ^°� uln ,y .r '•-
13UILDINGDIVISION PEIRAHT NTItACTUR+INFORMATI01Vs r
BUILDING ADDRESS: TAYLOR WOODROW HOMES PERMRN0.05030048
20320 TOWN CTR T-N 4 All
OWNER'S NAME: PERMIT ISSUE DATE
TAYLOR WOODR
E; SANITARY NO, CONTROL NO.
(925) 365-3100
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
mm D O D
30p LICENSED CONTRACTOR'S DECLARATION Job Description
+� 1 hereby".that 1 em licensed under provialans or Chapter 9(com
mencln{
with Section 7000)of Division 3 of dM Business and Professions Code,and my license is
in and erect. NEW CONDO. (1938 ' -LIV. SPACE)
Dase m 6'g GE 568 '
CHI7EC1'S DECLARA 10 C-33
pj Iuade my Pl Ihusetlu u o
05
5e, censod Pnrf rel
m OWNER-BUILDER DECLARATION
Y
_by
emrm that 1 am exempt from the Contnctah License Law for the
D int moan.IS
703 t.5,Business and Professions Cade:My city or county
Vwhich requires a permit an eonumet,elle.improve,demolish.or repair try structure
prior m its issuance,also requires the applicant forsuch Permit on file a signed suvment
< than he is licensed pursuant to do:provisions of the Conuacmfs license,us,(charter 9 Sq.Ft.Floor Area Valuation
$ (commencing with Section 70115)ofDivision 3 of the Business And Pmfessiav Cade)or $241650
that the Is exempt thmfmm and the buts far rise Jlegcd conception.My violation of
Section 7031.5 by any appllcant for a permit subjects the applicant n a civil penalty of APN Number Occupancy Type
not mom than Bw hundred dollars(5500).
I,u ownu of the pmpeny.or my emplopes with Mgu u theiruleeompenudon.
willdothewark.anddi Rrunum is net lmendsolmoffered Russia(So..7044.Business Re uired Inspections
and Professions Cade: Z Conmcmh License Lew does not apply m An owner of q P
property who builds or Improves thereon,au who doessuch work himself or through his
own employees,provided that such improvernoms ere not InamdM monesed forsele.If.
heMver,the building or improvemem is said within am year of completion,the owner.
builder will have du burden of proving that,in did ret build or Improve for purpose of
ole.).
❑1,as owner of the property,am exclusively contracting with licenutl convectors m
construct the project(Sec.7W,Business and Professions Cade:)The Convuuu's Lb
even Lew docs not apply to an owner of propeny who builds or improv thereon,and
who contracts for such projects with a emuacmr(0licensed purcu rt m the ConuactoM1
Licence taw.
❑1 am exempt under See. .B k P C fer due reason
Owner Data
WORKER'S COMPENSATION DECLARATION
. 110 I hereby office under penalty of perjury on of the following declensions:
❑I ham and will maintain a CeNOcomofconunuo self-InwoufmwmiamBCampu-
nation,An provided for by Section 3700 of the Labor Code,for the pu fa mance of the
work for which this permit is issued.
❑I have end will mainuin Workefs Compe sed.n I..,As requimd by Section
37x0 of the labor Code,for the pcf...of the woe for which this permit u issued.
Mywmirce cope sedan loan.oartier Bud Policy numberare: /�-,�pj��
Carrier. 'C r Policy No.:(](4T75`-'0
CERTIFICATE OF E7MPPTION FROM WORKERS'
COMPENSATION INSURANCE
This section need not hcomplamd if the permit Isfarom hundred Milos(SIM)
or less)
1 certify that in the performance of the work for which this permit is issued I NJI not
employ any person in try manner sn As an became subject to the Wartrn'Campensedon
Laws of CJifer ie,.Data
Applicant
NOTICE TO APPLICANT:If.after making this Cer incem of Exemption.you should
become subject in the Worker's Compensation provisions of dm Leer Code,you muss
.,0 forthwith comply with such provisions or this permit shall a deemed revoked.
,z.t CONSTRUCTION LENDING AGENCY
[-� I hereby aRlm that them is a construction lending agency for the performance of
W> the work fm which thin permit Is issued(Sec.3097,Civ.C.)
QLender's Nwe
z Lendefs Address
U0 1 owdfy that I haw road this appliation and sum that dm mese in(ormNon h
U,U carmcL 1 agrte m comply with JI city and county aminuas and aur IBM relating m -
0 SVbuilding construction,and hereby uthariae represenuthes of this city an enter upon the
W abow-mentioned property for Inspection Purposes
(We) Z.to haw,indemnify and kwp hnmless the City of Cupertino against
rrA Wblash Bud expenses which may In try way accrue against soud City
U onsegm of the ranting of this permit.
.. APPLICANT D STANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUR REGU 0
Re-roofs
.vigromm o aanUCanvactar I Mad
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WI11 the applioan,or fuwreb mgmcupant Bmrc or handle humdous materiel
As defined by the Common Muni el Code,Chapmr 9.12,and the Health and Safety
Code.Seeman 25532()7 All roofs shall be inspected prior to any roofing material being installed.
p Yes Mo
Will dm app)mant or ruture diag occupamse aequipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It huamowaircmumimnsu final by the Bay Anse Air Quality Management all new materials for inspection.
Disuict7
❑Yee
I haw mW the havamms materials requirements under Chapmrd.95 of ere Cniror-
,Sections 235)5,35533 and 25334.1 mu msund thuif dre building
does out current watont,that it is my responsibility m notify the ocuput or the
requirements mull be ren poor to issuance of a Culnca ,ofOccupan Signature of Applicant Dale
OM ari14dageat Data All roof coverings to be Class "B"or better
G