05030051 CITY OF CUPERTINO >*
BUILDING DIVISION PERMIT kcoI; T, TORANF RM ATIO„ N
BUILDING ADDRESS: TAYLOR WOODROW HOMES PFJIMRNO'05030051
OWNER'S NAME: PERMIT ISSUE DATE
TAYLOR WOODROW HOMES 2300 CAMIN 07/20/2005
11ME: SANITARY NO. CONTROL NO.
(925) 365-3100
ARCHf1ECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
300 LICENSED CONTRACTOR'S DECLARATION Job Description
iJ i thereby affirm that 1 am licensed under provisions of Chapter 9(commencing
a� with Section 70(10)of Division 3 of the Business and Profnsimu Code.and my licenseIt
I.full forts end effect. NEW CONDO 1691 SQ FT LIVING
z Liee^ I.W. 502 SQ. FT. GARAGE
O Conuator
ARCHRECTS DECLAR
Mcmund planta irks use ��
7
�c Ser L" mud Pm si
0OWNER-BUILDERDECLARATION
S I hemh firm that I am exempt From the Contractor's License Law for the
O o follnwin on.(Section 7031.5,Business and Bofeaion Cade:Any city or county
ISE! quires a Pont[to construct.after.harrow.demolish,or tartar any structure
S° poor to its smance.aBu acquired the applicant fm Inch Permit to rile asignedsuumenl
pp�Q dw ha is licensed purmant io the prevision of Ne Canuutob Deva law(Chapkx9 Sq. Ft.Floor Area Val$913030
(secure emiegwithS don700o)of DivWon3oftik Buain wdPmfemiov Code)or
— that he 6 exempt therefrom and Ne bun for the alleged macrame.My violation of
Section 7031.5 by any applicant for•permit subjects she applicant to a civil penalty of APN Number Occupancy Type
not mom than naw hundred dollars(5500). 36940017 . 0 0
❑1,uowvro(thepmpeny,ormyemploymwithwaguulhelrmlecompenutim.
will do the work and the swmure lsmalmamded oroQered fonalc(Sec.7044,Business Required Inspections
and Profession elan Code:The Conumme.License Law donot apply to&n owner of q P
property whobuildsor impmws themomand whodoessuch workhimselfor through his
awn employee,provided that such Impmwmants tee not Intended warhead for We.If,
howewr.the building or improwerent it mid within aro you of mmpledan,the ower.
builder will haw she burden of proving that he did not build or Improve(m purpose of
aic.).
❑1,as Owner of the property am exclusively contracting with licensed conuscuta to
construct the pmject(Sec.7044,Business and Professions Cade)The Contractor's Lia
cense law docs not apply to an owner of property who build,or minnows thereon,and
who contracts for such projects with a eonmetor(&)licensed pursuant to the Commmr's
License Law.
O 1 am exempt under Sec. .B k P C for this mason
Owner Date
WORKERS COMPENSATION DECLARATION
1 hereby grim under penally of perjury arc of the following declammus:
❑1 hawser!will mainuin aCeNOnk of Coven m self•imum forWaduYs Compen-
sation,as provided for by Section 3700 of the labor Code,for the performance of the
work for which this pemit is issued.
❑1 haw and will mainuin Worker's Compensation Insurance.as required by Section
3700 of the labor Code,for the performance of the work for which this permit Is hued.
My Warkce C'amPevs{do—n lnsumtee anierand Policy number ata: K}7�
Gnim G G7 C Policy No.: Ct D7�1
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(lh6section need notaecomplemtl ifthe permit Istrec nm hundred dollars(glee)
or Ica.)
1 certify that in the perfomaneo of the work for which this permh is issued,I Nell not
employ any person in my manners as to becamesubjeut to the Worker'Compennion
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If.after making this Cci inam of Exemption,you should
become subject in the Worke's Compensation provisions of the labor Codc,you most
,'Z foMwith comply with Inch provision or this Permit shall bu deemed rewired.
r O CONSTRUCTION LENDING AGENCY
(—i I hereby arm that Nem h a contraction lending agency for the rurfomance or
fl dm work for which this permit Is issued(Sec.3097,Ci,C.)
W Q Lender's Name
z Lender's Address
V Q 1 cemry that I haw mad this appliatian and auk that the&bow information 6
Iy r' c or c0.1 agree to comply with all city and county aNinamss and auk lows miming u
045.'1 building construction,and hereby author=Rpmaenkdwa Ofthis city mimifulmnlhe
W ahw.ourmanc!property for impaction purposes
(We)agree to sew,indemnify and keep hamlet the City of Cupertino against
raA
liabilities,judgement.cuts and sarcoawhich may In any wry accrue agaivt said City
V7 n Ne gnming of Nis Permit.
F7 PPLICA U DERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE RE"T
Re-roofs
S' natumo pp canUConumur ala
HAZARDOUS MATEalA1S DISCLOSURE Type of Roof _
Wal appliant or(muta Wilding asupant,ureorhandle haaNaa materiil
y de CupeNno Munim otic.Chapter 9.13.and the Health and Safety
Code,Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yet o
Will the applicant or forum build g occupsm sou cyulrmem err devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hvallous air con aminase as cd by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yrs u
huardeml materials requirements under Chapter 195 cribs Califor.
I SafayC .Swcti 25505.23533ata1255M.1undc ftifNte Wilding
decsl,la ntly wa k an4 Nat it 6 my rcapurnsu ly to notify the occ tnfthc
m menu n' to met Inissuanceofscanihmeof anpy. SignatureofApplicant Date
Owner amarivka.em o k All roof coverings to be Class"B" or better
el