05030063 CITY OF CUPERTINO
BUILDING DIVISION PERMIT , CON'CRACY'OR IrtF'rQLMATIorrw'F
BUILDING ADDRESS: TAYLOR WOODROW HOMES rMMITNO.05030063
OWNER'S NAME: PERMIT ISSUE DATE
TAYLOR WOODROW HOMES 2300 CAMIN
E; SANITARY NO. CONTROL NO.
(925) 365-3100
ARCHITECTAiNGINEER: BUILDING PERMIT INFO
BO EIECr PLO l�
�Sp LICENSED CONTRACTOR'S DECLARATION Job Description
with Section 7gpty n Don that
INon 3 of da Budrculicensed rand Frofeuimu visions of Chapter
`de end mylkenm Is
in full once and efrmtW CONDO 1691 SQ FT LIVING
qz LI"nm° o 2 SQ. FT. GARAGE
F D Co
ARCHITECPS DELL DECLAR O
I undcmun an Is be used as
yGLicensed Testis
a
Oat lam emp(f DECLARATION
.�a I rth mm the 11. ucmpt from the Contractors :My city
Law for the
p�0�• fallowin an.r( itot 703 t,almr.bp P .demnaCade:Myeilyarcounty
mquhca a ppmu requires
the Ater,hnpmw,h Permit I ri mpalr any stmcwm
—Zy pdoraits issuenee,alw requires the applicant farwch permitafile saignM summate
£ o thahebliceusedpuauanuaNepmviision3 ftheBuacaYWan¢sdarChepter9 Sq.Ft. Floor Area Val iIDd030
y $ (cram he
excwith SmtioernandoDiviis foraflMBuelnruwdon.my viCode)ur
that he ts nxempl therefrom and the bub far the alleged eamptlon.My Noladan of
Section 7031.5 by airy applicant for a permit subjects the applicant to a CMI penalty of APN Number Occupancy Type
not mart Nan five hundred dollars(SM. 36940017 . 0 0
❑I.u owner of the property.or my employees with wages u their sole compensation,
will do the work,and WeeWctum b not intended or offered for sale(Sec.7W4,Business Required Inspections
and Pmfeviou Cade:no Gnusoars Licence e Law does ant apply m an owner of q ,
property who buildsorlmprom therson.and who doessuch work himselfor through his
awn employees,provided that such Improvements art not Intended"offered forule.It.
however,Ne building or improvement is sold within oro year of completion,the owner.
builder will have the burden of proving dant he did not build or Improve for purpose of
sale.).
❑1.as owner of the prupeny,em exclusively contracting with licensed emuactoa in
construct the pmket(Sec.7144,Business end Professions Code:)Tate Cwtseear's Lb
cave law alma tet apply in an owner of property who build,or impm thereon.and
who contracts for such projects with a comracar(s)licensed pursuant to the Contractors
Lima.Law.
❑[am exempt under Sec. .B k P C fm Nie moon
Owner Dam
WORKERS COMPENSATION DECLARATION
I bemby affirm under penalty of perjuryoro or the following dwlmtione:
Q 1 have and will maintain a Certificate of Content to self-Insure for Werkera Compen.
Nation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑I have and will maintain Workers Compensation Insurance,as required by Section
3700 or the Labor Code,Tor the performance of the work for which thin permit it Instead.
My Workers Pounpinmadon Insurance carter and Policy number are: T
Grrier. P•CPolicy No.: V
C RTIFIC EMP TUN FROM ORKERS•
COMPENSATION INSURANCE
(Maseemm need not beconpleted ifthe permit is fmrone hundred dolbn(SIOo)
or lana)
1 Mindy Not in the performance of the work fur which this permit is burned.l shall nm
empoyanypemon in any manner an as in become sobjeclathe Wicleco Compmeadom
Lawn of California.Data
Apps ant
NOTICE TO APPLICANT:If.after making this Certificate of Exvnpclon,you should
become sub)=No the Workers Compensation provisions of the Lahoe Code,you must
OZ, foMwith comply with such provisinu or this permitahall M demand revoked.
,'Ze y CONSTRUCTION LENDING AGENCY
[—� 1hereby&Mml dant them is commutation lending agency fmthe pciformsom of
ai 7 the wank for which thin permit Is Issued(Sa.3097,Civ,C.)
QLanders Name
z Landers Address
U Q I certify that 1 here rand unit applicator and extra that the show far..due is
it,!' torten 1 agree to comply with W city and county on Inas and suite law meeting to
O kSJ^ building construction,and hereby author=representatives of this city to entre upon the
W ahave-memtioned property,for inspection purposes.
G (Wc)agree in tow.indemnify and keep harmless the City or Cupeniw..gamut
rat liabties, andexpeuses which may In any way acetum".not sand City
V z m c + of the tint of this permit.
AP A UNORR NDS AND WILL COMPLY WITH ALL NON.POINT Issued by: Date
SOURCE GU 0
Re-roofs
Signa sof Appli ✓Conuecmr a
HAZARDOUS MATERIALS DISCLOSURE Type Of ROOF
applicant or future building occupant Nom u handl.husNoes material
as dented by the Cupertino Munici ode.Chapter 9.11.and the Health and Safety
Calc,Section 15533(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yu o
Will the applicant or mare building occupant ux equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit ha'rardmus it mnamoenu u food by the Bay Area Air Quality Management all new materials for inspection.
Dhurler?
❑Yes u
1 have mad the haardeus nalimiaeemquimmenu under Chaparh.95 of the Califor.
ctyCodc.Socumui 25$13.35533 am115534.1 understood the lithe building
dors out on Ily haw a cement,mal is Is my responsibility in nod fy thC occupant of quo
re ,men is must be met mor missummofaCcnlRmor mpanry' SignatureofApplicant Date
All roof coverings to be Class"B"or better
Owen unmixed Agent ate