05030064 -------------
CITY OF CUPERTINO E"z•�' "'" "'
BUILDING DIVISION PERIVIIT ,CONTRACTOR TNFURMATI- N.
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BUILDING ADDRESS: TAYLOR WOODROW HOMES 'FRMr`ND'05030064
OWNER'S NAME: PERMIT ISSUE DATE
TAYLOR WOODROW HOMES 2300 CAMINO05
E: SANITARY NO. CONTROL NO.
(925) 365-3100
ARCHIIECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
YO6 LICENSED CONTRACTORS DECLARATION Job Description
I Im rby affirm Nat 1 ae licensed under provisia l of Chapter 9(commencing
nR! with Section TORR)of Division 3 of Me Businua and Professions Codc.and my Became is
inmllfameandnffem NEW CONDO 1691 SQ FT LIVING
jVi Z License CI a Lk.
;J Dam Cwt a ter
SQ. FT. GARAGE
ARCHITECTSDECLARAT N
y!".11 W sed a public me
c Ucc d Pmf clo
OWNER-BUILDER DECLARATION
I 4mbyMaso .(Sce that 1 1. exempt free Ne C Profession;
License Law for me
O O f re moxa. urnedon 7(13 L3,Business and Improve.
de sins Code:Any oily or county
$tri which its Isu a e.anh m uimM s elms W prove,deerlliN,or repair any awmure
_Zy pdoreiBlauanw,Wan,On Me pro islons of Me CohmPermit mcic ense Laedrutemem
F O that W is licensed purwant sa the Of Division
of the Canuxmrs and
Professions
law(Chapter 9 Sq.FI. Floor Area Val �Dl 0 3(]
r%, $
(commencing exempt
pt t ectionanion t and the ba ss for of the Busicgcd essmo antl Profcu vi Code)or
Net ha b eumpt tiertfrom and the bub far Ne alleged eumptian.Any violation of
Section 7031.5 by any Applicant far a permltsubjeca the applicant to a civil penally of APN Number Occupancy Type
not marc than five hundred dollars(s50B). 36940017 . 00
❑I,As owner of the property,or my employes with w`es As Neo sale compensation,
willdo thework.and Neammt.b not lnmndedoroRered mrsale(Sec.7044,Budnnsr Required Inspections
and Professions Onuac
Cade:The Cmes License Law dors not apply m e an owner of q P
property who bei Ida m improv thereon,and who does such work himsel f ur thmugh his
ownemployeoe.provided that each improvements sae not intended oroRered feasale.It.
however,the Wilding or impmvemenl is sato within an year of cnmplction,the Owner.
Wilder will have the burden of pmving that ha did nes Wild or improve far purpose of
sale.).
❑I,As Owner of the properly.am uclusively contracting with licensed contractors an
construct the project(Sec.7016,Business and Professions Cade:)The Contncmes LI•
ccnu law docs not apply An in owner of property who Wilds or improv Memon.and,
who contracts for such projects with aeommmior(O licensed pursuant an the Conmcmrs
License law.
❑I am exempt under Sec. .B it P C for this mason
OWIAr Data
WORKERS COMPENSATION DECLARATION
1 hereby a1Rmt antler penslty of perjury aro of tie folkfwing 4clantions: '
❑1 haw and will maintain a CW 0caa of Consent to self-insum fm Wmk esCompcn-
ration,as provided for by Section 3700 of the Iatmr Code.for the performance of(Ne
work for which this permit is Issued.
❑1 have and will maintain Worker's Compensation Wherance,As required by Section
3700 of the Labor Cade,for Ne perfammentt of Ne work for which thin permit is Ixwtl.
My Worker's am monad..lmmeecc carrier and Policy number am: A...py�
Cesder. PoIIry No.:CL&-w�5y
CER 6!T50FE EMPTION PROM WORKERS'
COMPENSATION INSURANCE
Crab Comfort mteed nothecmnpleed If the permit Isfaranchuminedollan($100)
or mu)
I Cavity that in the performance of the work for which tiffs permit is lewd.I shall nut
employ any penman in my manner an As An become subject to Ne Work'ea'Compenxdon
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:IL after making this CmtiOcate of Exemption,you should
become subject an me Worker's Compensation provisions of the labor Code,you mus
.J ZO faMwith comply with such provisions or this permit hall be doomed mvnked.
?ti CONSTRUCTION LENDING AGENCY
(-+ Thereby Mr..Nat Nero iso construction lending agency for Nc performance of
a> the work for which this permit Is ixwd(Soo,3197.Civ.C.) '
Q Lenders Name
=z Lenders Add.
U O 1 Certify that l have reed this application and mm Nn the above micummmn is
Ug F comm.l apo to comply with all city and county on inancea and slue laws mating In
CU Wilding conanctian,and hereby aulhodre mpmeenutiv of this city to enter upon Ne
W shove-mentioned property for Inspection purposes
(We)agme to save,indemnify and keep homeless the City of Capenm0 agamn
N Ihbilitiu, menu,cosu andeapensu which may in any myeecrw against said City
V7 in -- ling of this permit.
r7 UN R NOS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUR ULA S.
Re-roofs
Si nuurc ofA nusetor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Applicant ar future Wil 'ng Oc&M,11mm or handle haamdou mateAu
As dcMed by de Cupenino Munici Cade.Chapter 9.12.And the Health and Safely
Cole,Section 25532(x)? All roofs shall be inspected prior to any roofing material being installed.
❑Yu u
Will the applicant or future b og Occupant use equipment or devices which If a roof IS Installed without first obtaining an inspection,I agree to remove
mit haardous air corummanu u lined by ft Bay Area Air Quality Management all new materials for inspection.
Diauict7
❑Yu u
the harsrdoemoomiab requirements undcrChapmr6.95ofdte CAlifor.
n" I .Sccthau255DS.25533 ev123531.1 wdcrgmb thatifmc Wilding
ntly e A enant,that It b my responsibility tonotify arvp I Or de
mqu mcnsiwhk oat be met pnorwiuumuccofaCeNfcamof upaney. Signature of Applicant Date
7
DL4 d All roof coverings to be Class"B"or better
CII ver or"Ardragem D c
O