05030087 CITY OF CUPERTINO
BUILDING DIVISION PERMIT ,CONTRA0,T,,0RAN,I'�ORMATIg1�I .
BUILDING ADDRESS: TAYLOR WOODROW HOMES PERMIT No.05030087
20320 TOWN rTR LN if Al2
OWNER'S NAME: PERMIT ISSUE DATE
TAYLOR WOODROW HOMES 2300 CAMINO 2005
111WE: SANITARY NO. CONTROL NO.
(925) 365-3100
ARCHITECT/ENGINEER: BUILDING PERMITINFO
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�oo LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby efforts that I am licensed under provisions of Chapter 9(commencing
with Section 7M)of Division 3 of the Business and Prouulons Code,and my Ikanse s
intuit farts manifest. NEW CONDO. (17421 -LIV. SPACE)
jN2 Li also Lm.B
t, Dem Co.]mm ARAGE 5151
QyI A cx sDECLA C-32
roan p n Ill usW b roc
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enscd Proress' nal
R OWNER-BUILDER DECL TION
i f by alarm that I oro exempt from dm Contactors License law for the
p O fo owing no.n.(Semon 7131.3.Business and professions Code:My city or county
$ which requires•permit to Caanal.elmr,improve.demolish.or aPNr any,strocture
primmiu Wuana.aim requires lheapplicenl for such rarest m file a signed aaumenl
£ o that he slimmed pursuant to the provisions of the Carmine,License Law(Chapter 9 Sq,Ft.Floor Area Valuation
y (commencing with Section 7000)of Division 3 of the Business and Profusion,Code)w $217333
3 that he is a comet therefrom and the bus for the alleged exemption.Any violamet of
Section 1031.5 by any applicant for a permit subjects the applicant io a civil penally of APN Number Occupancy Type
not moa Nen five hundred dollen(f5W).
0 1,u owner of the pmpeny,or my amploymvlthwage u Neil sole eompeaution,
will do the work and incite cture snotsmnded oraQetW tarsale(Sec.713M.Business UW
and Patednns Cade:The Commoners Limnx taw does ant apply 0 an owner of Required Inspections
propeny w ho bui Id,or improves thereon,end who does such work himul f or t1mugh his
own employees,provided that ueh Improwmnnlsme not mmndW araRered forsale.if.
however.W building or improvement is said within arc year of ormpledm,Ne awoer-
builder will have da burden of proving Nat Im did nm bWld or Improve for purpose of
ole.).
❑I.a ower of due Property am rsclusively contracting with Imuslo mnaacton m
construct the project(Sec.76th.Business and Professions Code:)The Contractors Li-
cense taw dean not apply to an owner of property who Wilda or improves Neeson,and
who mnuacu for such pmjccts with aconuaesens)licensed Puvuanl an Ne Commsemes
Lkcnee law.
❑1 em exempt under Su. .B @ P C fm Ns mssen
Owner Dam
❑ WORKERS COMPENSATION-DECLARATION
ammI herebyfundePenaltyofpejury ors ofthe following d
eclaolions:
Elm
mentionamriiasofconsntmelf-inaumfmwmkersCom
pcn-
sation,u providefor by Section 3700 of Ne tabor Calc.for Ne perfonnanm of Nc
work for which this permit is Issued.
❑1 have and will maintain Workers Compensation Insuranm,u required by Sedan
3700 of the tabor Code,for the performance of the work for which this permit Is issued.
My Workers Com ena11 Inannas anis end Policy number ue:
Grtie Polity No.:
CERTIFICATE OF lFMPTION FROM KER
COMPENSATION INSURANCE
(This section reed not W eompmaed trust Permit sfmano hundaddellars($1011)
or loan)
I notify Not in Ne performance of One work for which this permit is Issued,I hall am
employ any person in any manncem as in became mbjut w Na Workers Compensation
lawsof California.Date
APplianl
NOTICE TO APPLICANT:If,arm,making this Cc410am of Exompim.you should
become subject in the Worker's Compensation provisions of Ne labor Code,you must
.J O forthwith comply with such Provisions or this Permit mill W dcemod revelled.
„z,t CONSTRUCTION LENDING AGENCY
Ir r�r 1 hemby.firm that Nen is a construction lending agency for the performance or
a> the walk for which this permit Is Issued(Sec.3097.Civ,C.)
LQ Iandeh Name
z Leaders Addross
U0 I mnify Na I haw and dux application and etc that the above Wmmadun s
IL C✓ conca I agree an comply with all city and county ordinances and role hew neldng m
OUbuilding cmmuction.and hemby anthadre repremnatives of this city m enter upon Ne
W show-mentioned Propcny fm Windom purposes
(We)agae to save,indemnify and keep humle s the City of Cupetuno against
rrAA Ilabilides,judgments,cod and expenses which may In my say acme against said City
U z to a of Ne Sooting of IN pertntn,
(CANT NDERSTANDS AND WI L C PLY WITH ALL NON9. -P01 Issued by:91to�t�zw Date
OURCEREG LATIONS. lw
f e-roofs
S' nuun afA xAZARDOUSMATE ALS DISCLOSURE Dau Type of Roof
" 'Bre pplkant or future Wilding mupant stare or handle heardous material
nod by 0!caped,Munsi ode,Chapter 9.11.and the Health and Safety
Cade.Section 25532(.)+ All roofs shall be inspected prior to any roofing material being installed.
❑Yes a
will the appucmt or fuium Wilds g=opae use equipment or devices which If a roof is installed without firs[obtaining an inspection,I agree to remove
mit hemmous air conaminenu u th by Ne Bay Area All Quality Management all new materials for inspection.
Dimict7
❑Yes
haw mW Ne humdmsmucriasrcquimmenu undm Chepur i93 of the Glifor.
.Hal &S,feny Com.Sem.25305,215 114 umbntubthaif Na WildinS
d ale miyhawaunmak Nat its 'bullymnomfy Neamvpant rNe
ulama which mm mel faCerdOateofoca� ignature of Applicant Date
owner nth ,ears enl afnA Dam All roof coverings to be lass"B"or better
G