02100003 CITY OF CUPEKI'INO i��
BUILDING DIVISION PERMIT CONTRACTOR`INFORMATION:
IIDILFi6(Ml4;Sf1MPERIAL AVE TAYLOR WOODROW HOMES PERMIPM02100003
lydhflR WOODROW HOMES 2300 CAMINO RAMON AFPLICATTh"ITY2002
PHONE: (925) 365-3100 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
r00 LICENSED COboRACPOR'S DECLARATION
yd I"iF I hereby affirm but l am licensed under pmvisinnsuf Chapter 9(cnmmendng UNIT D FIELD RIM(9Y&W'-IN HOUSE USE ONLY
�¢8 with Section7(KX))of Division 3 of the Business and Profession Code.and my license is
<d in fullonceandeff«L $NO NEW PERMIT ISSUED, ORIG. 02030118
P'nZ Licenm Class Lit.0
Fy N Dam Contractor
qq ARCHM.CPS DECLARATION
a I understand my plans shall he used as public recordsp
w 3 w
Licensed Pnafcssinnal
y-t�p
OWNER-BUILDER DECLARATION
rcZ 1 hereby affirm that 1 am exempt from the Contractor's License law for the
i a 00 following mason.(Section 7031.5.Business and Pmfcssions Cods:Any city or County 1 S O 13 7
a�$ which requires a permm ua
it consfr ,alter,improve,demolish,or repair any suucarc
r%
prior it)its issuancealso requires the applicant forsuch permit it)file aligned statement
rZ?x< that he is licensed pursuant to the provisions oflhe Cmnucmr's License Law(Chapterq Sq. Ft. Floor Area Valuation
y1-$ (cammcngwithSection7050)ofDivision3oftheBusinessandProfessinmCode)o'
— thel he icin
s exempt therefrom and one basis for the alleged exemption.Any violation of 35717018 . 00
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of APN Number Occupancy T
not mom than five hundred do]]..(W)). 101 - FOUNDATION P Y YPe
❑I,as owner of the pmpcny,or my employees with wages as their sole compensation,
will do the work,and the structum is not intended or offered for sale(Sec.7M,Business ±82 PiERS
and Professions Code:The Contractor's License Law does not apply In an owner of 103 - UFER Required Inspections
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.If. 104 — REBAR
however.the building or improvement is sold within one year of completion,the owner. 105 — ANCHOR BOLTS
builder will have the burden of proving that he did not build or improve for purpose of
Ba)e.)' 106 - SEWER & WATER
01,as owner of the property,am exclusively contracting with licensed contractors m 202 - UNDERFLOOR PLUMBING
construct the project(Sec.70G 1,Business and Professions Cade:)The Contractor's Li.
cense law does nor apply to an owner of property who builds or improves thermal.ad 203 - UNDERFLOOR MECHANICAL
who contracts for such projects with a canmctor(s)licensed pursuant to the Contractor's
License Law. 204 - UNDERFLOOR FRAME
I am exempt under Sea ,B&P C for this reason 205 - UNDERFLOOR INSULATION
ler Dam 301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER
I hereby affirm under penalty of Perjury one of the following declarations: 303 — ROUGH MECHANICAL
I ban and will maintain a Celli firm of Consent o self-insure for Worker's compel- 3O4 — ROUGH ELECTRICAL
sation,as provided for by Section 3701 of the labor Code,for the performance of the
work for which this Permit is issued. 305 — FRAME
❑1 have and will maintain Worker's Compensation Insurance,as required by Section 3 06 - HOLDOWNS
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Worker's Compensation lmomnce carrierand Policy mon Nor 307 — INSULATION
Carrier: Policy No: 308 - SHEETROCK
CERTIFI ATIS OF COMPENSATION IINSURAANC WOR KERS' 309 — EXTERIOR LATH
(This section need am be competed if lxrmh is intone hundred dollars ltugB 310 — INTERIOR LATH
leas.) 311 - SCRATCH COAT
1 cenify that in the Perfmmance of the work for which this permit is issued,1 shall not 313 - ROOF NAIL
employ any Persian in any manner sat as to become subject to the WorkersCompensation
Law,sMicant Calirnmia.Dare
Appl501 - FINAL ELECTRICAL ENERGY
NOTICE TOAPPLICANT,krsCaafter is madnprCc vi.doncmc of E Labor Code.
502 - FINAL PLUMBING ENERGY
become subject y the Worker's Comte nation pmvi.sinns in the rated Code,you mon 503 - FINAL MECHANI CAL ENERGY
OO fnrthwiN comply with such Prnvisinnsmthis permit shall beJccmcJ revoked.
'z.JCONSfRUCr10NLENDING AGENCY 504 - FINAL BUILDING ENERGY
I hereby affirm that thercisa commuction lending agency for the Performance of 505 - FINAL ELECTRICAL
a > th'work for which this permit is issued(Sec.3(197,Civ.C.)
Lendcr's Name 5 0 6 - GAS TEST
W Q
z Lender's Address 507 - FINAL PLUMBING
U O 1 cenify Nal 1 have read this application and nam that the above information is 508 - FINAL MECHANI CAL
LL P correct.I some to comply with all city and county ordinances and sum laws relating to
0 U building conswction.lend hereby authntlmrcposenreivesofbis Ciryloenteruponthe 5 FINAL GRADE
W aMrvcmentioned(We) ,m It)saw,
ankeephs. MOFIN G
(We)coree ro save,indemnify and keep harmless the City of Cupertino against
N Iiabi lines,judgment,costs and expenses which may f n any way accmc against said City F N LI WORKS'U Z in consequence of the granting of this pefmil.APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued byNW
NAIL Date
SOURCE REGULATIONS.
Re-roofs 604 - OF IN-PROGRESS
Signature of u
Aimbe m/Cotncmr Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Nc applicant nr future building oecupam score or LanJlc hasarJnus material
'fined by the Cupenino Municipal Come,Chapter 9.12,and the Health and Safety
m.Semen 25532fan All roofs shall be inspected prior to an roofing material being Installed.
Cl yes ❑Na P P Y g g
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mail hamfdnus air tomtaminants as Jclined by the Bay Arca Air Quality Management all new materials for inspection.
Douric'fl
❑Yes No
1 have read the baaardous materials mquirentent under Chapter 695 of the Count
ria Healon&Safety Code.Section 255115,25533 and 25511.1 undersand that if the building
does not currently haw a tenant,that I is my resrymsibility to notify the occupant of No
requirement which must he met prior it)issuance of a Cenifreate o(O'cupancy' Signature of Applicant Date
Owner oraumoroedagent Date All roof coverings to be Class "B" or better