02100008 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTORINFORMATIONs"'''..
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13UI ES.: PER AL AVE TAYLOR WOODROW HOMES PERMIT NO 2100008
:AsYe f FR WOODROW HOMES 2300 CAMINO RAMON APPLICATIQf@SIAUITY2002
PHONE: Cj 365-3100 SANITARY NO. CONTROL NO.
ARCHTTECDENGINHER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECB
0 0 0 0
�00 LICENSED CONTRACTOR'S DECLARATION
� Iworry al'firmthat lamlicensed under provisions OfChapter 9(commencing FIELD FIXES (AUeSFJIPtt�°LtDG 2)
G<U with Ration]IXXp of Divi.vinn Sof NC Business and Professions Cak,anJ my license is
X.py mmllfomcaadeffect. ORIG. #02030118 , NO NEW PERMIT ISSUED
qz class Lie.
p Z Date Contractor IN HOUSE USE ONLY
ARCHITECTS DECLARATION
o ¢< I militated my plans shall M used as public mord"
a
t�is
�pF Licensed Professional
dd OWNEm BUILDER DECLARATION
ConTION Y
vWi 1 hereby Maso affirm that I am exempt from Nc Convectors Cock:Any c law for thefollow \�'J
aap0 whichingrcawa ermitin)Ip LS.Business and Professionsh,oAny city orcounty
a�$ wainiresuisunPermit maonewn,alrcq improve,hPer ixq�re a sig any structure
r—Z> pronnitscensed pursuantce,also to(be
isionanl for sucContra a'al inense Aw(Cned ammcm
<
that
f�pcommescingwJpuavanuoNcpnwivioaolordeBusaurtandPromew(Chapmr9 Sq. PL Floor Area 16O51a3u''a(lon
that he a exempt Sandman Imid of basis for
nnheeged Business enJon.Anyavi Caon(if
$
that Section
o exempt Nercfmm and the bars for the alleged Gumption.Any violation of
a.,ro dID31.S by any applicant for a Pernriuuhjccts the applicant a civil penally of -3 bATW
nos more Nen five hundred dollen(SNp). be Occupancy Type
❑I,m owner of Neproperty,or my employees with wages as their sole compensation,
will du the work,and she abortion is not amended proffered for sale(Sec,7W,B timesa
and Profe dime,Caere:The Conutcmr's Liccnx Law does not apply m an owner of 102 - PIE Rs
IERS equlred Inspections
progeny who buil&or improves foredo,and who doessuch work himself or through his
Own employees,provided Nat such improvements art not intended or offered for sale.If, 103 — UFER
however,the building or improvement is sold within ane year of completion,the owner. lO4 — RE BAR
builder will have the burden of proving Nat he did not build of improve for Impose Of
sale.). 105 - ANCHOR BOLTS
1,as owner of the property,am exclusively contacting with licensed coronion to '106 — SEWER & WATER
Conswct the project(Sec.7041,Business and Professions Code:)The Contractors Li-
censelawdnesnotapplymanownerofpropenywhohuildsorimprowsNereon.and, 202 — UNDERFLOOR PLUMBING
who
enscontracts Low. fnr such projects with aconuacmgu
s)licensed pursuant the Conuactufa
License ta203 - UNDERFLOOR MECHANICAL
I am exempt under Sec. B h P C for this moon 204 - UNDERFLOOR FRAME
mer Data 205 - UNDERFLOOR INSULATION
WORKER'S COMPENSATION DECLARATION 301 - ROUGH PLUMBING
I hereby alarm under penally of perjury one of the following decimations: 302 — TUB & OR SHOWER
❑l have and will maintain a Ceti fica ,of Consent to self-insux for Workers Compcn-
an3O3 — ROUGH MECHANICAL
ion,a provided for by Section 3]1X1 of the Latour Code,for Ne Performance of the
work for which this pacmid I,issued. 304 - ROUGH ELECTRICAL
❑1 have and will maintain Worker's Compensation Insurance,a required by Section 305 - FRAME
371X1 of Ne Labor Code.for the performance of the work for which this Permit is issued.
My Worker's Compensation Insurance carrier and Policy number are: 306 — HOLDOWNS
Carrier: Policy N., 307 - INSULATION
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE 308 - SHEETROCK
(na"xe6on need not lr completed ince Permit is for one hundred dollars PSill)) 309 — EXTERIOR LATH
"'lei) 310 - INTERIOR LATH
1 verify Nat in the performance of the work for which this Permit is imucd.I shall not 311 - SCRATCH COAT
employ any petition in any mannerist as to become subject to the Workeri Comp nsiahm
La.mfcahfums.Date 313 - ROOF NAIL
Applicant
NOTICE TO APPLICANT:If.she,making this Ccnilicamof Exemption,you should 501 - FINAL ELECTRICAL ENERGY
become subject to the Worker's Compensation previsions of the Lahr Curt,you must 502 - FINAL PLUMBING ENERGY
z forthwith comply with such provisions or Nis permit that bee dccmcd rtvokcJ.
O
CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
[.. .Nw If which this
Nn Nercisaed(Sec.construction Cor agency lira Nc Performance of 504 - FINAL BUILDING ENERGY
ai ti Newark for which this permit is issued(Sec.3(19].Civ.C.) 505 - FINAL ELECTRICAL
W q bender'sNamc
= LcnJcr's Address 506 - GAS TEST
Vp 1 cenfly Nat I have mail this application and Sum Urn the above inmemnimn is 507 - FINAL PLUMBING
Iy F correct.l agree to comply with all city and county ordinances and tam laws rclnivgm S FINAL MECHANICAL
O building convection,and hereby autforim repecienatives of Nis city m+emerupon the
abnve�memioncd propmy forinspecron purposes. O9 FIN GRADE
Lie (We)ago m ave,indemnify and keep harmless the City Of Cupertino egaimi
fz�j3
liabilities,judgments,costs and expenses which may in any way accrue against said City 5 F N G
U M
APPLICANT OUNDERSTANDStAND WILL,COMPLY WITH ALL NON-POINT S 1 WORKS
Issued by. Date
SOURCE REGULATIONS.
Re-roofs 603 - OF BATTENS
Signature nl ApplivaHAZARDOUS MATERIALS DISCLOSURE mlContractor marc Typeof P404 - ROOF IN-PROGRESS
Will dm applicant of future building occupant store or handle hasaNaa material
cfined by the Cupcnino Municipal Cuda Chapter 9.12,and she Health and Safety
e."than 25532(a)'
d ' - All roofs shall be inspected prior to an roofing material beim Installed.
❑Yea ON. P P Y 8 g
Will the applicant arfmturebuilding Occupier,uxcquipmemurdevices which If a roof is installed without first obtaining an inspection, I agree to remove
emit hazardous air cunmminunls as defined by the Bay Amu Air Quality Management all new materials for inspection.
Diin,11
El Yes 0N
1 have mad the hwamous materials requirements under Chapter fi 95 of the CUlifor
nia Hcald,A Safety Code.Satious 25:55.25533 and 25534.1 understand that if the huilJing
does not currently have a moan,Nat it is my fesry+aibibly to nouly nbe Occupant of the
requirements which most he met prior m issuance of a Ceruficam of Occupancy.
Signature of Applicant Date
Owner Or aumaamd agent Ga. All roof coverings to be Class "B" or better