02100006 CITY OF CUPERTINOs '`
BUILDING DIVISION PERMIT CONTRACTQR INFORMATION "
BUILp@d0A8 glshlMPERIAL AVE TAYLOR WOODROW HOMES PERMI'IN®2100006
r
1ldhOR WOODROW HOMES 2300 CAMINO RAMON APPI.ICATITVY'V/ITI2002
PHONE: (925) 365-3100 SANITARY NO.// / CONTROL NO.
ARCI IDECf/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
p00 LICENSED CONTRACTOR'S DECIARAI'[ON
�w� IWmbyaffirm that Iamlicensed under pmvislmunrchapter 9(commencing FIELD FIXES (PTE���p1ion1N HOUSE USE ONLY
Wa4 with Section 701h of Division 3 of to Business and Professions Code.and my license is
��„ infmlfracaoderfeet. ORIG. 402030118 , NO NEW PERMIT ISSUED
F12 Z License Class Lic.Y
n F q Date Co..,.,
ARCHTEC'S DECLARATION
1 understand my plans shall he used as puhlic raonds I�g�/
o k!
nEx Licensed Professional
OW NIam exempt
LDER UEthe RAFION
Comment \.�S
ua 0 1 hereby.Hirth that 11. ,u sin from the Cssions Code:Any c law lin the CiK'.L—
a.m—p o following reawa Knottit)1DL5,Business and improve.
de Professions demolish,
Any city s county
wsF wmrn reyairea a rmit hr ennstmca,Imnimprove.mmmnh,nr repair any stmmare $180137
prior to its issuance,also nspares the ap ulicnm frostier pareniuo flea signed sulement
mat W is licensed Pannoniato the provisions of rhe Chrom wis License law(Chapter9 Sq. Ft.Floor Area Valuation
a�$ lurmmcncing with Section flick))of Division 3 of be Business and Professions Gale)or 35717018 . OO
9 shat he u eumpt therefrom and the basis for the alleged exemption.Any violation of
Section 71131.5 by any applicant for a permit subjects the applicant o a civil penalty of APN Number Occupancy T
not mom than eve hundred dollars(s51gp. 101 - FOUNDATION P Y YPe
❑Las owner of the property,or my employees with wages as their sole compensation. ±132
will do me work,and the infusion,is not intended or offered for sale(Sec.7B4d,Business
and Professions Code:The Commit License law does not apply to an matter of 103 - UFER Required Inspections
pmpcny who builda urimproves then,on,and whodassuch wart himselforthrough his
mvnemployeas,provided thatmehimproemenceare notimmndedorofferedfrrule.lt 104 — REBAR
however,me Wilding ar improvement u sold within ore year of campledon,the.,-
btildcrwill have theWfden of Fuming Nathe did notWild orimprovefar jurlaseof 105 - ANCHOR BOLTS
Pete')' 106 - SEWER & WATER
01,as Owner of the property,am exclusively contracting with licensed contractors to 202 - UNDERFLOOR PLUMBING
construct Ne project(Sec.TW,Business and Professions Code:)no Contractors Li-
censeLawdasnotapNym an owner of property who Wilds orimproWsmamnn.and 203 - UNDERFLOOR MECHANICAL
Lorenntactts lmm
for such projects with aconcKhandful s)licensed handfuo fie Character's' 204 — UNDERFLOOR FRAME
I an exempt under Sce. ,B&P C for this reason 205 - UNDERFLOOR INSULATION
of Dam 301 - ROUGH PLUMBING
WORKER'S COMPENSATIONDECLARATION 302 — TUB & OR SHOWER
Ihereby ammrunder Penalty ofperjuryone oThe following declarations:
303 - ROUGH MECHANICAL
❑Tna ve ono winfor by
neCion37M of Commmuo arta,for a refformsce of the 304 — ROUGH ELECTRICAL
satian,as pmvideJ for by Section 3IDn of me lalmr Axle,Iia dm perfurmancc of the
work for which this permit is ounce. 3 05 - FRAME
0 1 have and will maintain Worker's Compensation Insurance,as required by Section 3 06 - HOLDOWNS
370()of the IaW rCode,for me pedormarec of the work for which this Permit is issued.
My Worker's Compensation Insurance carrier and Policy number are: 307 — INSULATION
Canner: Policy No.: 308 - SHEETROCK
CERTIpICCOMATEPEN ATION INSURANCEORKERS' 309 — EXTERIOR LATH
(This section need not he completed if the permit is fmsione hundred dollars($100) 310 - INTERIOR LATH
lea'.) 311 - SCRATCH COAT
I cenify mat in the performance of the work for which this permit is issued.l 0.11 not 313 - ROOF NAIL
employ any person in any manner m as to become subject m the Workers Compensation
Iawsof Califomia.Date 501 - FINAL ELECTRICAL ENERGY
NOTICETOAPPLICANT:If.after making doxCerifiCaue of Excatiaturryou 11 502 - FINAL PLUMBING ENERGY
become subject to the Worker's Compensation provisions of the Labor Code.you must 503 - FINAL MECHANICAL ENERGY
zOnathwimmmplywimmchpruvisinmmthisPermitsnauhedecmedrevokeA. 504 — FINAL BUILDING ENERGY
.N. CONST'RUCI'ION LENDING AGENCY
F IherehyalTumthmtheraisacondoner..leading agency rnrfire Performance of 505 - FINAL ELECTRICAL
pis ti he work for which this Permit is issued ISce.XYR.Civ.C.) 506 - GAS TEST
Wo Lcoks"'Namc
0. IendcfsAddress 507 - FINAL PLUMBING
Up I cenify Nat 1 have heist this application and sum that the aWvc information is -508 - FINAL MECHANICAL
{✓ti h correct.I agree to comply with all city and county oNinancea and shote laws reliningm S51 FINAL GRADEbuilding conswction.and hereby authons,reprcmnutores of this city to cnmupnn thelU above-harmhncdprnpny for inspectonpmpoa. FIN I G
(We)agree m save,inJcmnify and keep harmless rhe City of Cupeninn.gainsIA Imbilitcs.judgmenu,costi expenses which may in any waryacconcagainet said City N LI WORKSUZ in consequence of me granting of this Permit.APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued byNAIL Date c G
SOURCE REGULATIONS.
(Applica
Signature
Re-roofs 604 - OF IN-PROGRESS
HAZARDOUS
Dam n
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building nccupant sore or handle hasandous material
efred by me Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Section 25532(x)+ All roofs shall be inspected prior to any roofing material being installed.❑Ye0N
Will me applicant nr future building..pan,uecyuipmcm nrMviccs whish If a roof is installed without first obtaining an inspection,I agree to remove
emit havandom air conuminants m relined by the Bay Area Air Quality Management all new materials for inspection.
Disrin?
❑Yes 0 N
I have read me havardous materials iccluiremerasumcc,Chapter b.95 of me Caddo,
nix health&Solely Galc,Sccuons 255115,25533 and 255341 understand that if lW building
JOcs not currently have a tenant.mon it is my resprmsi hility to mots the Occupant of the
requirements which must he met prior missuance ofaCeolBcateofOccupancy. Signature of Applicant Dale
Owner(it amhuneca agent Date All roof coverings to be Class "B" or better