02030174 CITY OF CUPERTINO °'"'°°�"'�
BUILDING DI VISION PER IT SCO RA'CR INr'dAT, �I�� _
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pg°RI PERIAL AVE. TAYLOR WOODROW HOMES PERMrrNO.02030174
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PZNYPiR WOODROW HOMES 2300 CAMINO RAMON PeRMrfl `R/"29/2003
RIMe: (925) 365-3100 SANITARY NO. CONTROL NO.
ARCHDBCDENGINEER: BUIIDINO PERMIT INFO
BLS LU 8 MECH
:0 ii LICENSED CONTRACTOR'S DECLARATION Job Description
0 I hereby affirm Nal 1 em Iimnred undo pmvisiom of Chepmr 9(mmmencing ^
2004withSecnon70B0)ofDivislon3of the Busin•_u and Professions CaM,and myliccne is r 2��
D� I.mu roma and effect. NEW TOWNHOME
Llccnm Clsa Lk.a
LL Dam cSDECr LIVING AREA 1649 SQ. FT. �Ufl.®��^
ARCHITECTS DECLARATION Vl
1 understand my plena shall he used at public racoma GARAGE AREA 430 S Q. FT. $12 619 .
G Licensed Pmfcssmvel
8 OWNER-BUILDER DECLARATION
1 hereby arthro that I am attempt from Ne Commences License Law for the
oo following mason.(Section 70313,Business and Professions Cade:Any city at county
$ which requlma a recall to constmet,alter,improve.demnitsh.Or mpur any stmeture
prim in its issuance.aim requires the 9PPlinm for men pemth to rile aigoad Imenem
F met he is licensed pursuant to the Provisimuofthe ContractoisLmmcLaw(Chapter 9 Sq.Ft.Floor Area Valuation
y (commencing with Section 7000).f Division 3 of the Businessland Pretensions Code)or
that he is accord Ihemfrose and the buts for the alleged exemption,Any violation of
Section 7031.5 by,"applicant for.permit subjects the applicant m e civil penalty of APN Number $IAe93Pgsy Type
not more Nen five hundred dollen(5500).
❑I,as owner of the property or my employees with wages An theirmle compensation,
will do the work and deswcmm is nor imendedmoffered forulc(Sec.7044,Business Re uired Inspections
and Professions Code:no Comossmors Licerue Law dons Out apply m an owner of q
property who bullds car Improvas thereon and whodom uch workhimselforthrough his
own employees,provided thatmch Improvements am not Intended mortared for sale.If. 101 — FOUNDATION
however,Inc building or Improvement Is mid within one year of completion.the awmr•
Wilder will It the burden of proving that he did not Wild or improve for purpose of 102 - PIERS
nsm')' 103 - UFER
u owns(of the&c.70.am tidos and eanuudng with )The Cenntracmn m
aomtrea sax protect(Sec.7014,Business and Rofeaiana Code:)71re conuactm's U• 104 — REBAR
come Lew does not apply to an owner of properly who Wilds or improves thereon,and 105 — ANCHOR BOLTS
who mntracts for such prejects with a conuacdor(s)licensed pursuer to the Cantnemes
License Lew. 106 - SEWER & WATER
exempt under Sm�COMPENSLA_
B k P C for this mum 202 - UNDERFLOOR PLUMBING
203 - UNDERFLOOR MECHANICAL
ORKEON ,
I thereby afiren undng declarelmns: 204 — UNDERFLOOR FRAME
❑I haveand will mnminacedOcemorcousenitoulf•msumforwahees Compen. 205 — UNDERFLOOR INSULATION
satin,as,provided for by Section 3700 of the labor Code,for dm performance of the 301 - ROUGH PLUMBING
wmkforwhichthisPermBlalssued. 302 - TUB & OR SHOWER
r]I have and will maintain Workers Compensation Insurance.as acquired by Section
3700 of the labor Cods,for the performance of the work for which this permit la based. - 303 — ROUGH MECHANICAL
My workers Compensation lnsunnm carrier and Policy number am: 304 — ROUGH ELECTRICAL
center'. Pollry No.:
CERTIFICATE OF EXEMPTION FROM WORKERS' 305 — FRAME
COMPENSATION INSURANCE - 306 — HOLDOWNS
(Tnlsamtlm need nolWcompleted iflhe remit le intone hundred dnllm(SIW) 307 - INSULATION
ctrl"`) 308 - SHEETROCK
1 certify Net in pufmmanco of the wah fm which Nb (mit r1 Issued,I shall not
cmpl crwn laay man an` N a n ' IsboCompcwtion 309 — EXTERIOR LATH
ave`° °' °' 310 - INTERIOR LATH
App1k t '
Norlc PLICAN:If.after making this Cedficamo paerryll�w0, 311 - SCRATCH COAT
ism them to tiro Workers Compensation previno her Cndc,you must
.�ZO forthwith comply with such pmvtsions or this Permit arta I bodeemd m
ewked. 313 — ROOF NAIL
7a- y CONSTRUCTION LENDING AGENCY 501 - FINAL ELECTRICAL jN! RGY
E4 1hcmbyOff.thatfmieemnstructionlendingagencyfortheperformanceor 502 - FINAL PLUMBING ENGY
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the work for which this permit Isluued(Sec.3097.Civ.Q 503 - FINAL MECHANICALIanticr'a NandarwAddress 504 - FINAL BUILDING ENGY
U O I certify wt I have mad sale application mutism that the show information It 505 — FINAL ELECTRICAL
W F cormck 1 agree to comply with all city and county ordinances and whom laws mining to
p U bu0ding,mimed Property
and hemby°uNodrerepmstnmtiws of sats city to color upon dm GAS EST
0W [hovcmconstrudion,and her Insby audhodee rosea
LL (We)agree m waw,indemnify and kap harmleu the City of Cupertino against 0 7 F I
H liabilities,judgments.costs and expenses which may in my way mems,against aid City 5
IC,
`
tj 7 In consequence of the gaming of this Permit.
F7 APPLICANT UNDERSTANDS NO WILL COMPLY WITH ALL NON-POINT Issued by:5 Date
BGULAMONS,
Re-roofs
Signatuseof ApplicenUContnctor Dem 5 4 - INAL PUBLIC WORKS '
HAZARDOUS MATERIA Re Type ofR 2 - ROOF PLYWOOD NAIL
Will the applicant or future Wilding numrem bend-,Imeudom mamrfai
as denned by the CuKrdnw Municipal code.Chapter 9.17,and the Health and Safety 603 — ROOF BATTENS
Code.Sectionu537(a)? JJ All roofs sbigkbeins prP Wirt%( gWglr,slaterial being installed.
❑Yea ANO
Will the applicant Or future Wilding occupant um equiPmml On devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit havudnus air mnhominants as dullard by ile Bay Am Air costly Management all new materials for inspection.
District?
1:1 Y. IQrvu
In—read the handout materials requirements under Chapter 6,95 order Califon
ria Nesbit A SafstyCodc,Sack ns75505,75533 and 25534.1 understand he if the Wilding
does not currently hew rank that It Is my rapmenhony m noufy the Occupant or the
gp�wnim m",t oma an cwR ancy.ar nature of Applicant Date
Owner or h°rlandagent Data All roof coverings to be Class"B"or better