02100004 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRA,TORINFORMATION
Bu1L1i 1s. MPERIAL AVE TAYLOR WOODROW HOMES PERMITN®2100004
TAYd 1WR WOODROW HOMES 2300 CAMINO RAMON APPLICATTVY`g1Tg2002
PHONE: (925) 365-3100 SANITARY NO. 7 CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
µ40p LICENSED CONTRACTOR'S DECLARATION
ourI hereby affirm that 1 am licensed under Provisions of Chapter 9(commencing REVISION (BLDdo'iDes�ie o B)
y with Section70(XE of Division 3 of the Business and Professions Cods,and my license is
„ immltforce and eued IN HOUSE USE ONLY (ORIG. #02030115)
oq License Class Lim.a
Z r O Date Commons,
ARCHITECTS DECLARATION
O < I understand my plans shall he used as public records
3LL Licensed Professional
tLLO OWNER-BUILDER DECLARATION
Y 1 hereby affirm that 1 am exempt from the Contractor's License Law for the
so
w ❑O following reason.(Section 7031.5,Business and Professions Cocc:Any city or county
n'5$� which requires a pemrit to construct,alter,improve,demolish,or repair any structure $167578
w�" priono its issuance,also require the applicant Icer such Permit o lila aligned statement
SC?< that he is licensed pursuant o the provisions of the Contractor's License Law(Chapmr 9 Sq. Ft. Floor Area Valuation
of (commencing with Section 7WB)of Division 3 of the Business and Professions Case)Or
$ Nat he is esempt therefrom and the buil for the alleged exemption.Any violation of 35717018 . 00
Station 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number ` Occupancy Type
not mom man rive hundred dollars(s5011k 101 - FOUNDATION
❑I,as owner of the property,or my employers with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7094,Business ±e2 PiERS7
and Professions Code:The Contractor's License Law docs not apply in an owner of10 3 - UFER Required Inspections
prone"'who builds or improves thereon,and who das such work himself or through his
own employees,provided Nat such improvements am nm inhibited or offered for sale.If, 104 — REBAR
however,the building or improvements sold within one year of completion,rot owner- 1OS — ANCHOR BOLTS
builder will have the burden of proving that he did not Wild or Improve for purpose of
.to') 106 - SEWER & WATER
❑ I,as owner of the property,am exclusively contracting with licensed contractors to 202 - UNDERFLOOR PLUMBING
consumer the project(Sec.70OQ Business and Professions Code:)The Contractor's Li-
cense Law does not apply to an Owner of property who Wilds or improves therson,and. 203 - UNDERFLOOR MECHANICAL
who contracle for such projects with a communist licensed pursuance the Contractor's 204 - UNDERFLOOR FRAME
License Law,
I am exempt under Sec. .B&P C for this recon 205 - UNDERFLOOR INSULATION
erDar 301 - ROUGH PLUMBING
WORKER'S COMPENSATIONDECLARATION 302 - TUB & OR SHOWER
I hereby affirm under Penalty of Perjury one of the following declarations: 303 — ROUGH MECHANICAL
❑ Thaw and will maintain aCenif¢ate of Consenuo self inseam for Worker's Compton.
satiun,u provided for by Section 3700 of the Labor Code.for the performance of the 3 04 — ROUGH ELECTRICAL
work for which chis perms is issued. 3 05 — FRAME
❑ I have and will maintain Workers Compensation Insurance,as required by Section 3 06 - HOLDOWNS
3700 of Or,Labor Cale,for the pcRormancc of the work for which this permit is issued.
My Worker's Compensation Insurance Cartier and Policy number are: 307 — INSULATION
Carrier: Policy N., 308 - SHEETROCK
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE 309 - EXTERIOR LATH
O'busection meant becompletediftM permitisforone hundreddollamnla7 310 - INTERIOR LATH
nr1Co) 311 - SCRATCH COAT
1 certify Nat in the performance of the work for which this permit is issued.I shall not 313 - ROOF NAIL
employ any person in any manner m as 4)benrme subject to the Workerc Compensation
Laws of Californin Date 501 - FINAL ELECTRICAL ENERGY
Applicant n shoam 502 - FINAL PLUMBING ENERGY
NOTICE TO APPLICANT:is aper making this CcbiOmm the
Exemption,you
become subject cop)nine Worker's Compensation Permit
tshalons of rdemedUntie voke,you mon 503 - FINAL MECHANICAL ENERGY
OO forthwith comply with such provisions Lir this prmiuhallbedeemed revoked.
z CONSTRUCT ION LENDING AGENCY 504 - FINAL BUILDING ENERGY
[-+ i4 Ihereby alRrmOat more is rsuuctionleadingagencylorlheperformanceof 505 - FINAL ELECTRICAL
a > the work for which this permit isissued(See.3097,Civ.C.) 506 - GAS TEST
Iq
Line Na
Dme 507 - FINAL PLUMBING
Llo ca
U O LcnJcr's AJJr1 certify mace 1 have read this application and seam that the slow information is 5 08 - FINAL MECHANICAL
0U bonde�limsomco,and herebysh othro countyordinancesof and Cute laws relating 5 FINAL GRADE U�—
U. building agree to
ply hereby a city
and county ordiiveof this city to law,r upsn to
above-mentioned property for MxKcuon purposes. VO ,FIN ANNI G
P. (We)agree I.saw.indemnify and keep harmless the City of Cupertino against
fzry Imbilirics.judgment,casts and expenses which may in any way name against said Ciiy 5N LI WORKS
U M APPLIin CANTOof the UNDER3'LANDS ANnd ng of this D W ILL.COMPLY W 17'11 ALL NON POINT Issued byF NAIL Date
SOURCE REGULATIONS.
Signature of ApplicaRe-roofs 604 - OF IN-PROGRESS
HAZARDOUS
Date
IIA]ARDOUS MATE RIALS DISCLOSURE Type of Roof
Willt eapplicantor furore building occupant slate Lir handle hamalarial
of neJ byy me Cupcnino Municipal CnJe,Chapter 9.12,and the Ilcelth health anand mSafety
de,stains 25532(arf All roofs shall be inspected prior to an roofing material bei" Installed.
C]Yes C]No . P P Y g g
Will the applicant or future building occupant use equipment Lir devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit havardous air comaminant as defined by the Bay Area Air Qual try Management all new materials for inspection.
District!
❑Yes E]No
I have read me hwardous materials requirements under Chapter 95 of me Califor-
nia Ihour&Safety Conte,Sections 25505,25533 neJ 25534.1 understand mat if me huilding
does not currently haw a tenant,mat it is my resp rroihility in mai Iytbe Occupant of the
requirements which mug W met Prior it)issuance of a Certificate of OiCtgancy. Signature of Applicant Date
Owner or aumnrited.,at Date All roof coverings to be Class"B" or better