02100009 CI'T'Y OF CUPEKI'INO
BUILDING DIVISION PERMIT inCONTRACTOR INFORMATION:-
BUUI)6Q8�&IS3MPERIAL AVE TAYLOR WOODROW HOMES PERMIT Np2100009
AYItfOR WOODROW HOMES 2300 CAMINO RAMON APPLICNFT' S1f10)3Tg2002
PIIONIi:
(925) 365-3100 SANITARY NO.// CONTROL NO.
ARCUITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�!Op LICENSED CONTRACTOR'S DECLARATION
f�ZGI hereby affirm that l am licensed under provisions mf Chapter 9(commencing PLAN B FIELD FJY�C�SsSr�S'� HOUSE USE ONLY
with Se
<w ction701X0of Division 7rf Ne Buainsaand Professions Coad,mid my license is
infNmncandelfca. ORIG. 402030112 , NO NEW PERMIT ISSUED
Z License C1.w Lic.M
Co Z_a Dow Comracwr
2F=£�£w ARCIIITECI'SDECLARATION
�a k a 1 understand my plana shall be used as public rettadx
K�"V
w 3 w t- Licensee Professional ✓��
1— oVi OWNC:RBUILDER DECLARATION
R
tii<E I hereby effort that I am exempt from the Commcmes License Law for the
w.00 fallowing reams{Section 703I.5.Business and Pref,minns Code:Any city or county
at r S E which requires a pemtit m construct,alter improve,demolish,or repair any structure "'t$154018
FZ< prior o its issuance,also requires the applicant for such Permit o file asignedslalomenl
m
that he islicens,dpursuant mthe Pmviume,oftbeCmurannreLt..Law(Chapter 9 Sq. Ft. Floor Area Valuation
�F0 (commencing with Section 7100)of Division J of the Business and Professions C,de)or
that he is exempt therefrom and the basis for the alleged exemption.Any violation of 35717018 . 00
Section 7071.5 by any applicant for a petmil subjects the applicant to a civil Penally of APN Number Occupancy Type
not more man lam hundred dollars(S500). 101 - FOUNDATION p Y YP
❑ I,u owner of the property,or my employees with wages as their sole compertvtion,
will do fie work,and the structure is not intended or offered for sale(sec.7W,Business
and Professions Crude:The Commodes License law does not apply to an owner of10 3 - UFER Required Inspections
m
ppeny who builds or improves put and who does such work himself or through his
Own employees,proviked that uch impmsmntenrs art not intended or offered for sale.If, 104 — REBAR
however,the building or improvement is mW within one year of completion,the owner-
builder will have the burden of previous Nat M vindid not build or improve for purpose of
sale') 106 - SEWER & WATER
❑ I.as owns,of me pmpeny am exclusively contracting with licensed contractors or 202 - UNDERFLOOR PLUMBING
construct sheprojectnotaplyto an
rofprprtynudes and who
sds or ilbe Cmnuactoradd 203 - UNDERFLOOR MECHANICAL
w nae law c does not apply je as with
owner of property who sedd,or ire t to the
Centra.and
LcencLcontracts for such pmjecls work ac.nuanmrts)h,emsed pursuant to me Commnrn204 — UNDERFLOOR FRAME
I am exempt under Sec. ,B&P C for this reason 205 - UNDERFLOOR INSULATION
mer Date 301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER
I hereby affirm under penally of perjury one of the following declarations: 3O3 — ROUGH MECHANICAL
❑ lhave pnd rovide for
maintain of the dent Labor Cone.for
rtforerformaceoPem 304 — ROUGH ELECTRICAL
station,as provided fur by Section J70B of the Labor Gale,for the Performance of the
work for which this permit is issued. 305 - FRAME
❑I have and will maintain Worker's Compensation Insurance,a required by Section 3 06 - HOLDOWNS
71011 of the Labor Code,forme perfamanee of the work for which this paomit is issued.
My Worker's Compensation lnsurence carrier and Policy number am: 307 — INSULATION
Carrier: Policy No.: 308 - SHEETROCK
CERTIFICATE
COMPENSATIONION INS RAO CEORKERS' 309 — EXTERIOR LATH
(This section need not he cnmplewd B ilhe permit is forma,hundred dmlars($100) 310 - INTERIOR LATH
role".) 311 - SCRATCH COAT
I certify that in the Performance of the work for which this permit is issued,I shall not 313 - ROOF NAIL
employ any p,rma
n in any mnw as ner to become subjeeuo the Workeri Compensation
Laws of Califomia.Date 501 - FINAL ELECTRICAL ENERGY
Applicant
NOTICETO APPLICANT:If,after making this Cenowmeof Exemption,you should 502 - FINAL PLUMBING ENERGY
become subject to the Worker's Compensation provisions of the laMn Code,you must 503 - FINAL MECHANICAL ENERGY
O ,Z, forthwith comply with such provisions.,,his permiuhot be dammed mvok,d.
0 504 - FINAL BUILDING ENERGY
CONSTRUCTION LENDING AGENCY
Ihereby.11i'.that mere is a construction lending agency lits the Performance of 505 - FINAL ELECTRICAL
gY, >
the work for which this permhisissued(Sec.JIN7.Cis,C.) 506 - GAS TEST
mG std,,:
] z landcr'sAddreas 507 - FINAL PLUMBING
U O (certify that Ihaw read this tyand applicationandulna That the slater iw refiiun is 508 - FINAL MECHANICAL
0Ubuneingcontrmcomply,ardherebyaall utyrimrelmyoNinesofthinces dsmwlanterupingm 5 FINAL GRADE
0 building construction,anJ hereby authnri¢rtPocsenlatiacs of this city menter upon the
Wshow mentioned property for inspection purposes. 10 FIN ANNI G
(We)agree m save,indemnify and keep harmless the City of Cupertino against
N liubi litics,judgments,costs and expenses which may in any way accme against said City 5 N LI WORKS
U Z to consequence of the granting of this Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WIT)AL1.NON-POINT Issued by 0 F NAIL Date
SOURCE REGULATIONS.
Re-roofs 604 OF IN-PROGRESS
HAZARDOUS
SiSignal..of AppliceO Date11AZARDOUS MA'fg occupa DISCLOSURE Type of Roof
Will theapplicant or{Muni building e,Chapter
sourorand the
licalloanmaterial
Jc,Sce o 25 Cupertino Municipal Code,Chapmr 9.12.and the Ilcelm and Safety
e. Dyes us72(')1 All roofs shall be inspected prior to an roofing material beim Installed.
_ ❑Tea ❑N. P P Y g g
Will the applicant or famrc building occupant use equipment rr devices which If a roof is installed without first obtaining an inspection, I agree to remove
emit hazardous air contaminunuas defncd by the Bay Area Air Quality Managemam all new materials for inspection.
District?
❑Yes ❑No
1 have read the hamodous materials requirements under Chapter 6 95 of the Cali for
nia Ilculth&Safety GWe,Sections 2550.5,25577 and 25574 I uml,rswnd that if Ne building
does not currently haw a tenant,that it is my responsibility m notify he occupant of the
reyuimmcros which mug N mel prior to issuance of a Certificate of Occupancy. Signature of Applicant _Date
Owner rr authorised agent Date All roof coverings to be Class nBn or better