02100067 CITY OF CUPERTINO • ;
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:-
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I1u111i 01sgMPERIAL AVE TAYLOR WOODROW HOMES PERMIT NO 2100067
YdMR WOODROW HOMES 2300 CAMINO RAMON APPLIcATTIFSy�Y2002
IION17: —79-2-5T3 6—s-3 1 o0 SANITARY NO. CONTROL NO,
ARCHITECTIENGINEERo BUILDING PIiRMIIINTO
BLDG ELECT PLUMB MECH
0 0 0 0
X00 LICENSED CONTRACTOR'S DECLARATION ] 6D�y�g'y� p�
ebrU Ihereby affirm that lamlicensed uOur,prmikiomofChapter 9(commenting TRUSS CALES-INUHOUJL' L1UbE ONLY
a2� wi in Section 7ragBof Division J of the Business and Professions GNC,and my license Ls
mmlunnemmeffect. FOR PLAN A/B/C/D, BLDG 1-12
�Z Liemse Class Lic.g
ii°z—c pare cOntracror ORIG. 402030112
Q 1 understand my plans shall be dDEC^AR¢cm3
us
cU
to Q ; Limused 11 tessiorod
FrigOWNER-BUILDER DECLARATION
rc <y 1 hereby affirm that I am exempt true the Cummnor's License Law car the .
a r❑0 fallowing reason.(Section 7031.5.Business and Professions Code:Any city or county
w (< which requires a Femtit m construct,alter,improve,demolish,or repair troy Mmotloe
HZQ prior it)its minaret,alae requires the applicant for such permit 7o file a signed statement
ppxx that be islicertedpursuant it)the pmvislonsofthe Commcmr'sLicense,Law(Chapter 9 Sq. Ft. Floor Area 154VaI181tion
FO icommencing•with Section'Bgg)of Division 3 of the Busi ties,and Proleaslons Code)(itW that he is cacmpt therefrom and that basis for the alleged exemption.Any violation of
Section 7031,5 by any applicant for a pelmil subjects the applicant)a civil penalty ofOet.D otic Type
ant mom than five hundred dnlmra(ssBo). P Y YP
❑ I,as owner of the pmpeny,or my employees with wager as their sole compensation,
will do the work,and the structure is not intended m offered for sale(Sm.7044,Business 1:83: FE)bTlIBA
and Professions Cash:The COOLIMtors a«tree law does not apply to an Owner of 102 - PIERS equlred Inspections
progeny who builds or improves thereon,and who don men work himself or through his
own employees.Provided that such improvements srenm intended m offered(orsale.If, 103 — UFER
however,the building or impeovereem is sold within one year ofcompletion.the owner. 104 — REBAR
builder will have the burden of proving that he did not(mild or improve for purpose of
„I.). 105 - ANCHOR BOLTS
❑I,as owner of the property,am exclusively contracting with licensed convectors to 106 - SEWER & WATER
construct the project(Sec.7f ,Business and Professions Code:)The Contractor's Li.
cense law does not apply to an Owner of property who Wilds or improves thereon.and 202 - UNDERFLOOR PLUMBING
who contracts for such projects with a contractors)licensed pursuant to the Contractor's' 203 — UNDERFLOOR MECHANICAL
License law.
1037MI am exempt under Sec. B S P C for this reason 204 - UNDERFLOOR FRAME
net Date 205 - UNDERFLOOR INSULATION
WORKER'S COMPENSATIONDECLARATION 301 - ROUGH PLUMBING
I hereby affirm under Penalty of perjmy one of the Billowing decimations: 302 - TUB & OR SHOWER
I have and will maintain a Cenificae ofConaem to self-insum for Worker's Compcn- 3O3 — ROUGH MECHANICAL
nn,u provider for by Section 37W of the Ichor Cone,for the pesfonnance of the
k for which this penmi is issued. 304 - ROUGH ELECTRICAL
1 have and will maintain Wurkers COmpe ort Insurance,u required by Secdun 3 05 — FRAME
of thc tabu,Code,for the peormmamx ofNe wink for which this permit is issued.
Worker's CnmMmarition Insurance carrier and Policy number am: 306 — HOLDOWNS
Carrier: Policy No.: 307 - INSULATION
CERTIFI COMPPENSATIONIINSURANCE
ON FROM ORKf:RS' 308 — SHEETROCK
(Thisiawflan neednm Mcnmpleted ifthe permit is livor hundmildollms(gll0) 309 - EXTERIOR LATH
odes.) 310 - INTERIOR LATH
1 certify that in the Performance of the work for which this permit is issued,I shall not 311 - SCRATCH COAT
employ any person in any manner so as to become subjecuo the Workers'Compensation
Lawsof California.Date 313 - ROOF NAIL
Applicant
NOTICE TO APPLICANT:IL after making this Cenilicatc of Exemption,you should 501 - FINAL ELECTRICAL ENERGY
become subject o the Workers Compensation provisions of the labor Code,you most 502 - FINAL PLUMBING ENERGY
OO forthwith comply with such provisions or this Permit shall be deemed revoked.
z CONSfRUCTIONLENDING AGENCY 503 - FINAL MECHANICAL ENERGY
[-� I hereby affirm Nat there is a construction lending agency lar the perftamanccor 504 - FINAL BUILDING ENERGY
C >
'he mirk(Or which this Permit isissued(See.3W7.Civ.C.) 505 - FINAL ELECTRICAL
WQ Lender's Name
] z Under'sAddress 506 - GAS TEST
U O 1 cenity that I have read this application and state that the above information is 507 - FINAL PLUMBING
ty F corer l agree to comply with all city and county ordinances andnale lam"Clatingm 5 FINAL MECHANICAL
building cnnmction,and hereby amhono,representatives of this City to enter Orono the W mtiveabove mentioned property for inspection purposes. 09 FIN DE
(We)agree to save,indemnify and keep harmless the City of Cupertino against
ti Iiubililics,judgment,costs and expenses which may in any way rant,against mid City 5N N G
in consequerm,(if the granting of
his permit.
U ^ APP ACAN'T UNDERSTANDS tAND WILL COMPLY WITH ALL NON-POINT Issued by 51 WORKS Date
SOURCE REGULATIONS.
Re-roofs 603 - OF BATTENS
Signature til ApFlicaHAZARDOUS MATERIALS DISCLOSURE naractor Dat` Typeofft0f4 - ROOF IN-PROGRESS
Will the aFplicam nr future building occupi m store or handle hvardom material
defined by the Cupenino Municipal Code,Chapter 9.12.and the Hcalib and Safety
ale,Sectios ON.n 25572(.)7 All roofs shall be inspected prior to any roofing material being installed.
IF ❑Ye
Will the applicant or future building occupant use equipment Or devices which If a roof is installed without first obtaining an inspection, I agree to remove
Co it hazardous air contaminants m defined by he Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes 0 N
I &
roan the hmardl u,materials mgmosocr is anter Cbapmr fi 95 of the Califor-
nia 11.11,a:Safely Coda,Sochons 25505,25533 and 25534.1 undermand that if the building
does not cnnenlly have a tenant,that 11 Is my reslNmsihility In nolify the IceuFam of the
mr,mmments which must be met prior or issuance of a Cenilicatc it 0mroncy. Signature of Applicant Date
Owner or aathorixed agent Date All roof coverings to be Class "B" or better