02030165 CITY OF CUPERTINO
RUILIIINC DIVISION PERMIT A TRACTOR INFORMATION:
BuB.plpry®tgnsslMPERIAL AVE TAYLOR WOODROW HOMES PERMITN412030165
40 1YDOR WOODROW HOMES 2300 CAMINO RAMON APPLICATInr1�2002
PHONE. --T925) 365-3100 SANITARY NO. / `�/ CONTROL NO,
ARCI IITECT/IiNGINHER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
00 LICI!NSI!D CONTRACTOR'S DECLARATION pQ6ty�J� fi�Jt''�p[tqtk_
rc�P 1wmbyaffirmmm1amfthe Ildoderpmvfsh,ns of.Codr, 9(commencing
heiNEW TOWNHOME dMefsg C1'1ON
with Scaion]IMkp nl Division 3nf the Business and Pndcssinns Cndc.send myliccnse is
�o„ inmBmmcandmNct. 1456 SQ. FT. LIVING SPACE
,OgE License Claes Lic.If
oz-o Date Commetnr 469 SQ. FT. GARAGE : $12029 . 85
C<=2R ARCHITECTS DECLARATION
% p�
Ygw� Ionce rsmnd u
my d.withall M could as public recent, ~e14ALED
�>V
=LL0 Liccnsed Prolesional
OWNER-BUILDER DECLARATION 2003
t�i a I 1 hereby allirm that 1 am exempt from she Contractor's License Law for the
w_0 0 following reason.(Section 7031.S,Business and Professions Code:Any city ser county iJ J
., O
a. ,2 which requires a Permit to construct,alcor,improve,dr00
or repair any structure
prior ar its issuan[c,aw reyuims the applicant for such permit In tilt a signed xlammenl �Y1�t�k���}'.s���s`�yp7Pj�g
1-56 that he is licensed pursuant m the provisions of the Contractors License Law Clasper 9 Sq. Ft. Floor Area —_•�B�\�
as-$ (commencing wi th Section]IMp)of Division 3 of NC B dinners and Proussions Code)or `�,1v
a — Nat he is exempt therefrom and the hasu for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil peraby of
not mere than ave handled dollars(350T. e Occupancy Type
❑ I,ae owner of the property,or my employees with wages a their sole compensation,
will Jo the work,and the structure is not intended or offered for sale(Sec.704,1,Business
and Protrusions Code:The Contractor's License Law does not apply m an owner of 102 - PI ERS equlred Inspections
property who builds or improves thereon,and who dots such work himself or through his
own employees.provided that such improvements are not intended or offered for sale,If. 103 — UFER
however,the building or improvement is sold within one year of completion,the owner
builder will have the burden of proving Nat W did not Wild or improve for purpose of 104 - REBAR
sole.). 105 - ANCHOR BOLTS
.umvner of the property,am exclusively convecting with licensed conUMIt)Mto 106 - SEWER & WATER
concoct the project(Sec.7614,Business and Professions Code:)The Contractor's Lt
cense law does not apply to an owner of progeny who Wilda or improves thereon,and, 202 - UNDERFLOOR PLUMBING
Latawmmrsuch projects with acontrulor(s)Eansed pursuant to the Contractor's
oae203 — UNDERFLOOR MECHANICAL
Iamrxemptunder See. B&PCoadisrawn 204 - UNDERFLOOR FRAME
c— D. 205 - UNDERFLOOR INSULATION
WORKER'SCOMPENSA ECLARATION 301 - ROUGH PLUMBING
I hereby affirm under pens of qury one of Ne following declmmions: 302 — TUB be OR SHOWER
❑ Ina andwBlmaintainaceai0ramdfcen mtawlrnsarefmwarktracempm 303 - ROUGH MECHANICAL
wtiuq az PmvideJ for by Section J]IX)of Ne labor Code,for the prrfnanance of IAe
wok B,rwldch Nixpermilixisi 304 - ROUGH ELECTRICAL
❑1 have and will maintain Workers Compensation Insurance,as required by Section 3 0 5 — FRAME
3704 of the Labor Cole,for thc performaocc of be walk for which this Permit is exalter
MyWorker's campensaunnInsurance carrier and Policy number am: 306 - HOLDOWNS
Carrier: Policy No, 307 - INSULATION
CERTINCATE OF EXEMPTION
WORKERS'
COMPENSATION INSURANCE
308 — SHEETROCK
(This section need not he completed if out permit is Intent hundred dollars;($30(h 309 - EXTERIOR LATH
less.)
310 - INTERIOR LATH
1 send,that in the padmanantt of the walk for which this permit is issued.I shall but 311 - SCRATCH COAT
emplo any Person in any mane . a e To 'oche Wmkers'Cempensninn
Laws as 313 - ROOF NAIL
AppOram
NOTICETO APPLICANT:If after mak,ng thn Cenificai entptlmbyoa shnto 501 - FINAL ELECTRICAL ENERGY
heliumsubject I.the worker's Co.
Pmvisi a Total,Crack,you muss 502 - FINAL PLUMBING ENERGY
OZ forthwith comply with such provisions or this Permit I W deemed revoked.
z 0 CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
4 1herebyaffirmOatthereisaconswctionlendingagencyfirthePerformanceol 504 - FINAL BUILDING ENERGY
a > the work for which this Permitisissued(See.3o9],Cii.C.) 505 - FINAL ELECTRICAL
W a Lender's Name
;Dz under,Address 506 - GAS TEST
U O I crafty mat l have read this application and state Na the awve information is 507 - FINAL PLUMBING
W (~ correct.I agree w comply with all city and county ordinances and state laws relating In
wilding cnsovction,dad hereby aurhmiae representatives of Nie city to enter.pan the 5(& F NAL MECHANICAL
W above-mentioned(Weare,In tertysave for inspection purposes.
wa Q 9 F I N
VI (Wc7 ng e m cost,indemnify and keep hamdcu the City of Cupcnsts against vv
.0 N liabilities judgments,coarsing expenses es which may in any way accrue against said City 5 N
V z APPLICANTeUNDERSTANDS(if the granting of'his Permit, O
AND WILL COMPLY WITH ALL NON-POINT Issued by51 - I WORKS Date tJ V
RCF.REGULATION .
D 2— Re-roofs
Si namrcof Applica1 ^°tractor Dam BATTENS
603 - OF IA2ARDOUSMA ALS DISCLOSURE Type0fR9f4 - ROOF IN-PROGRESS
Will Ne applicant or future building occupant store or handle hanedous material
as de0ned by Ne Cupertino Munrerpe Code,Chapter 9.12,and the Ilexlth and Sultry
ale,Section 25532(.):, All roofs shall be inspected prior to any roofing material being installed.
❑Yes Nu
Will the applicant(it future building occupant tau equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
Diamct]
❑Yrs 2<
I have read the bamrdnux materials requirements unJerChapmr 6.95 of doe Ca'
niallcalth&Softy Cod,Sccuoa,; 5505,25533 and 25534.1 understand that ifth,huilJln
NeteN ��• !•a/1 ^�
s not currently have a no.nNm it is my responsibility m ¢
nufy the cup t of e / l C�-
m4t�whichmunW bne,xedanttmaCen1ammOccur
'snc Signature ofApplicant Date
Owner or euthnriso m / All r1 coverings to be Class "B" or better