02030127 CITY OF CUPERTINO
i BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10110 IMPERIAL AVE TAYLOR WOODROW HOMES 02030127
WNER'S NAME: APPLICATION SUB DA
AYLOR WOODROW HOMES 2300 CAMINO RAMON 03/212002
14 TION[: SANITARY NO. CONTROL NO.
(925) 365-3100
q t Zo ARCHITECr/ENGINEER: BUILDING PERMIT INFO
14
<UE BLDG ELECT PLUMB MECH
Gia u u o
Z H 2 LICENSED CONTRACTOR'S DECLARATION Job Description
O Z_G 1 heresy a).f mm 1 n3licensed sneer provision of Chapter 9(comma¢nse
F.�tS it infllto=andefect. onlofh BuzinexxandPnfe ionCwk.andmyliccnw TOWNHOME LIVING SP . 1771 1MT7.2707 .
infull and effect. ■ ■0 �,46 ®
a.a scene ems. Co a GARAGE SP. 498 GARAGE ■■■ 7
a.m Date Contractor
3 ARCH ll be ue DECLARATION
as
3 1uWcmane my plans shall be sue¢public mcoNs APR 2 2 2003
O O Licensee Professional
z OWNER-BUILDER DECLARATION y''�
1 hereby affirm that 1 1. exempt Business an the Cessions i s License Law for the BUILDING
-t? following reason.ISenith t I am xempt e,N Professions Code:Any city w county
p�{F p which regw¢v a pem,i„n cons,m<6,her,i.......demolish,or repair any s,rucmrc
m.-prior to its issuunea.also requires the applicant for such permifso Cite a signed statement -
e3.— _ dpunuanftothe Provisions ofMeCommitteesLicense Law(Chapter 9 S -Ft Floor Ar Valuation
(coNal he et licenw
g ifs Secrerin and the basis for
t meelifiedcs andlmi.An,
Code) o .i'� t : ri.-�+q aUe i:',Viii F1, i '"
or He is ezempi thd algid end the basis for the ,(far eiemp.iJr..Any l violation '''
of Section than iv any hundred
o ll for r permit mhjens the upplicam o civil penalty 'A 571 7ni R on
Pr not more man Ove nnodmd dolmra asW). APN Number .: Occupancy Type
01,as more,of the property.Lir my employees with wages as their sale compensation,
'
will do the work.and the stmcmm is not intended or offered for sale(See.'I00.Y -1 O2 — PIERS Required lUSpeCtlOn$" •' �
"Buiineis and Professions Code:The Commnm's Licenla
se w docs not apply to an —
ownerofpnpertyWhobuild,or improve,thereon,a ad who does such work himself 103_ - UFER
or through his own employees.provided that such improvements are not intended oroffered
. .. .- ._--- ._ ... _.....__._,
orale mon- ,h will
ete p - -ins oleliednoneyearof 104 - REBAR .
inaporfoythe owner-bt'IJerwll hove the harden of pain ng,hat he did not build or 105 - ANCHOR BOLTS
improve for purpose of sale.). �
- - - - - --' 106- ._-SEWER & .WATER' - - - -- - -
L mc, her of Ne p(Sec.7 ames Profeing with licensee mnvacson m
i°anseLahwdoesnotlappiv�nmonerofproertywhion.,cade:1TheCannaems 202 - UNDERFLOOR PLUMBING
i apply property what builds or impruvn thermn,
.', and who cammcu-for.such Prajens.wiN a conreclons)licensed pursuant io me.- ..-2 03--__--UNDERRLOOR-MECHAN.S.CAL__-
Commcmr..License Law. - _.-..-. .. ..-
J, am exempt underSec:'t ' " 't ' ,B&PC for his reason 204 - UNDERFLOOR:l'FRAME•,ti'
4 '= ow Data ? Son- ; ' 205 - UNDERFLOOR INSULATION
R 'S PENSATIONDECLARATION 301 — ROUGH PLUMBING
I hereby affirm penehy of per jury one of.the following declarations: 302 — TUB & OR SHOWER
-f ❑ 1 have and will maintain a Certificate of Consent to self insure for Worker's 303 - ROUGH MECHANICAL
Comn,pensatioas Presided for by Section T/W of the Labor Code, far me
petramo,nce of be wank hr whiehhis pnini,is ixsul 304 - ROUGH ELECTRICAL
❑I has.and'will imolai Wakens Cumpensatiun'Gsumnce,as required by Section 305 - FRAME
d]W of the Labor Code,for the performance of the work for which this permit is 306 - HOEDOWNS
issued:My Workee,Contamination Insuamncanner and P.1hynumber arc:
, 307 INSULATION
Cm r r „ - .t policy No..' -
,t_CERTIFICATION.OF EXEMPTION FROM WORKERS'i i.'k_)� 15308 h-k,SHEETROCK\.• :I"*= I `
COMPENSATION INSURANCE Is 'a• _
ITh,simian'nvedom be'cdmplmed ifthe perm,is n.rone hrrdreed°0°rt 310 - INTERIOR LATH
1 trends that m he ,forma P-ot`the work for r,hr6ti retissued, -3'11---'"S CRATCH COAT - -- -- -
snalit ply 'y pert an'n ,mrnner so as r�i�. nj kr°Permit
is
kl 313 - ROOF NAIL.,:'`
C. tee srlCall ir'D .501 _..- _FINAL -ELECTRICAL..-ENERGY-..
_
-APPI rs. _ ['� _
NOTICETOAP `tt'maktg nti eat ex -poor yon snoym hm502 - FINAL PLUMBING ENERGY
e e subjen to rheH rka' Compsnsrt p in flh Labor Cede,you must
Z
fail ,!In vomjilwith suchpnv o thisp ed J ked_ 5,03 -.- FINAL MECHANICAL-ENERGY
_ . . -
v. t r ^v'CONSTRUCTION LENDING AGENCY
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