02020013 CITYOFCUPERTINQ-,
euanwc,ntv[stoN. : PERMIT ' +CONTRACTOR,INFORMATION: = ='
< iBU1LDING ADDRESS:,y, f• ,x - " PERMIT NO
OWNEftS NAME,.- ... '' -' -'_ - -" " APPLICATION SUB DATE --
TAYLOR'.-WOODROW HOMES .02/05/2002
t� .HONE , r •• - - SANITARY NO. CONTROL NO.
4Wp ARCHITECT(ENGINEER:, BUILDING PERMIT INFO
'k,,a C ' (7 - BLDG ELECT PLUMB MECH
w Z „ LICENSED CONTRACTOR'S DECLARATION Job Description-
as
escrl tion -
I hp by 0).f thin I l3 l .ft d pr l 1„m of art Cu )fc mine c'ng ]I
C bbfdI e*.Ad.Ba,1 ] 'f di Ba a neProfession Axle amyl' n. DEMO.
isremRm< aerc«t
�z a Ida ase Cl u + L".# S 2,047 BLDG. 3 CANNERY WAREHOUSE .
y LL'Ot; .. f
ARCHITECTS DECLARATION I
< 1 understand my plans shall he used as public mcords
y 6 dd 1 1 O O . Licensed d Professional .. •� � �. . ;. 4 -•.. �
OWNER-BUILDER DECLARATION .s-
u'i.-m ' 1 hereby affirm fairs am exempt from the Conlnnor's License Law for the s v
(=?Q .following all lSeefion70313,Business end Professions Code:Any city or county � - -
I,S 0
which requires a Permit to construct,alter impose,demolsh or rarlair any niuclu«
, Pried to its,ssuniice'xl gmrcrthe ppl,cen,for such Permit to fl gnrdsmm t
Ibil hq dlcesed puisuanl,nlFi2Rb mons of the Cont ,meL cm La {Chapter9 - i .S Ft F'lOOl Area , 5 1 ation
loom nig with Sect onl]WO)nf 'vie n3 flhc Busing amt Pit fSi lone Code) ¢:' 1 9•h g .i �. ....... ..
.I , 1•-. `s 1.. :A ri EP ei.' I _......., - ._. . _ _.. ._
Art
t h s dxempi!h f o tine the bas.fo the alleg<tl ex+unpl rid A y iol 1 on
a n701156 bumf "' - '
t Y e Y PP .15300 ,s bje tithe apple Ito l'Ix rally-
of e= -
n
fn ,morcme ren dreddnll ) - b - - Occupancy Type
❑1,
as net.
the propenY,uimY crnployees ai,h wa8es iuheir sole uimpcnsalIon, --..._...._....._._.__ . .. .. a.. ". _ _ _ _ _ _
"will d the wbrk'.ilnd N swnure. _h nt nded or oRered far sole(Sec,1044 1,_ ;-_-
_.
Bus nes nJ P fie.si s C d Th Cont 1 e Lcense Law docs u,apply - • eelulre asp Mons
!.t r f p perry Wh bmltls r' Prov 'there n rid who docs such work himself
w
.J or t..ugh h s own employees.prov dad iho,such impro�cmcnu arc nm intended or s
;oRered for tile.lf hbwe'vei;SAe buildidg'or impiv'vem'chi ii solA wi,hih oha Year of "'-- '-..__.___. ... . ___...... _ ._ .._.. _. _ ......
f_-'- in;oeliun:,he ownervbuildcr will have the buNcn ofpmving that he JiJ'not build or
improve fo p iTo `
q e�m� ,_.. _. .......
s sf,hep party m los ly nt 1 g Ih l' J unvoct , •
continue,t Ih reciter a IS y to a B and Pif ons Cade)Theimproves
ve there r s _
It- Lice h L des not apply, an f p pony who builds se improves thereon, - - `�" '
aAd who License
La h projat iih a coin cmrfs)licensed pursuant m.me _
Central Lmenu La ... -. .. - �MAR-0'6
;• ., •' ❑lmat exempt undit,.Seo.• :E-Al P C lnnhis reason
OW a '.:.F ,..Dile .R v..'
WORKERS COMPENSATION DECLARATION
BUILDING
a
,l hereby ATimd pcnityinfppiury..A fine following declartailem: -
❑ ( hove mil Ammo a e Cenifican,of Corium m ulfansum far Worker's - - !
compcnsalioh;asro
;pvided•for,by.Section ]]00 of the tabor Cade,=for the f '- I` i. 1'
pert rm ace'of the workf r 'hich this pertnit s rcsucd. , 1, if
,•c
❑1In
hA ond•willmaime n Wo ke'e Compe s t'n urani< os«gvired by Sxuan
-
l]00 of the Labor Code far me performance of,he work for which,his pumil is _ ,. -
" "- issued.My Worker's Compensalidn lnsurenceceirier end Pglicy'numbei arc:': 'te,.
'a is d -r pot cy No . ) e +• ''l -� f.i sN 1 : q. -- —� i -
l
t `F1'rfICERTIFICATIONOF
_ COMI ENSATION INS
fl'hsueA'nn edit ttwc pined if lh prtnt 6'for n hu dad
doll Tax If
'---
rhall t emP oy o y pc n a y morin so m I be bine bice m,he Work - • ' ' "
Co.
o pc lonld xafC lfm Dete' " w'-
` NO'1ICEt0Al PLICANT If all rmaking lhis Ccnica, fE peon you5hn la
Z.
become subject 1 d e Worker's Co al etin nv Prs of me Labor Cod m you I s
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fidarthisitheomply wiflasu6provisimnscr This permit Nall A,deemed riT.1ked.
CONScoNLENDING AGENCY - - - _-
1 h -ny vRair,.Ihm[Write.
erc itu.e construction lending agency fo the per(oimance t L '
of the rk f r. h ch tits palm t 'slued IScc.]fH1,Cn C 1' - '
Wt.
' Lend sN ne''d..:o .,'.„r..,.,o_.:.... .:..1i. ..: ..- .. .- - .. ,
Lenders AJercss .. •. .. ... - - ,.,. -._- ..
w ,
1 can re Iha,l ha a read th's applica, n my oldie that theabove inmlllla lata is /
Q0 u .to if I repair, whu all city mricounty nlowiee Ands um tlaws urner
V to budding co wnion andherebyauthonurprcsenmtives f,hu ilywmler upon '
}y W ,heabo e m mi neo p pend ftranspacific.purpose _
L.,
P. ce to sa eiAd,molly and keep ha I Ai ttic C ry f C pen no against
I6n V1 liabd ties. A ans,ensuand expensed which may in Any way accruct against said ' e, bd
U
it in Are node ohhe gm Air,of,his gamut.
APPLICA'(gT UNDERSTANDS AND WILL COMPLY Wrrll ALL NON.POINT' t/
-a s Recuunojxs� '" n Issued•by: Da[ O
nm rc, fApplicvn,/C manor; , < •'
HAZARDOUS MATERIAI S,DISCLO$URE ' Re-roofs
wulmeapprcant f wrchulld' gonvpAM tore handmhnmNo sma¢nsi 'type of Roof
n d fined by the Cdpen Mun c pal Code Ch pia 9 12 a d,h H hh d Safety s
Code Seca 255a2ed) , -�� Cam ra l a. :,, ,� f •`- ' 1 •e j r .Lt" Cf s! { 'Y-,`-x -i,.. _.
All roofs shall be inspected prior to,any roofing ma[enal{being installed:
• LWIIIheeppl p yo f t b le' g occupant cqup to a swh�ch _[f a roof is installed without first obtaining an iris pectioti,'I agree'to remove
nnM1 allo a a, dined by ByA Arq AIryM ge , -
)( g
is T,to`ve all.new.materialsrfor,.inspectiot Applicant understands and will comply with._
�9
t. ,• tit :af all non-pomt'sou ce regulations
1 base tad'ttie heavd us moro2 req ,rtmemo'undcr 4,1 mgfi stand(the ,
Calf he it in il o s efme cur Code Sections 25505 t itis and 25S]4 I understand that
dciipamdn8doequirem nt,whily ah mustbtenant,that nsmyresponsibility tonotifythe -
acupa I f Ih rcquiremems which must be inn p r to issuance of a certificate of ' t "^tee-'•tt TC/`� .J�/V" Z
.occupancy ate
' Signature of Applicant D
owger or andhorroadagent 0.4, All roof coverings to be Class B" or 6etier',
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.OFFICE". -. .. .. . .. -. - .. _ ._ ...