02030191 CITY OF CUPERTINO '�+OWWW -'
BUILDING DIVISION PERMIT CONTMwT6R INF0RMATI0N '
Bulf-101ARTItItEssIMPERIAL AVE TAYLOR WOODROW HOMES PERMrrN(02030191
WN�1}SYWR WOODROW HOMES 2300 CAMINO RAMON APPLICATIO"�/BP9Y2002
HONE (925 365-3100 SANITARY NO. CONTROL NO,
ARCHITECI'IENGINCER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
JO0,p LICENSED CONTRACTOR'S DECLARATION Job Description
a u F 1 hereby affirm that I am licensed under provisions of Chapter 91 commenting NEW TOWNHOME
�Z1V with Section 7lkkBof Division Sof Oc Business snit Professinns Coticimdmy license is
<XX inlmlfn eandeHeet. 1589 SQ. FT. LIVING SPACE
Z License Class Lie.p
o�_ Dam Contractor 492 SQ. FT. GARAGE : ALeo
ARCHITECTS UIiCL0'mY� �aARATION
I unJcrsmnJ my plans shall he used as public records
�ad
U
3� Licensed Professional 0 3 2003
OWNER-BUILDER DLCLARATION NOVI'1 V Y L
d<Z 1 hereby affirm that 1 1. uempt from the Comas Co 1:Any c Law Ino the
—00
following mosun(Section 7871.5, t.alter. and Professions Code:Any city er county
which requires a e,also re nmss the aper,improve,h Permit t or repair any structurecap%RMn
HZe
poor to issuance,also requires the applicant Gu such Permit to asigncJ sOtcmcm
that he is licensed pursuant o Ne pow isions of the Contractor's Lice nu l<w(Chapter 9 Sq. Ft.Floor Area
ua�C (commencing with Section 70CKB of Division 3 of the Business and Professions Code)Or
y $ Nal he is exempt therefrom and the hams for the alleged exemption.Any violation of
Section 7071.5 by any applicant for is permit subjects the applicant to n civil penalty of
not more than rive hundred dollars($500). C Occupancy Type
Q 1.m;owner f the property,or my employees with wages as their sole compensation, 3:01: Feb
will do the work,and the structure is no,intended or offered for sale(Sec.7140,Business
and Professions Code:The Conuacto$License law does not apply to an owner of 10 2 - PIERS equlred Inspections
property who builds or improves thereon,and who does such work himulf or Nmugh his
Own employees,provided Nat such improvements arc not intended or offered for ale.If. 103 — UFER
however,the building or improvement is sold within one year of Completion.the mvner. 104 — REBAR
builder will have the burden of proving that he did not build or improve for purpose of
ale'1' 105 - ANCHOR BOLTS
L7 L as owner of the propeny,am exclusively contracting with licensed contractors to 10 6 - SEWER & WATER
construct the pmiecl(Sec.7041,Business and Pm(essions Code:)The Contractor's Li.
cense law does not apply to an owner of property who builds or improves themon,and, 202 — UNDERFLOOR PLUMBING
who contacts for such projects with a contrautor(a)licensed pursuant to the Convectors
License Law. 203 - UNDERFLOOR MECHANICAL
❑I am exempt under Sec. ,B&PC for this mason 204 - UNDERFLOOR FRAME
woo Bate 205 - UNDERFLOOR INSULATION
VORA!I�"
ATIO301 - ROUGH PLUMBING
Therebye8imsunlowing declarations: 302 — TUB '& OR SHOWER
❑ I have and will maintain a CeriricamofConsent in wit mom for Worker's Compete 3O3 — ROUGH MECHANICAL
a00 tion,as provided for by Section 37of the labor Cade,for the performance of the
won for which this .i,is issued. 304 - ROUGH ELECTRICAL
❑I have and will maintain Worker's Compensation Insurance,as required by Section 3 05 — FRAME
3711(1 of the labor Civic,for the performance of the work for which this permit is issued
My Worker's Cnmpemvatino Insurance carrier and Policy number ere: 306 — HOLDOWNS
canner: Policy Nn: 307 - INSULATION
CERTIFICATE
COMPENSATION 1INS RANON CEORKCRS' 308 - SHEETROCK
mus seaionnecd of h completed if the Permit is forone hundred doll.(il0q 309 - EXTERIOR LATH
or leas.) 310 - INTERIOR LATH
I certify that in the Pedommnce of the work for which this permit is issued,1 shall but 311 - SCRATCH COAT
employany person in any manner to nnln the Workers'Compensation
Law
of Dile— i hr y 313 - ROOF NAIL
NOTICE TOCANT.If,after making this Cc ificam ten,you should 501 - FINAL ELECTRICAL ENERGY
Mame subject the Worker's Comp,nation pAw of the UNOCCode.you must 502 - FINAL PLUMBING ENERGY
C) z forthwith comply with such provisions or this permit shall he deemed revoked.
z0 503 - FINAL MECHANICAL ENERGY
CONSTRUCTION LENDING
iN+ Iforhereby which
this
that there isacd(See.YAR.Co, gency for the performnnce of 504 - FINAL BUILDING ENERGY
ai ti the work for which this permit is issued(Sec.11th], iv.CJ 505 - FINAL ELECTRICAL
IAz Lender's Name 506 - GAS TEST
Le de Address
U1 certify Nat 1 have read this application and sum that she above information is 507 - FINAL construction. PLUMBING
U2 f correct.1 agree to comply with all city and county ordinances and state laws relating m 5 FINAL MECHANICAL CAL
building consction.and hereby authoriac representatives(if this city to enter upon the
above-mentioned property lou inspection purptuos. 09 FIN DE
(We)egrec to save,indemnify and keep harmless the City of Cupertino against
F',o) liabilities.judgments,costa and expenses which may in any way accrue against aid Ci ty Ij N (1 l O
U Z in cnm¢qunc
ccuf the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON POINT Issued by51 WORKS Date
RCC REGULAT
Re-roofs 603 - OF BATTENS
Signature of ApplicxHAZARDOUS MATE . DISCLOSURE Dom Type ofR004 - ROOF IN-PROGRESS
Will Ncapplicant orfuturc buildi twcupant smrc or handle haardous material
as defined by the Cupertino Municipal Cole.Chapter 9.12,and the Health and Safety -
cede.seeeezss3z(a)7
E]yea R4., All roofs shall be inspected prior to any roofing material being installed.
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
emit hazandous air contaminants as refined by the Bay Area Air Quality Management all new materials for inspection.
District9 �N/
C]Y.
In w mad Ne hamWms mamrialswquimments un&rChapwr 6.95 of the Califon
nix Health gr Sa(cty Gak,Sttrorts25N15.2s5A am125530.1 un@stood that iftM Wilding —
drca nut currently hast a renal,that it is my reeprmiNlity to ramify the mcupsnt of Ne
c es which must he 'nr niauance of a Cem enteof Osupancy.
`L. Signature of Applicant - Date
Ownermamm�i"agent Date All roof c erings to be Class "B"or better