02030190 CITY OF CUPEWl'INO > X -- r 'z Fo
BUILDINGDIVISION PTRMIT CONTRACTOR INFORMATION:''
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Bu1111161AgIIIESsIMPERIAL AVE TAYLOR WOODROW HOMES PERMITN®2030190
41 Y/DiOR WOODROW HOMES 2300 CAMINO RAMON APPLICATION;yBPtry2002
PHONE: 9 2 5 3 6 5-310 0 SANITARY NO CONTROL NO.
ARCIIITECI7ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECII
00 LICENSED CONTRACTOR'S DECLARAI ON
I Lamb affirm Nal I am licensed under provisions Of Cha ter v Ommenctn Job Description
with Section 00(bol'Divisom 3 of Be Businenand I'mmodurw CWc.an�g b NEW TOWNHOME p
0ogna infulkoveandcl(ecl. V d589 SQ . FT. LIVING SPACE
Liar Chao Liemf �� 92 S FT. GARAGE :
F z=� Da Comfort Q. $12619 . 80
ARCIInECTS DECLARATION
3Wil.V 1undersand my plansshallbe usedes public Curtis aBVy f1 L
p e]oo3
G Liecoud Pmtessionto
t—o=�< OWNER-BUILDER DECLARATION
rc <E 1 hereby a(lirm that 1 am exempt from Ne Comracmr's License 'p,
Is. 00 (allowing reason.(Secdun 7071.5,Business and Professions Code:Any city art conn
$ wbich requires a permit io construct.alar.Improve,demollxh,or repair any svact
HZa
prior it)in issuance,also requires the applicant for such pfroutto file a signedsaament
that he is licensed pursuant o the pmvistros of the Conuacmr's License Law(Chapter 9 Sq. Ft.Floor Area $167Wfition
n (commencing with Section 7000)of Division 3 of Be Business and Prnfciinns Code)or
— that he is exempt therefrom and Ne basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjecu The applicaa to a civil penalty of
nm more Nan five hundred dollars(8500). e Occupancy Type
❑1,as owner of the property,or my employees with wages as their sole comppeart on.
will do the work,and the structure is not intended or Offered for sale(Sec.7i ,Business 1:191 Febii
and Professions Code:The Contractor's License Law does nor apply to an owner of10 2 - PIERS equlred Inspections
pmperty who builds or improves Thereon,end whodoes each work himself onhrough his
PIER-
Own employees.provided That such impmeramnlsam nod inondedoroRemd total*.If, 103 — UFER
however.the building or improwment is sold within one year of completion.the Owner-
builder will have The burden of Proving that he did not build or improve for purpose of
`_a1e')) 105 - ANCHOR BOLTS
Lam,as owner of Ne pmpeny,am exclusively convecting with licensed contraction to 10 6 - SEWER & WATER
consvun the project(Sec.70ssq.Business and Professions Code:)The Conuacmrs Li.
cense Law does not apply to an owner of progany who bunds or imprnvas Nemo^,end, 202 — UNDERFLOOR PLUMBING
Lwho Commit for icense Law. such prujecuwith aconvnetnr(s)licensed pursuant to the Contrumr's 203 - UNDERFLOOR MECHANICAL
exer�under Sec. ,B&PC for this reason 204 - UNDERFLOOR FRAME
own oa 205 - UNDERFLOOR INSULATION
WORKER'S COM PENSATIOCLARATI 301 - ROUGH PLUMBING
Ihcrchy allure under penalty of pyaj ryone of the following declma(ions: 302 — TUB & OR SHOWER
❑ Ibaae end will for byneCion 37 re of the
abor Cork,for
pariucrs Compere 303 — ROUGH MECHANICAL
satin^,as provided for by Section 7700 of the Labor Cork,for the pennfmance of The
work By which this Permit is issued. 304 - ROUGH ELECTRICAL
❑I have and will maintain Workers ComPensalion Insurance,as required by Section 3 05 - FRAME
3700 of the Lahr Code,for the Performance of the work for which This permit is issued,
My Worker's Compensation lnsummce Cartier and Policy number ale: 306 — HOLDOWNS
Carri,,: Policy No.: 307 - INSULATION
CERT'IPICATE OF OMPENSATIONINSURANCE ION O WORKERS' 308 — SHEETROCK
(Thissectinnneed nmbecomletedinhe remail is ler one hundred dp)ar5($10) 309 - EXTERIOR LATH
mass) 310- - INTERIOR LATH
I certify That in the performance of the work for which This Permit is issued,I shall not 311 - SCRATCH COAT
cmployanyperulninany mannerm ore suh!1!W.,afa,CmmnCo.oion Lmm'dC ar313 - ROOF NAIL
Applicant
NOTICE TOAP L ANT:IIa(Icrmal this Cf. nuld501 - FINAL ELECTRICAL ENERGY
O ,� becforomenconfltmlhirI.kerrCompeprowIaMCodeyoufrun502 - FINAL PLUMBING ENERGY
fnnhwith comply with such pnwisinns onhi.ulFm' M deemed revoked.
7 C !% 503 - FINAL MECHANICAL ENERGY
q CON.STRUCr10NLENDiNGACENCY
[-+ N+ Itherchyanirm mm there is a construction lending agency liume,,crfurmanccof 504 - FINAL BUILDING ENERGY
C Theweakforwhichthispermili oxmd(Sec.3097.cmC.)
4n 505 - FINAL ELECTRICAL
W dcri Name
z LC i'sAddrcss 506 - GAS TEST
U O 1 cenify that 1 have rend this application and sale that the shout information is 507 - FINAL PLUMBING
P:
comet.l agree to comply with all city and county ordinances and state laws totaling to
DU buildingconawction,andherebyauthonremiumsemativssofthiscitytoenterugmthe 5 FINAL MECHANICAL
W
above mentioned WC)
it)roperty
for emnifyan keep
09 FIN E
(We)agree m save,indemnify and hick may
an the City of Cupensts against /
III in
of atit.the grantiosts ng expenses thisPermit. may in any way accrue against said City Cj N N G
U z A APPLICANT
of UNDERSTANDS
of this pc WI
^+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by'51 WORKS Dale
t�E REGULATIONS,
0Z Re-roofs 603 - OF BATTENS
Signature of ApplicaMConvactor ,Data
NAZARUOUS MATE DISCLOSURE Typeofl?lof4 - ROOF IN-PROGRESS
Will the applicant or future buil rkcupant store of handle hmmdous menial
as defined by the Cupeni90 Muni iipa COM.Chapter 1).12,and the IIcalth and Safety
Cole,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes
Will theapPlicamor futurcbuildingrx:cupumusccyuipmcmnrdcviccswhich If a roof is installed without first obtaining an inspection, I agree to remove
emit haz.ad air Commands as dc�d by the Buy Arca Air Qn,h y Management all new materials for inspection.
District, aN/
❑Yes
I have mad the hamblous mamdals requirements under Chapmr 6.95 of the Califor-
nia llcalth&Safely Codc,Sections 25015,25533 end 25534.l undersand Thor if The building
does not currcmly haw a tenant.deal it is my mspmssibility a Limit,tbe occupant of Be
menuwhichmuuromeIprinr MceoI Ceflif[aaafacupmwy. Signature of pplicant Dale
L
Owner or authnrizcd agent Date All ro coverings to be Class "B"or better