02030188 CITY OF CUPEWHNO
BUILDING ' Awa a
DIVISION CONTRr1CTOR�INFORMAT-ION�.,,
PERMIT ,
31JE.11051AIIIIESsIMPERIAL AVE TAYLOR WOODROWHOMES PERMI'TNI02030185
W YzIwf3R WOODROW HOMES 2300 CAMINO RAMON APPLICATI"VtTg�� 2002
PHONE: (925) 365-3100 SANITARY NO. // CON IROL NO.
ARCHITECT/ENGINHER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
[:00 LICENSED CONTRACTORS DECLARATION Job Description
�w 1- 1 hereby affirm that I am located antler provisions of Chapter 9(emorm ncinB P
i with Section 7lMA)of Division 3 of NC Business and Professions Code.and my license is NEW TOWNHOME
t_em, in mumrceaneeacn' 1589 SQ. FT. LIVING SPACE
pz Lieenseclaa.. Lie.« 492 SQ. FT. GARAGE : $12619 • 80
N F! Date Cnmramnr FINAL
ARCHGECT$DECLARATION �®
3 yQ lundcrstand my plans shall la used as public records
C 06G
£a, 301- Licensed Professional DEC 3
Os OWNER-BUILDER DECLARATION 0 �oo�
w
m�00 1 hcrehy o(Sco that 1. exempt from the Cnnu'ns Co License Law for the
m-p CO which ire requires
a,(Section 7031.5.Business and improve.
Co de:Any city or county
6 W LL which rcyuircs a Permit m construct.alter amprnve,demolish,O repair any structure
pris-Za fuennsficrO dpursuarc nt it)
hovisio aul soffnsuch cCouoe,minoicensle e ned aw(Chtemem
�y $ (comeel he ncing wit pusuion700e of Divisnnf Ne Cn usines'undPnse LawlCode)apter 9 Sq.Ft. Floor Area $BUMMING
22
that
exemia Section and of baiiinn3 of aleged essaption,Any
violation
_ Nat he u exempt Nertfrom and Ne basis for the alleged caemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty of
not more than five hundred dollars($500), C Occupancy Type
❑I.m ownerrof Ne pmpcny.or my emplo ms with wagn u teir wlc compenution,
will do be,work,and the structure is not intended proffered for sale(Sec.7W,Business
and Professions Code:The Contractor's License Law does not apply fit an owner of 102 - P I ERS equLred Inspections
property who Wilds or improves thereon,and who does such work himself or through his
own cmPlnyecs,pmvidcJ Nauuch impmvemenb ere notmandedmOBcredforsalo,lf, 103 - UFER
however.the building or improvement iswld within one year ofrnmpletivn,Nc owner- 104 - RE BAR
builder will have the burden of proving But he did not build or improve for purpose of
"It)' 105 - ANCHOR BOLTS
Lasowncr of the property.am exclusively contracting with licensed contractors to 106 - SEWER & WATER
construct the project(Sec.7044,Business and professions Code:)The Control Li-
mose Law does not apply to an Owner of praKny who Wilds or improves barren,and 202 - UNDERFLOOR PLUMBING
whe contracts for such projects with a muttramm(a)licensed pursuant to the Contractors 203 - UNDERFLOOR MECHANICAL
License Law.
l am exempt under Scc. .B&PC for Nis rcuon 204 - UNDERFLOOR FRAME
? Date 205 - UNDERFLOOR INSULATION
WORM eR'SC MPENSAT DECLARATIO 301 - ROUGH PLUMBING
Ihcreby anirm uaderpen.", purymMufthefallntion declaradons: 30 - TUB & OR SHOWER
❑
Have and will maintain a Cenificatc of Cnnsent toself-insure far Worker's Compen-
cotion,as provided for by Semicon 37M of the Latin,Code,for the performance if the 303 - ROUGH MECHANICAL
work for which NiaPermit isissued. 304 - ROUGH ELECTRICAL
❑1 have and will maintain Worker's Compensation Insurance,as required by Section 3 05 - FRAME
3910 of Ne Laurie Code,for the performance of the work for which Nis permit is issued.
My Worker's Compensation insurance carrier and Policy number am: 306 - HOLDOWNS
Cnrie,: Policy N..: 307 - INSULATION
CERTIFICATECOMPENSATION INSURANCE WORKERS'
308 - SHEETROCK
(This.section need notMcompleted ifthc permit is for tine hundred dollars(S lisp 309 - EXTERIOR LATH
orrima) 310 - INTERIOR LATH
1 cenify that in the performance Of the work for which this Permit is ismed.1 shall not 311 - SCRATCH COAT
employ any person in any manner sO s hero cluh' Bich WOrker.s'Compenution
Laws mrca&Ww.Da1g�_
Appfican, 313 - ROOF NAIL
NOTICE TO APPLICANT: making rhos Ccntficmc ,ynv should 501 - FINAL ELECTRICAL ENERGY
become suhjcn to the Worker's Compensation provisii N bor Cor Codc,Ymu most 502 - FINAL PLUMBING ENERGY
OO forthwith comply with such provisions or this Permit shall be deemed revoked.
z . CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
Ihereby nRrm Nat there is a construction lending agency for NC Performance Of 504 - FINAL BUILDING ENERGY
Ix the work For which this permit is issued(See3097,Ci,C.) 505 - FINAL ELECTRICAL
Q Lcndcr's Name
DZ Lenders Address 506 - GAS TEST /
U O 1 unify
Nat I have mad this application and sus that the chose information is 507 - FINAL PLUMBING
OFF umdingcostrect.I agree to comply hith all rebyaity lhori mmnrynNtives of and city
laws to enter
momte 5 FINAL MECHANICAL
building construction,and for ins auNon representatives nl this city nr cnar upon Nc
} W aWve-(We)agree
to save,
findrou ify ankeep purposes. O 9 FIN E ///�-•/5 �
in (We)ague m cove,indemnify and keep harmless the Cary of Cupertino against V
Uh I.eimocommeeof thelmsLsand expenses ininfin,Ili thisPermit, may in any wayaroma against mid City
U '•' APPLICANTOUNDERSTANDStANWILL COMPLY WITH ALL NON-POINT Issued by 51 WORKS Date 1
SOURCE REGULATION
ecp /0 Signature of A—PplicanVContramnr • —49 Re-roofs 603 - OF BATTENS
HAZARDOUSM LSDISCLOSURF. Type of R664 - ROOF IN-PROGRESS
Will me applicant or future bull g occupant store or handle hambdous material
as defined by she Cupeninu Municipal Code.Chapter 9.I1,and the Heahh and Safety
de,Sectonzss3na7 All roofs shall be inspected prior to an roofing material beim installed.
❑vel tin P P Y g g
Will the applicant or future building occupant use equipmcmor devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit bamrdous ailemnmmirmns mcJ by the Bay Area Air Quality Management all new materials for inspection.
D'soact/
C Yes No
Ihave mad me Coce,Srdoussn.505lsrequirconeres and255undcrChaper 6.9.5 dermadmouilf the Caldin
doest I Out
cu SWeryhaw aSecdonshat it i 2my resMY5534.I to mm rid a occupant
pant is(me
dues not cut which haw a tenant,Nm it is my responihility W mtdfy Nc occupant of Nc
irtrtlfnts wmm�must arm lsmanccofa Ceniftnaof0ceupanep Signature of Applicant Date
O ncrorauthoriantlagcm• Date All roof co rings to be Class"B" or better