02030162 CITY OF CUPERTINO n 'W�Sdn-+ to
BUILDING DIVISION PERMIT +CONTRACTOR INFORMATION'ji
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B II-TL0gAg16Eiis1MPERIAL AVE TAYLOR WOODROW HOMES PERMIl030162
lyYtGR WOODROW HOMES 2300 CAMINO RAMON APPLICATION.�sMfgy2002
PHONE: 92 5-73 6—5-310 0 SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECII
O O O O
I LICENSED CONTRACTOR'S DECLARATION
I theSection
elfDililum3 ft he edunderndProfssonsCodr,and my
NEW TOWNHOME d8MTfft�8nON
a
with Seatonby ofn that( .licen Business and Professions Cwt,a9(com cenm is
mmllinceandefleel. 1456 SQ. FT. LIVING SPACE pp��wwpp �t
cipz License Clam Cman 469 SQ. FT. GARAGE : $12029 .tF3r7. 11,1N y`�®
F��� Dae Co,DECL
ARCHITECT'S DECLARATION
C< I unJcratanJ my plans shall M used as public records
LLOLiacnwd Professional
to JAW .2 2004
OWNER-BUILDER Im doc Contractors
ntrION
�y, 0 I ree.ou.ereby Si,e that I am exempt from Ne Comms Co :License Law for the 1BUILDI TIG
dx00 which ngmasna archinon construct,
t,altem and r,impove.deioli C.oe:epeonay or county
x 2 which requires a permit m cnnswr6 alter,improve,demolish,or mpair any structure
at
prior In its issuance,also requires the applicant lin such permit tri file asigned swmmem
that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq. Ft. Floor Area $154Va11$ttion
�roF° (commencing wi th Section Traitor Division 3 of the B usincas and Professions Code)or
y $ that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a Penrod subjects the applicant to a civil penalty of
not more than five hundred dollars(S500). a Occupancy Type
❑ I.as owner of the property,or my employees with wages as their role compensation,
will do the work,and the strvmum is or intended or offered formic(Sec.7044,Business —
and Professions Code:The Contractor's License Law cars not apply to an owner of equlre
10 2 - PIERS d Inspections
proprny who builds ter improves thereon,and who does such work himself or through his
own employees,provided Ban such improvements are not intended or offered for sale.If, 103 — UFER
however,the building or improvement is sold within one year of completion,the owner
builder will have the burden of proving Nat he did not Wild or improve far purpose of 10 4 - REBAR
sal'.). ' 105 - ANCHOR BOLTS
Ifi as owner of the property,am exclusively contracting with licensed contractors to 106 . - SEWER & WATER
mslrod the project(Sec.7(144,Business and P ofeasions Code:)The Canuacmr's Lt
wase law does not apply m an owner of property who Wilds or improves Hereon.and 202 - UNDERFLOOR PLUMBING
who contracts Bsrsuch projects with a contranons)licensed Pursuant at the Connacmr'a
License Taw. ' 203 — UNDERFLOOR MECHANICAL
❑ I am rwnut under Site ^BSepCf"Iflareason 204 - UNDERFLOOR FRAME
�-
SATION oanf'� 205 - UNDERFLOOR INSULATION
WORK(: OMPE LARATION
I M1crchy affirm unJer penalty of perj rte onhe muowting dedaratiotn: 301 — ROUGH PLUMBING
❑Thaw and win maintain accnificmc of cnnaenuo self-inmra 0+r workcr'e ComPcm 302 — TUB & OR SHOWER
smith,as provided for by Section 3700 of the lahar Cot for the peHormmice of the 3 03 - ROUGH MECHANICAL
work for which this p.in isissued.
❑1 have and will mountain Workers 304 - ROUGH ELECTRICAL
's Compensation Insurance,1 icyuired by Section 3 O 5 — FRAME
37(X1 of the Labor Code,f or the Performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number a¢: 306 — HOLDGWNS
Carrico PooicyNo.t ' 307 - INSULATION
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE I 308 — SHEETROCK
nhissectirm necdnal bremodmed lithe permit ishoonchunemddollars gI00) 309 - EXTERIOR LATH
Icor::.) I 310 - INTERIOR LATH
1 certify,That in the performance of the work for which this Permit is issued,I shall net 3 11 — SCRATCH COAT
cmployan hersnnl any manner so us + ntye h�cc he'l4mmN'Compensation
Lawsuf Ski, f\ ' 313 - ROOF NAIL
Apoiran
NOTICE TOAPPLICANT:If,of@r making this Ccniticmc olaRgeallation,you should 501 - FINAL ELECTRICAL ENERGY
0zbecome suhj.tto the Worker's Compensation poutoneam'stsfe lalxn Code,you most 502 - FINAL PLUMBING ENERGY
forthwith comply with such novitiomo,ons .it M dermal revoked.
z CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
F= Ihereby ruEndmthreeisaconatmctionlending agemyImthe performance of 504 - FINAL BUILDING ENERGY
a > the work for which thi:permnisissued(Site.31y07.Civ.C.)
Lend505 - FINAL ELECTRICAL
W Q er's No me
7z c"°er'aAadreaa 506 - GAS TEST
U O 1 unify that I have read this application and swat that the above information is 507 - FINAL PLUMBING
W t, correct l agree to comply with all city and county ordinances and state laws relating to
OU huildiall consuuction,and hereby authorimmocimbertivesofthis city toenterupnnlhc 5 FINAL MECHANICAL
W aMice-mentioned property for inspection purposes. O9 FIN
y (We)agree to save,indemnify and keep harmless the City of Curie ninn against
y
liabilities,judgments.costs and expenses which may in any way beeme against said City 5 N G
U z in conscytworref the grantingol this perm it. I
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by 1 - WORKS Date
E REGULA'IONS. t
• ' Re-roofs 603 - OF BATTENS
Signature of Appliwn0 on ncmr Dam
HAZARDOUS MATERIA(. OSURE Type of RG(f'4 - ROOF IN-PROGRESS
Will the applicant or future building in mamre or handle hamrdous material
as defined by the Cupenino Municipal Code,Chapter 9.12,and the Hculth and Safety
tor,oyes 25532(x)7 t3N" 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
em it hazardous air cutworms..as defind by the Bay Area Air Quality Management all new materials for inspection.
DisBicl'/ t
❑Yes [�
I have read the hamNous mawrialsmyuirements umler Chapmr 695ufthe CaI for
ni,Health X Smmand yCoh.Sectiore 25505.25533 25534.1untkrsoutd N4liftW hailing
does not currently haw u tenant,Out his my mapensihioity to notify the occupant of the V 4
n mon mm wowcrrtincamararapan`g Signature of Applicant -' Date
16 x •0 All roo overings to be Class "B"or better
Owner nor amMri'reJ agent Date