02030161 CITY OF CUPERTINO
BUILDING DIVISION PERMIT 'CONTRACTOR INFORMATION
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Buff1l?l®c1A94IsbIMPERIAL AVE TAYLOR WOODROW HOMES PERMIT N(02030161
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hr1R1I0WOODROW HOMES 2300 CAMINO RAMON APPLICATIONlry#TV 2002
"ONE: 925 365-3100 SANITARY NO. // GG // CONTROL NO.
ARCIII'1'17CIMNIGINHER; BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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P�^tOp
LICENSED I a mliNTRd TOR under
SDisions fChap Q��yy�� �g�p�yp��_
ON
thereby..7NXFnrmlhmla3mda,cemormax pmviofessof,Code. n my license is NEW TOWNHOME d8R'T IJC.n ON
with llioncn ndelof Diviafnn3of thc Business and Pvlfcssions Calc.enJ my license is �®
mow infullf. lass effect 1456 SQ. FT. LIVING S 1
Z Z,y,cs Dau,zClens Licx
cn Fo rare contractor 469 SQ . FT. GARAGE : 2
--'-f' ARCHITECTS DECLARATION Q (��
'g w' I understand my plans shall M used as public muord.x DEC 3 O 2003
%OyU
u1LLLLO'G I.ICCnYd PIIIICaflllnal
ag OWNER-BUILDER DECLARATION BUILDING
f 1 herchy ufnrm that 1 1. exempt from the Tessio Contractor's License: nyLaw for the
.Ra follow ingoomsa.(Scninn 7031.5.BusinessandPndcemoli Code:Any city structure$ which its ima a pemtit ns nmstrthe alter,improve.demolish,or repair ed mrucmre
t-Ze this he
lensed ponsten,in ms trovii applicant for such Permll It,Liensen eLaw(CmIn em
FFx
that in,wiJpuntion70hcpmvisionsu oftheBthe mness a Nofettiom;C pmr9 Sq. Ft. Floor Area $154IkQl&tion
skF$ (rad he is xempthhemfOu7lkk)bf Dasis n3 th theBusiness
exemption.
Any iCOJc)or
�.. that he is exempt therefrom and the buffs for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a Permit subjects the applicant o a civil penalty of 3 5AWIqdn%ei0 Occupancy Type
not more than five hundred dollars($500).
I,as owner of the property,or my employees with wage As their able compenutibn,
will do dm work,south mucmm is not intended oroffered for sale(Sec.7044,Busincu -
And Pmfauibna Code:The commences Licente Law does not apply to an owner of 102 — PIERS egmred Inspections
property who builds or improve thereon,and who dons such work himselror through his
own employees,provided that uch improvements art not Intended.,offered for sale.If. 103 - UFER
however.Ne building or improvement is sold within one year of eampletion,the owner.
builder will have the burden of proving that he JiJ not build or improve for purpose of 104 - REBAR
sale.). 105 - ANCHOR BOLTS
al'a.ownef M the property,am"elusively contract ing with licensed contractors to 106 — SEWER & WATER
cnnsWcl the project(Sec.7044,Busiram enJ Prbfcasums Code:)The Conlmctor'a Li
cease Law does not apply to an owner of pmpery who builds or improve thereon.and, 202 - UNDERFLOOR PLUMBING
who cmoracta for such projects with a conhaclm(a)licensed pursuant to the Contrumm's
Liana l.aw. 203 - UNDERFLOOR MECHANICAL
❑ I am exem in under Sec. ,B&P C for this reason 204! — UNDERFLOOR
FRAME
�d Dare 205 - UNDERFLOOR INSULATION
WORKER'SCOMPENSATIO :CLARATION 301 - ROUGH PLUMBING
I hereby aRrm under Penally of per' y one of the following declarations:
❑I have and will maintain a CeniBcate ofConsentto self-insum for WorkehCompem 302 — TUB & OR' SHOWER
smma,u provided for by Section 37alof the Ichor Code,for the performance of me 3 03 - ROUGH MECHANICAL
work for which this pernd is issued. 304 - ROUGH ELECTRICAL
❑1 have and will maintain Worker's Cumber
Insurance,u mquiod by Section 3 05 - FRAME
371X1 of Ne Lubar Code,for Ne performance of the work for which this Permit is issued.
My Worker's Compensation Insurance cxmer and Policy number am: 306 - HOLDOWNS
Caric,: Policy No: 307 - INSULATION
CERTIFICATE OF EXEMPTION COMPENSATION INSURANCE WORKERS'
CE308 SHEETROCK
(This section need not be completed ifthe Permit is butane hundred dollars(Slap 309 - EXTERIOR LATH
urlem.) 310 - INTERIOR LATH
I centry Nat m thc Performance of the work far which this permit is issued.1 shall not
employany Person in by mannctpas to hcc raps jcwt,lhe Workers'Compensation 311 - SCRATCH COAT
Ap,licf Car 313 - ROOF NAIL
npMfcam C'4�—�„�
NOTICE TO APP ICAN. .after making this Cenihcete nf ' puon.y.0 sh..Id 501 - FINAL ELECTRICAL ENERGY
become subject to the Worker's Compensation provisions of bur Cale,YOU must
oz forthwith comply with such provisions or this permit shall ne deemed revoked. 502 - FINAL PLUMBING ENERGY
z CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
Ih...byullirm sat there is a cunswninn lead,np agcnc,lilnhe perfurmencc Of 504 - FINAL BUILDING ENERGY
Ix
'he workfor which this Permit i"Amed(Set.NAD,Civ.C.)
Lcnd505 - FINAL ELECTRICAL
W Q cr'a Name
z Lendcr''aAddress 506 - GAS TEST
Q O 1 cenify that 1 have read this application and sine then the above information is 507 - FINAL PLUMBING
W F correct.l agree to comply with all city and county ordinances and state lawsrclating to
OQ building construction,and hereby authmlmrcprcsenunivesofthis city tocorerurym@c 5 FINAL MECHAN CAL
W shove-mentioned property for inspection purposes. O9 FIN
(We)agree to save,indemnify and keep harmless the City of Cupenino against I
ji liabilities.judgments,costs and expenses which may in any way accrue agaimi mid City 5 N G �--.
Q z in consequence of the granting of this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH AI.1.NONPOINT Issued by61 - I WORKS Date I
.E REGULATION .
110 1-02 Re-roofs603 - OF BATTENS
Signamm of APplicam1Cun mchlr Dale
HAZARDOUS MATE��kk .S DISCLOSURE Type of R@�4 - ROOF IN-PROGRESS
WiII thc apPlicam nr forum huilditlgoecupanlstore or handle hamNous material
as defined by the Cupertino Mumi, Code,Chapter 9.12,and the health and Safety
ode,section 25532b.)?
n Yns E 0 All roof's 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 haseNnun air contaminantsas Jc teed by the Bay Area Air Quably Management all new materials for inspection.
District
❑Yes u
I havemad Nek,S"dus 23S)5. 5533re en5under Chapterti Lifthe Califin
dosnoth55a(myCw atecdotcsnat it ismyrsaadhili.1 it)noumndeoccop lwofthe
Jens not currcnlly base a mwnk Nat itis my mspumihility m nodly the occupant of Nc r f J ll
h mo. ee rfa am It[ Signature of Applicant Date
Ownmor maho and ageN / ,Dam Z. All ro coverings to be Class "B"or better