02030193 CITY OF CUPEWHNO ,,;
BUILDING DIVISION PERMIT CONTRACTORINFQRMATION
BmLplA�grsIMPERIAL AVE TAYLOR WOODROW HOMES PERMIT N(02 03 0 193
I
Y`14QR WOODROW HOMES 2300 CAMINO RAMON APPLICATI"fIP15y2002
_ONE: (925) 365-3100 SANITARY NO. CONTROL NO.
ARCHITECIDENGINEGR: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�Op LICENSED CONTRACTOR'S DECLARATION
1 humb alto.that 1 am licensed under r inions of Chapter 9(commencingJob Description
with Section 7003)of Division 3nfthe Business and ProfessioorCmk.rnd my license is
NEW TOWNHOME p
in fall tome and effect. 1589 SQ. FT. LIVING SPACE
�n� License Class Lic.0
oZrpDam Contractor 492 SQ. FT. GARAGE : 6>aQj. �®
^req ARCHITECTSDECLARAIWN E�i�o
a 1 understand my plans shall M used as public records
�Owu
LLo L.icensedProlessional NO 2..4 2003
OWNER-BUILDER DECLARATION
00 hi maso .Sect that 11. exempt from the Cautions o License law far rite
w.pO whowingmason.(Section 7(OOSI Business and Pnsfdemols Code:Any city.county
'K$ which re9uires a peros t it)re a fires th L alter,improve,demolish.m repair any structurePi III TV
1°� pnnnoits issuance,also reyuiresthe applies.for such permit mfleaaigneJ avmmem
t�< that heinrcensedpursuant tnthe provisions ofthe ContractorsLicenwlaw(Chapter 9 Sq. Ft. Floor Area tion
sip (commencing with Section 7BXE of Division 3 of the Business and Professions Com)or
UIre3$ that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a penad subjects the applicant to a civil penalty of e U Occupancy Type
not mom than five hundred dollars OM0f
❑ I,aa owner of the property.Or my employcea with wages as their ante compensation,
will do the work,and the structure is not intended or offered for sale(See.7004,Business
and Professions Code:The Conoacmis Lt..law does not apply to an towner of10 2 - P I ERS equired Inspections
pmperty who builds or improves foram,and wh idnes such work himself or through his
own employees,provided that such improvements arc not intended or offered formle.If, 103 - UFER
however,the building or improvement is sold within one year of completion,the owner, lO4 - RE BAR
builder will have the burden of proving that he did not build or improve for purpose of
soled. 105 - ANCHOR BOLTS
I,as owner of the property,am exclusively confuting with licensed contractors to 106 - SEWER & WATER
contact the project(Sec.7W,Business and Professions Code:)The Conoscmr's Li-
cense Law does not apply tosnowner o(property who Wilds or improves themon,and. 202 — UNDERFLOOR PLUMBING
Lwho icense Law�for such projects with aconlaacmr(s)liunuu
licensed the Conuumie 203 - UNDERFLOOR MECHANICAL
empt under Sec. B&PC for Nis reazon 204 - UNDERFLOOR FRAME
`— Qate 205 - UNDERFLOOR INSULATION
woRKhR's comsA �111o'E'Dwrq
nory 301 — ROUGH PLUMBING
Iherehy affirm under penalty fury onodeclarations: 302 - TUB & OR SHOWER
❑ I have and will maintain a Certificate of Consent to self-insure for Workeri Compete
sation,as provided for by Section 371)of the Labor Code,for the performance of the 303 - ROUGH MECHANICAL
work ter which this Permit is issued. 304 - ROUGH ELECTRICAL
0 1 have and will maintain Worker's Compensation Insurance.as required by Section 305 - FRAME
371)of the Labor Code,for thc performance of Ne work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number am: 306 - HOLDOWNS
Carrier: Policy No.: 307 - INSULATION
CF.RI'IFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE 308 - SHEETROCK
(Thissecoon need not McomplemdiftM permiinfornnehundreddollan(SIfd) 309 - EXTERIOR LATH
oulcia) 310 - INTERIOR LATH
I certify that in the perform Ice of the work for which this permit is issued,I shall not 311 - SCRATCH COAT
mai any perand in any marinerv�§�Igt bcFryt�essrpiu�nlbc Wnrkcrs'Comltcnsminn
Laws ie.Dp" - i{� 313 - ROOF NAIL
Applie+o
NOTICETO APPLICANT:It.arta making this Cc room llrption.you should 501 - FINAL ELECTRICAL ENERGY
become subject w the Worker's Compensation prnv' the 111 Codc,you must 5 02 - FINAL PLUMBING ENERGY
z O forthwith comply with such provisions or no
this he Jccmcd Lurked. 503 - FINAL MECHANICAL ENERGY
CONSTRUCTION LENDING AGENCY
(-. Ihereby affirmthathere isaconstrctionlending agency for epaforman<cof 504 - FINAL BUILDING ENERGY
z >
the work for which thispermitisissued(Sce.3097,Co,C.)
Lendes Name 505 - FINAL ELECTRICAL
W Q r'
� Z Linde nAddrenn 506 - GAS TEST
U O I certify that 1 have read this application and state that the above information is 507 - FINAL PLUMBING
" F correct.I agree m comply with all city and county ordinances and state laws relating to 5 FINAL MECHANICAL
r � above
bov mentiowniun, rty hertbyauthodzerepreunmtives of tonicity menmr upon the
anrnrmeminrmd propcny for inapccdon purlaucs. O 9 F I N
(-' 0. (We)agree to save,indemnify and keep harmless the City of Cupertino against //''�� aa-� 1
to liabilities,judgments,costa and expenses which may in any waynecom against said City S N G �ti(/,•r U (///
U in consequence ofthcgrantingofibis Permit. j, UU
r-r APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by 51 WORKS Date
RCi'RECULA
Re-roofs 603 - OF BATTENS
Signnwre of ApplicanVCnm...r Date
HAZARDOUS M? IALS DISCLOSURE Typeof ROCC4 — ROOF IN—PROGRESS
Will the applicant or future bull goccupamnore or handle hazardous anamdal
as defined by be Cupenino Municipal Code.Chapter 9.12,and the licalth and Safety
isle.Section 35531(aj7 All roofs shall be inspected prior to any roofing material being installed.
❑ra
Will the appocant or Imore buildingoccupom use equipment or devices which If a roof is installed without first obtaining an inspection, 1 agree to remove
emit hazardous air contu.inams as defined by the Bay Area Air Quality Munugcomol all new materials for inspection.
Disoict7
❑Yes 0<11
I have mad the haandousmamrials requirements under Chapar6.95 of the Califor-
afm
niaHcalN�Sycodele.5ections 35505,25533 and 15511.1 understand thaifthe building V
does not currently haa tenant,Nat it is my responsibility to notify the occupant of the C J (L
muiremcnu which mustMm 'ssuancc nfa Ccnifcetc of Qcupancy. ,Signature of Applicant Date
owner oraomoa,ed.,cut Dale All roto coverings to be Class "B" or better