02030195 CI'T'Y OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
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BUILTO(17194tESIMPERIAL AVE TAYLOR WOODROW HOMES PERMITNO2030195
IT."BOR WOODROW HOMES 2300 CAMINO RAMON APPLICAT0rSsYwPffY2002
PHONE: (925) 365-3100 SANITARY NO,/ 7 CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
�00 LICENSED CONTRACTOR'S DECLARATION
a��+P I herehy moret that l am uCem,ed ruder pmmalnnsof chapter 9 tenmmeneing Job Description
with SectionTXXpnf Division TO me Business and Professions Code,and mylicenc is NEW TOWNHOME
F>w inIall[owe land clicel. 1589 SQ. FT. LIVING SPACE
F �jj License Class Lic.M?_o Dam common, 492 SQ. FT. GARAGE QQQ yGy1
W£ ARCl11TECTSDECLARATION
� � I understand my plans shall he used as public records
apa0
3
Licensed Pnticssinnal
OWNER-BUILDER DECLARATION DEC 1 0 2003
m <Y I hereby affirm that 1 am1. exempt from Be Cocoons Code:s License Law by the
u+?o O which re uires a ermit t ]tonstr Business and Profusions hOAny city nr county
w$fL which requires a permit m construct.alter.improve.demolish.or repair any structure
nations issuanec,also rea i ms the applieam for such permit m file a signed statement
tb<
that he is licensed pursuant mtheprovisions aftheCuntrscmrsueen.,el Law(Chapter 9 Sq. Ft. Floor Area tion
�_a (commencing with Sechon7000)of Division 30flhc Businessand Pm@Minns Code)or
that he is exempt dutchman and be basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty ofOccupancy Type
not mom than five hundred dollars($5(10). -3 bAWNTf�
❑I,u owner Of the pmpeny,ar my employees with wages as their sole compensation,
will do the work,and the s metwe is net intended or offered for sale(See.]Iola,Business
and Professions Code:The Convector's License Law does not apply to an Owner Of 102 - PIERS equired Inspections
property who builds or improves thereon.and who does such work himself or through his
Own employeem,provided that such improvements are not intended nr offered far sale.If, 103 — UFER
however,the building or improvement is sold within One year of completion.the owner. 104 — REBAR
builder will have the burden of proving but he did nm build or improve for purpose of
same). 105 - ANCHOR BOLTS
,esawmr of the property.am exclusively contracting with licensed contractors to 106 - SEWER & WATER
construct the project(Sec.70al Business and Professions Coal The Convector's 1.1.
cense Law does not apply to an owner of property who builds or improves da mon,and 202 - UNDERFLOOR PLUMBING
who comment for such pmjeca with a contractor(s)licensed pursuant to the Commam's
License Low. 203 - UNDERFLOOR MECHANICAL
❑ IamexemptuaderSec. .B&Pcrnrmitreatan 204 - UNDERFLOOR FRAME
�1. &'Kp.p'y"",nmm
-� D205 - UNDERFLOOR INSULATION
CODECLARA301 - ROUGH PLUMBING
Ihandwilmaiainat7`1 205
Co 302 — TUB & OR SHOWER
❑1have and will for by ecertificate of Con sent to od,fumfor Woderace of the
aadan,a provided for by semm�3nX1 nr the ober ctae,forme Performance or the 303 — ROUGH MECHANICAL
work for which thisfetmilisissaed. 304 - ROUGH ELECTRICAL
D 1 have and will maintain Worker's Compensation Insurance,as required by Section 305 - FRAME
371X1 of the Labor Code,for me performance of the work for which this Permit is issued.
My Worker's Compensation Insurance carrier and Policy number are: 306 — HOLDOWNS
Cartier: Policy N.,: 307 - INSULATION
CERTIFICATE OI'EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE 308 — SHEETROCK
(This section need not he completedi(the permit is for one hundred dollars 00) 309 - EXTERIOR LATH
irhn,'f 310 - INTERIOR LATH
1 certify that in the performance of the work for which this Permit is issued,l shall not 311 - SCRATCH COAT
amployany perstn many manner toIK rep mol rk
Wncri Cnmnmt
peion -
pwa i� ,<�� 313 - ROOF NAIL
id OTICEA�PPLIANT:If.after makingthis COsefZCCallyou should 501 - FINAL ELECTRICAL ENERGY
became Subjecto the Worker's Compensation p Osians of rhe' Mar Cod,you must 502 - FINAL PLUMBING ENERGY
z z0 forthwith comply with such provisions or NisPermit shalt Mdeemed mvnked. 503 — FINAL MECHANICAL ENERGY
CONSTRUCTION LENDING AGENCY
I hereby affirm that mem is a construction lending agency for perlormmceof 504 - FINAL BUILDING ENERGY
W. > do work for which this la:man isissued(See.3097,Civ.C.) 505 - FINAL ELECTRICAL
{T] 0 Lender'abl me
z Lcuder'sAddress 506 - GAS TEST
U O 1 verify mat I have real this application and sate that the above nomination is 507 - FINAL PLUMBING
0 U building construction,
agree to comply with all city and county ordinances(if and stem laws relating e 5 FINAL MECHANI CAL
building ca tee to o comply
hereby a city rizzand aunty ordinan es mid state
law enter.,on me
> W shovmmentioned property dim inspection purposes. O9 FIN E
(We)agree to save,indemnify and keep harmless the City of Cupertino against
oH•O y liabilitics.judgmena,costs and expenses which may in any way acme against said City 5 N G
U z in consequence of the granting Of this permit.
^' APPLICANT UNDERSTANDS AND WILL COMPLY WITH AL1,NON POINT Issued by51 WORKS Date
RGF`EGULATIONS.
g- Re-roofs 603 - OF BATTENS
Signamm of ApplicanVComruuu ata
HAZARDOUS MATE DISCLOSURE. Type of�QJf4 - ROOF IN-PROGRESS
Will the applicant or future building Occupant store or handle moammus material
as defined by the Cupenim,Municipal Code,Chapter 9.12,and the I Il ad Safety
e.Section 255320)7 / All roofs shall be inspected prior to any roofing material being installed.
❑Ya ?
Will the applicant Or future building occupant use equipment or dcviccs which If a roof is installed without first obtaining an inspection, I agree to remove
emit haeallous air contaminants as defined by be Bay Arca Air Quality Management all new materials for inspection.
District?
❑Yes GN
1 have real the hacardous materials mquircmena under Chapmrii 95 of the
CJifnor
dcstoieumntlyhuwatenan(,matitidmyesrysmihililytonOtilythOccupan1101meg-
e /O
r ll
rcymremMiassnamornustbemm rionn isammcc ata Certificate of Q'capancySignature of Applicant Date
Owner nr amhnriagJ agent (D /o� All r o coverings to be Class "B"or better