02110028 CITY OF CUPERTINO :,reas
BUILDING DIVISION PERMIT COIVTRe1C'OR INFQ MATION:
BGIMG'R2SULTS WAY TAYLOR WOODROW PERMITNO02110028
° bIMffii€ WOODROW ONE RESULTS WAY PERMITLSSffME9/2003
E; SANITARY NO. / ` CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0
�0o LICENSED CONTRACTOR'S DECLARATION
MI hereby aR,m Nat 1 sm lieemcd under provisions of Chapter 9(commencing - Job Description
with Section 70DO)ofDividon 3.1'the Business and Profouiom Code,and my hear.is
infail force and affect PEDESTRIAN PATH —' ---
'�Z License Clue Lie..
Date Common
ARCHnT=S DECLARATION
31 understand my plans shall he used as public«cards
3lit t;d Licensed Profession,]
OWNER-BUILDER exempt
DEthe Com IGN
1 naso.(firm that 1 I.S.caempt from the Profession
License Law co the G G/
E02 following recon.(Section 703 construct.
Businessand Profdem u Cale:Any city or county f
�$ which myulrm a permit re eonstmd.alter,Improve.forsu demmUh,erre pair any atmnuk
thatpriholtscensed also rmor to
the applicant she ConMch mit 1.1con tlgncdrutemcnt
g p (commencingwJpumtion7 the pmviviIron(of theBlncwr'aUceuersw(Chapur9 Sq.F[. Floor Area Valuation
a that he Is
Section and 00)of
basison3Mthoeged exemton.An vi Cnde)of
Net ere 6 sump]therefore and the buB fm the ailegc4 csamPtian.Any violation Of
Sccllon 7031.5 by any applicant for a Permitlubjects use applicant to a civil reality Of APN Number lm81t�ffftby Type
not mane Nan 0w hundred dollars(5500).
❑I.u Owner Orion property,wmy employcu with wages as their ole compensation,
will don the work and thaswcture 1.notlntended w°Remd torture(See.7041,Business 35 7 2 074
and Profueiwu Code:The Contractor,License Law does not apply to an Owner Of Required Inspections
property who builds or Improves thereon,end who d°euuch work himself or through his
Own employees,provided that such Improvements are notlnknded wo0ered formle.If. 101 — FOUNDATION
however.the building Or Improvement Is sold within one year of completion.the owner.
Wilder win the burden Of proving that M did not Wild or improve for purpose Of 102 - PIERS
i1c) 103 - UFER
1.as owner Of the Property,am exclusively canuacting with licensed contractors to
corutrvet the project(Sec'7041,Business and R°faatlons Code)The Common's U. 104 — REBAR
come Law does mol apply ton an owner of property who W Lids or improves themon,and. 105 — ANCHOR BOLTS
who cenuacu for such pro)ees with a contractor(s)licensed pursuant to the Contnn°Ya
License law. 106 - SEWER & WATER
I am exempt under Se .B d:P C for this own 202 - UNDERFLOOR PLUMBING
Onte !Y-29W KER'S P SAT ECLARATION 203 - UNDERFLOOR MECHANICAL
IhembyalBrm under penalty o ry oae
ad following declarations:
204 — UNDERFLOOR FRAME
0 I haw and will maintain a CeNOesteo(Coesent o sal6lnsum for Worker,Cumpem 205 — UNDERFLOOR INSULATION
sation,as provided for by Section 37W of the IuWr Code,for the performance of the 301 - ROUGH PLUMBING
work for which this Permit is Issued. 302 - TUB & OR SHOWER
❑1 Mw and will maimain Workers CompemNon Insurance,as required by Section
3700 of the fair C°de,roe Ne performance or the w°rk(w whim this Permit 1.mood. 303 - ROUGH MECHANICAL
MyW°,keYa Compensation insurance carrier and Policy number arc: 304 — ROUGH ELECTRICAL
Carrier: Policy No.: 305 - FRAME
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE 306 - HOLDOWNS
(Tho secdn,wed not be completed lithe permit 1,for one hund,udd.11.($100) 307 - INSULATION
orkea.) 308 - SHEETROCK
I ccrti(y Net in the performance of the work for which I omit is issued.l.hell not 309 - EXTERIOR LATH
Croft my muner� l,aslct he Workers mA
CompcOn
I.ew
pp°nr y` 310 - INTERIOR LATH
Allean
NOTICE TOA ICANT,It, ;after making this ertBleaor pt nmonld 311 - SCRATCH COAT
become suolen o the Woher's COmrewdon povlstms IeWr Code,you must
0z forthwith comply with such provisions o,Nis Permit shall be deemed rooked. 313 — ROOF NAIL
z ° CONSTRUCTION LENDING AGENCY 501 - FINAL ELECTRICAL ENERGY
(-i 4 Thereby affirm that them I.x ceuwction lending agency for the performance of 502 - FINAL PLUMBING ENERGY
0:+✓ the workLem.'.fur which this permitb4tued(sec.3071,Civ.CJ 503 - FINAL MECHANICAL ENERGY
C>J Q lender's Addo
j 2 LcnderlAdamsa 504 - FINAL BUILDING ENERGY
U0 I certify that 1 haw read this application and slaw that the show information 1. 505 - FINAL ELECTRI CAL
W F cored.I agree to comply with all city and county ordinances and alat law,muting m
p U abonngcntioned on,andhetebyamho,imooses. tlwro(Niscity loenmryPon Nc GAS TEST
U aAOvcmconstr dpropertyion.and for by AmI lipureprs. O7 FIN
(We)agree w saw,indemnify and keep harmless the City of Cupertino.gains]
rap liabilities,judgments,emu and expenses which may in my way acme against said City 5 A ICI
U 7 In consequence of the Starting of this Nook.
n7• Ar W ERS7AND WILL COMPLY WITH ALL NON-POINT- Issued by:5 DatC
&/� 12,
S R R ULA S _
L Re-roofs 5 LuD14 INALAL" PUBLIC WME=ORKS
Signature O(ApplicsMCOnt r Data
HAZARDOUS MATERIA SGLOSURE Type of Roof
Will the applicant Or future buil din ant Nem or handle havandom materia] '
u deRnW by the Cupe iitw Municipal .Chapter 9.11,and the Health and Safety
Code.Section 25532(.)7 All roofs shall be inspected prior to any roofing material being installed,
❑Yes
Will the applicant or future building wcupant Lisa cyulpment Or devices which If a roof is installed without first obtaining an inspection,I agree to remove
cell h coni us'air conuminanu u dontud by the Bay Area Air Quality Management all new materials for inspection.
Dl.icO
❑Yu °
I hew mW the huudem reuguisoquimmenuuaw,Clume,6.95ofthe Collins.
nit Hcalthh SafelyCede.Socures 25515,35533 and 25334.1 undesuM thurfthe Wilding
does net,woody haw a tman Net It it my napomibuity an notify the oaomem Or the
lob mug be me o gamess,oft Ccmfiesw of npuuy. Signature of Applicant Date
owner nr.n nrircd agent D.te All roof coverings to be Class"B"or better