02100002 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR�INF'ORMATION
B"11150811SESEMPERIAL AVE TAYLOR WOODROW HOMES PERMIT"t2100r002
RTAY81OR WOODROW HOMES 2300 CAMINO RAMON APPLICATITIU wmq/2002
I 7�
PHONE: (925) 365-3100 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�a0o LICENSED CONTRACTOR'S IJIiC1.ARA'1'ION
us P 1 hereby allirm that 1 am licensed under provisions of Chapter 9(commencin
gZ5 with"croonInabofDivisionJofNCBusinessandProactinnsGxlc,andmylicenseu UNIT A STRUCTL�� � �--IN HOUSE USE ONLY
in
-;o% m full and effect. (ORIG. #02030115) f NO NEW PERMIT ISSUED
z2&1z License Class Lic.N
FyFp Dam Co'namm
ARCHITECT'S DECLARATION
O to U
w 1 understand my plans shall be used as PUM1Iic accords
n
a- Cf Licensed Proretsirnml
S OWNER BUILDER DECLARATION
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OO I hereby,Sect that 1 1. .Burin from the Contractor's :Any c taw for the
i S p 0 following mason,Section 7BJL5.Business and Profession❑rde:Any airy of manly 6 7 5 7 8
X
$ which requires a permit n construct,alter,improve,demolish,or repair any structure
FZa, pnnr n its issuance,alsn regmres the applicant for such permit to life a signed Statement
II < that he is licensed pursuant tothe provisions Ofthe Cnnaria'sLicense Law(Chapter 9 Sq. Ft. Floor Area /'valuation
�$ Nm ft(C,smmeacing with Section 70h)of Division J of the Business and Profession Code)or
35717018 . 00 `7
be is exempt therefrom and basis fat the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the aPplicurt to a chi l penalty of APN Number Occupancy e
not mate Iran five hundred donate($50h. 1 O 1 - FOUNDATION P y TyP
❑1,as owner of the Pmpeny,or my employ¢.win wages as their sole compensation,
will do the work,and the fracture is not intended or offered for safe(See.7fWa,Business 102 FiERS
and Professions Code:The Contractor's License law does not apply to an owner of 103 - UFER Required Inspections
property who builds or improves thereon,and who does such work himselfor through his
own emplaytes.provided that such impairments ate not infrared ar offered for sale.If, 104 — REBAR
however,the building or improvement is Sold within one year of completion,the owner- ],OS — ANCHOR BOLTS
builder will have the burden of proving Oat he did not build or improve for purFow of
Mr.). 106 - SEWER & WATER
❑ 1. a invour of the praPerty.am exclusively contacting with licensed contractors to 202 - UNDERFLOOR PLUMBING
contact the pmject(Sec.7W.Business and Professions Code:)The Convector's Li�
erose lawdoes not apply br an owner of property who builds or improves nmon.and 203 - UNDERFLOOR MECHANICAL
Who contracts for such projects with a contractions)licensed pursuant to the Conformers
License Law. ' 'Z 04 — UNDERFLOOR FRAME
lam exempt under sec. ,B&P C for this Mason 205 - UNDERFLOOR INSULATION
er Date 301 - ROUGH PLUMBING
WORKER'S COMPENSATIONDECLARATION 302 - TUB & OR SHOWER
I hereby affirm under penalty of perjury one ohne following declarations: 303 — ROUGH MECHANICAL
❑1 hove and will maintain a Ccni fcam of Consent to self-insure for Worker's COmpem
nation,as provided for by Section 3700 of the labor Code,for the performance of the 304 - ROUGH ELECTRICAL
..,it for which Of,permit is issued. 3 05 — FRAME
❑1 have and will maintain Worker's Compensation Insurance,m required by Section 3 06 - HOLDOWNS
3700 of the Labor Code,for the Performance of the work for which this points issued.
My Workers Compensation Insurance canner and Put icy number are: 307 — INSULATION
Carver: Policy No.: 308 - SHEETROCK
CERTIFICATE PFNSAI'IONIWsuRANCGORI<ERs• 309 - EXTERIOR LATH
(This section need not he completed five,Fermit is formic hundred dollars(SIM) 310 - INTERIOR LATH
311 - SCRATCH COAT
1 reply that in the pefforomm a ol'the work fnr which this permit is issued.I shall not 313 - ROOF NAIL
employ any person in any manner an az to become subject to the Workers'Compensation
Laws of California.Dale S01 - FINAL ELECTRICAL ENERGY
Applicant
NOTICETO APPLICANT:II;alar making this Cent licate of Exemption,you should 502 - FINAL PLUMBING ENERGY
become subjutto the Worker s Compensation provisions of the labor Cotte,you must 503 - FINAL MECHANICAL ENERGY
0 X forthwith comply with such provisions or this Permit Shall he deemed favored.
CONSI'RUCTIONI,ENDINGAGIiNCY 504 - FINAL BUILDING ENERGY
Ihembyaflirmthat them isacontraction lending agency onthe perliamanceof 505 - FINAL ELECTRICAL
0 ? the work for which this Permit isissued(See.3lN7.Civ.C.)
Lender's Name 506 - GAS TEST
{gt Q
] z LenIO'snddreas 507 - FINAL PLUMBING
U O I certify that 1 have read this application and state that the above information is 50 8 - FINAL MECHANICAL
IS. 0
Career,1agree to comply win all city and countyordinancesof and come laws
rlatingto /ll
abovenmennswctiogarty hereby authon p representatircs of this airy to cnterupmthe 5 FINAL GRADE
W aMrvrmc of ned agree In ertysaw for inspection an keep ha l O FIN G
(We)ogee to save,indemnify and rich harmless the City n Cupertino against
F"faq' liabilitin,judgmcnu.costs and expenses which may in any way same against said City 5 F N LI
WC
U z in
UNDERSTANDS AOf the pantod,of tND WILL COMPLY WITH ALL NON POINT 6 0 F NAIL (A�
Issued by. Date
SOURCE RRGUhATIONS.
Signamrcof ApplicaRe-roofs 604 - OF IN-PROGRESS
HAZARDOUS
Date AT.ARDOUS MATE RIALS DISCLOSURE Type Of ROOF
Will the applicant or fMuni building row Chapter
aptmarc tar handle Health
and
of nrd M1y the Cupertino Municipal Code.Chapter 9.12.am the Ilcalth ear Safcry
e.semina 255320)7
❑Yes ❑No All roofs shall be inspected prior to any roofing g material being Installed.
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Will the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection, 1 agree to remove
emit hammous air contaminants as defined by ase Bay Area Air Quality Management all new materials for inspection.
D'sirict'1
❑Yes 0 N
1 have read the maardousmarenafs requormenes antler Chapmrfi 95 micro Califor-
nia health A Safety Gar.Section 25505,25533 and 25570,1 un@rslaml that if the building
does not curicaly have a armor.Nat it is my msponshohly in notify the Occupant of the
nquimmcnu which..at be act poor to issuance of a Cenilicalc Ol 0.cupancy. Signature of Applicant Date
Owneror authorised agent Date All roof coverings to be Class "B"or better