02030120 CITY OF CUPERTINO
BUILDING DIVISION PERMIT tiaCONTRACT�URT�N +OR�MaATION
B4'tP09�P° RIAL AVE. TAYLOR WOODROW HOMES PERMITNO'02030120
' WOODROW HOMES 2,300 CAMINO RAMON PERMrrlst1r/Tl9/2003
(925) 365-3100 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
uCi LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm Nal l sm licensed under provisions of Chapter 9(commencing Job Description
with Section 7011n)of Division 3 of dm Busioeas and Professions Cade,and my license is B
^'1 in fun force and effect. NEW TOWNHOME FIB`i�l�p ALED
]JF Dant Clue Lk.N LIVING AREA 1649 SQ. FT.
0 Dau Contractor
ARCHITECT'S DECLARATION 8
1 undcnund my pHu
nhabo u
ll sed u public records GARAGE AREA 430 SQ. FT. $12 6 7�� 0(D 0 2.004
;u. Licensed Professional (��
j0 OWNER-BUILDER DECLARATION
�UlLiD�NG
y I hereby,from that I am exempt from the Contractor's la
License w for the
F.ao following reason.(Section 7031.5,Businessand Profeviom Code:Any city ar county
vat$ii which m turas a permit to construct,alter.Improve,demol W,or repair any structure
f �^ prior N its Issuance.also reptims the applicant forsuch permit to rile a dgeedsuument
ggg�<
that he pa licensed pursuant to the provislona of Ne Convectors License Law(Chapter 9 Sq.Ft.Floor Area Valuation
(commencing with Section 7M)of Division 3 of the Business and Profession,Code)or
Nat he 1,exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.3 by any applicant for a permit ubjecu the applicant to a civil penalty of APN Number $]ObdtQ3Bt6Cy Type
not mom than five hundred dollen(5300).
❑I,nwmrorthepropcny,ormycmploymaw'iNwg utheirwlecompem lion. BmG
willdo Ncwvrk,and thea Wctum is natintended oreRemd forsum(Sec.7044,Buries
and Profaudom Code:The Convectors License Law does met appy to an Owner of Required Inspections
property who builds orimprows thercon,and whodoas such weak himselfea through his
Own employe,provided lhatsuch Improvements are not intended oroRered fee sale If, 101 — FOUNDATION
howeve.Ne building or improvement la and within one yearc f completion,Ne owner-
builder will hate the burden of proving Nat he did nm Wild or Improve for purpose of 102 — PIERS
site.). 103 - UFER
u owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7014,Business and Professions Cade:)The Convectors Li. 104 — REBAR
cense law docs not apply to an Owner of property who Wlids or improves Merman,and, 105 — ANCHOR BOLTS
who contracts for such projects with a contnctor(l)licensed pursuant to the Convectors
Licemelaw. 106 - SEWER & WATER
at uempt undm5 .B 6:PCfor Nb resume 202 - UNDERFLOOR PLUMBING
° 203 - UNDERFLOOR MECHANICAL
71 WORKER'S P SATIDN LAR ON -
Iherebyelfirmunderpemltyof a neer onowmgdeclatadons: 204 — UNDERFLOOR FRAME
❑I have and will maintain a C.mills Consent to ull-wum for worker's campen. 205 — UNDERFLOOR INSULATION
astion,u provided for by Section 3700 of the labor Cade,for Ne Performance or the 301 ROUGH PLUMBING
work mrwhuh this permit is!send. 302 - TUB & OR SHOWER
C:]I have and will maintain Wo sce,Compensation Insurance,as requited by Section
37IXsof the labor Code.for the perform,nceaf de work for which this permit is issued. 303 — ROUGH MECHANICAL
My Worker.Compensation I...ce prier and Policy number are: 304 — ROUGH ELECTRICAL
Carder. Policy No.: 305 - FRAME
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE 306 - HOLDOWNS
rmhsection need not becompleted if the pcmmitisfor one hundred donorISIM) 307 — INSULATION
or less.) 308 - SHEETROCK
1 eenify that i n to anse,of work fol,Ivhich NIv permit Is Isiucd,I shall ata -
ampo on orw01 ray mann b ec w t eWorken'Compemnion 309 — EXTERIOR LATH
Applies- ° rh . 310 INTERIOR LATH
bN fl9, PPLICANP..If.after making l anmeHm emptu 311 - SCRATCH COAT
suhim to Ne Work=',Compcmuadon prov'' Libor Code.you mou
Z fib ash comply with such provisions or Nis bo nam d meted. 313 — ROOF NAIL
Z. CONSTRUCTION LENDING AGENCY 501 - FINAL ELECTRICAL ENERGY
I hereby dBmm that dem is a contraction lending agency far the performance of 502 - FINAL PLUMBING ENERGY
C.>
(y Qthe work for which this permit 0issued(Sec.J097,Civ.C.) 503 - FINAL MECHANICAL ENERGY
Lendcra Namc
Lendce,Add=s
Ds
]z 504 - FINAL BUILDING ENERGY
U0 I eenify that 1 have mad this application and mm that the above information Is 5 05 - FINAL ELECTRICAL
correct.1 agme to comply with all city and county oniinancas and state laws relaling to
0 Q building construction,and hereby authorise mprcwnutiws of Nv City to enter upon Nt 4GAEST
eleveng constrWNopeny Impowdon Odd rposea
Q6 (We)agree to save,indemnify and keep harmless the City of Cupc agsimt O 7 rat llObillimt,judgments,costs and expmmu which may In any vey smut agdast lot COy 5 WICAL
U 7 In corummenee of Ne goosing Of this permitAPPLICANT UNOERST S AND WILL COMPLY WITH AIL NOW TNT Issued by:5 Date
R LAT70NS O -
Re-roofs
Sig mofApplican lot 'DISCLOSURE Data of 4 INAL PUBLIC WORKS
TyPe 2 - ROOF PLYWOOD NAIL
WIII We applicant or future bas accuryntsrorc orhendlchuallous material
u defined by the Cupertino Municl Code,Chapter 9.13.and the Health and Safety 603 — ROOF BATTENS
Cmm.sa,Mm2553xfa)7 All roofs sbidlIbe ins j7ripNtop%Uofj2�®aterial being installed.
❑Yes No
Will the applicant or future Wilding Occupant use equipment at devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air ronwning b;u d by the Bey Arca Air Quality Management all new materials for inspection.
Dlsvict7
❑Vas u
I new mad thehmeardousmatersisrcqulmno nu under Chapter 6.93 of the Califon
rlalicelthaSafctyCo ,Sec6u35505.15533md35534.1.dl.mdthnlftite Wilding ,
date out currently hew e te that it h my mpooslMllly m notify IhC mcupanl of Nc
Nigizoagp m aencearaCmtyll"ar ea Signature of Applicant ' Date
mer Or amhoPoad`gem Oam
All roof coverings to be Class"B"or better