02100007 CITY OF CUPERTINO
BUILDING DIVISION PERMIT 9C0NTR'ACT0R INFORMATION
BUIL 1 r9.:MPERIAL AVE TAYLOR WOODROW HOMES PERMITNO21//00007
OFT-ftYLOR WOODROW HOMES 2300 CAMINO RAMON APPI-CATT�J"J''ITyr2002
PHONE: (925) 365-3100 SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER: BUILDING 1117RMI'r INFO
BLDG EL II PLUMB MECH
0 0 0 0
w00F LICENSED CONIVACIOR'$DECLARATION y�
u`� I herchyaffvm that l am licensed under provisions of Chapter 9(commencing RETROFIT DE TA /D)
/D)
wltb Section IRMl)of Division 3 of dm Rostra and Professions Cnde,and my license is
in full orce and effect ORIG. #02030112 , NO NEW PERMIT ISSUED
O �Z License Class hit.M
Z F Uam contractor
ACyy ARCIII con DECLARATION K oZ2 1 understand my plans shall be used as public records
LLor Licensed Pndessional y \
j OWNER-BUILDER DECLARATION �pY
<f I hereby affirm that 1 am exempt from the Contractors License Law for the e`
following maxou.(Section 7031.5,Business and Professions Code:Any city or county 1
$ which requires a permit to constrict,alter,improve,demolish.(it repair any slruaure 15 4 018
FZy prior m its b uance.atso rcyvires the applicant to such Permian Elea signed¢tammenl
gg < tbut he is licensed parmanti,,the provisions of the Comnemr's License Law(Chapter 9 Sq. Ft. Floor Area Valuation
ad (commencim with Section 7000)of Division 3 of dm Business and Professions code)or
Nat be u attempt therefrom and the frobasis for the alleged exemption.Any violation of 35717018 . 00
Section 7031.5 by any applicant for a permit subjects Be applicant to a civil penally of APN Number Occupancy Type
not mom thanfive hundred dollars lk50q 101 - FOUNDATION P Y YP
0 I,as owner of the progeny,or my emplowas with wages a their sole compensation,
will do the work,and be net..is not intended or offered for sale(Sec.7044,Businev
and Professions Cods:The Contractor's License Law does not apply m an owner of 103 - UFER Required Inspections
propenywho builds or improses thereon,and who creatures work himself or through his
own employees,provided that such improvements are not intended oroRereci for We.11, 104 — REBAR
owever,the building or improvement is sold within am gear ofcomplction,the owner. POS — ANCHOR BOLTS
builder will have the burden of proving that he did not build or improve far purpose of
Mla') 106 - SEWER & WATER
01,as owner of the property,am exclusively contracting with licensed contractors to 202 - UNDERFLOOR PLUMBING
construct the pmject(Sec.7044,Business and Professions Code:)The Contractor's],I.
cense law does not apply to an owner of propeny who wilds or improve thereon,and, 203 — UNDERFLOOR MECHANICAL
who contracts for such projects with a comomou(s)licensed pursuant o the Contractor's
License Law. 204 - UNDERFLOOR FRAME
I am exempt under Sec. ,B&P C for this...a 205 - UNDERFLOOR INSULATION
er Date 301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER
I hereby afrrm under penalty of perjury one of the following declarations: 303 — ROUGH MECHANICAL
I have and will maintain a Cenificem incontinent m self-insudefor Warker s Comp,m
sation,a provided fol by Section 37M of the Labor Code,for the pad.. a ed the 3 04 - ROUGH ELECTRICAL
work for which this permit is issued. 305 - FRAME
0 1 have and will maintain Worker's Compensation Insurance,as required by Section 3 06 - HOLDOWNS
37)(0 of the Labor CnJe,for me performance of the work for which this permit is issued.
My Worker's Cnmpiramiln Insurance carrier and Policy number um: 307 — INSULATION
Came: Policy No.: 308 - SHEETROCK
GIiRTIFIGG MPENSATIONTEl OF ION INSURA CEORKERS' 309 — EXTERIOR LATH
(This section need notes completed Rita,Permit is forms,hundred di lars($HMd 310 - INTERIOR LATH
onma) 311 - SCRATCH COAT
1 ccnify that in the performance of the work for which Nix permit is issued,I shall not 313 - ROOF NAIL
employ any peruse in any manner tat as become subject to the Workers'Cum sensation
Laws of California.Data 501 - FINAL ELECTRICAL ENERGY
Applicant
NOTICE TO APPLICANT.If.after making this Criificate of Exemption,you should 502 - FINAL PLUMBING ENERGY
boom,subject m the Workers Compensation provisions of the labor Calc,you must 503 - FINAL MECHANICAL ENERGY
zO forthwith comply with such provisions or this permit shall be deemed revoked. 5
CONSTRUCTION LENDING AGENCY 04 — FINAL BUILDING ENERGY
4 I hereby blind that dam is a construction lcndingagenylio the performance of 505 - FINAL ELECTRICAL
W' > the work for which this Permit is issued(Sec.3AO.Co.C.) 506 - GAS TEST
W� t7 Lentis',Name —
D z Le der'sAddress 507 FINAL PLUMBING
UO IceneemarIhave readthis ty anccunyostare that and
same lmmmtainn e, 508 — FINAL MECHANICAL
0 F correct.lagree ocomply wile all miry and cnunrymrdtivesos and star t laws,dating e 5 FINAL GRADE
Q buildingconswainn,and hcmby authonprposes. tivcs of Or,cirymcnmr urym the
Wabove-meminneJ progeny for inspection purposes. lO FIN ANNVIG
(We)agree m save,indemnify and keep harmless me City of Cupertino against liabilities.judgments,costs and expeduces which may in any way attme against mid City 5j N LIRKSGU,'Z inconsemencemfthegranir,ofthispermit. CAPPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by60 F IL Date
SOURCE REGULATIONS.
Signature of ApplicaRe-roofs 604 - OF IN-PROGRESS
HAZARDOUS
Dam
HAZAUS MATERIALS DISCLOSURE; Type of Roof
Will the applicant or future building occupantrd
store or handle hvsous material
defined by the Carman Municipal Code,Chapter 9.12,and the Health and Safety
e.Section 25532(a)?
❑Yea 0 N All roofs shall be inspected prior to any roofing material being Installed.
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
emit haeandous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
Dutrim7
❑Yes ON.
1havemadtheharaNnusmamrixlsmquimmentsun&e Cwpml6.95ofthe Califnr
ria s not
ur Safetyhaw aSecuoru8At i my
r sod 25534.1 understand a occupant
wilding
Jtcs sol currently have a tenant than it is my responsibility m notify Ibe saeupanl el the
requirements which most N met Four it,issuance of a Cenincateof Occupancy, Signature of Applicant Date
Owner or aumorived agent Dam All roof coverings to be Class"B" or better