02100010 CITY OF CUPERTINO
BUILDING DIVISION PERMIT kACNTRACTORANFORMATION:�.
RUlgytrygApupESSIMPERIAL AVE TAYLOR WOODROW HOMES PERMIT M®2100010
YEYOR WOODROW HOMES 2300 CAMINO RAMON APPLICATTVIAYDITN 2002
PHONE, (925) 365-3100 SAW EARY NO.// vv / CONTROL NO.
A R C I ITITiMENGINPER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Op
LICENSED CONnsedunderp DECLARATION pD
hereby affirm that I am filo,BJ under provisions of Chapter 9(commencing ob
FIELD REV I S I OI (R2T�!'fft NG WALLS)
wish Sxctionand effect.Division J of the Business and Professions Clvdc.and my license is
m fttluomc and erre°. IN HOUSE USE ONLY, NO NEW PERMIT ISSUED
Lict,qz Date mss Lic " ORIG. #02030196
oiF Dau TS DECr
QQ As shall M'
sari B I understand my plans shall M uxeJ as public records
au a.
au a. LicenxJ Pmlessinnal
OWNER-BUILDER DECLARATION �, r
at P I hereby amrm that I am exempt from the Conuacmra License law for the V
w�00 following mamn.(Section 7031.5.Business ami Professions Cole:Any city or county
which requires a permit to comem,alley,improve.demolish,or rtput,any staCm
m
la$- rplinnn it,iss ance,alsu requires mcaPplicurn far such pmmit R,Rlcasignedslalemenl
s£-m�m'< that he is licensed pursuant m the Photiatal of the Cantreanr's License law(ChaFmr 9 Sq. Ft. Floor Area $1$0 Ts'l3llation
yFS (commencing with Section 700E of Division J of the Business and Professions Csde)or
y Thal he is exempt thcmfram and die basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant)a civil penalty ofOCCU araC
no,more than five hundred dollars DYXq, -5 nAPNNI& Occupancy Type
❑L as owner of the Prolixity,or my employees with wages as their sole compensation.
will do she work.and the structure is not intended or offered for We(Sec.7W Business
and Professions Code:The ConOumrs License Law does not apply to an owner of10 2 - PIERS equlred Inspections
bacilli who Wildaorimproves thereon,and whodoesauh ro
wart htmwlformugh his
Own employees,provided that such improvements art not intended oroRewd limeade.It. 103 — UFER
however.Ne building or improvement is mW within me year of completion,the owner-
buiWer will have the burden of proving that he did not build or improve for purpose of 104 - RE BAR
We.). 105 - ANCHOR BOLTS
❑ l,as owner of the properly,am exclusively contracting with licensed contractors to 106 - SEWER & WATER
construct the praiser(Sec.70,14.Business and Professions Cude:)The Contractor's U.
cense law does not apply to an owner of property who builds of improves themon.and 202 - UNDERFLOOR PLUMBING
who contracts for such projects with a contractor(s)licensed pursuant o the Comacior's
License Law. 203 UNDERFLOOR MECHANICAL
I am exempt under See. ,B&PC for this moan 204 - UNDERFLOOR FRAME
net Data 205 - UNDERFLOOR INSULATION
WORKER'S COMPRNSATIONDECLARATION 301 - ROUGH PLUMBING
v
I hereby affirm under penalty of perjury sem of the following declamations; 302 - TUB & OR SHOWER
l have and will maintain a Ceniraae of Consent to self-imam for WorkoisCompen 303 — ROUGH MECHANICAL
.lion,as provided for by Section 37M of the Labor Cords,for the performance of the
work for which this Permit is issued. 304 - ROUGH ELECTRICAL
❑1 have and will maintain Worker's Compensation Insurance,as required by Scclion 3 0 5 - FRAME
YNXI of the labor Curie, N
for e perlm
kmance of the work for which this permit is ia.cd.
My Workers Compensation Insurance carrier and Policy number am: 306 — HOLDOWNS
Carrier: Policy No.: 307 - INSULATION
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE 308 - SHEETROCK
musixectilm nesdnmbecompleWd ditto permit isfnrmmhundreddoliars($100) 309 - EXTERIOR LATH
or less) 310 - INTERIOR LATH
I cxnify that in the performance of the work for which this permit is issued,1 shall not 311 — SCRATCH COAT
employ any Forum in any manner sit us m heeomu
o sobjeco the Wmisrox ComPenution
Lawsof California.Date 313 - ROOF NAIL
Applicant
NOTICE TO APPLICANT.If,alter making this Certificate of Exemption,you should 501 - FINAL ELECTRICAL ENERGY
hccome aobject[,,the Wmkers Compeilocni pm vision,or the lahor Lode.you most502 - FINAL PLUMBING ENERGY
0,2 forthwith comply with such provisions or this permit shall be deemed revoked.
Zo CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
t.. .N. Ibemhy.M.that there I..construction lending agcuy]or the performmccof 504 - FINAL BUILDING ENERGY
IY > me work for which this permit isissued(Sectt.30V7,Cis.C.)
IOnaers Name 505 - FINAL ELECTRICAL
6[7 0
]z Lembo'sAddre. 506 - GAS TEST
U O 1 madly that I have read this application and soon that the above ministration is 507 - FINAL PLUMBING
rar F correct.l agree to comply with all city and county ordinances and stem taws relining u, 5 FINAL MECHANICAL
0 U building construction,and hereby authorim rxpresxntmivo of this city to cateruptmthe
as aMwe. cut(W)age 1.saw tinemnifyan keephs. 09 FIN 1
(We)agree to save,ori nmdy and keep harmless the City of Cupertino against
y Iiahilitics,judgmenls,cosis andexpxnwawhiah may in any wayaccwe against said City 5 N
in
his Profit.
U 4
APP(.CANTeUNDERSTANDSof file Standing of tAND WILL COMPLY WITH ALL NON-POINT Issued by5 1 WORKS Dat o v
SOURCE REGULATIONS.
Re-roofs 603 - OF BATTENS
Signawrc of ApplicaHAZARDO nor¢
HAZARDOUSMATERIALS DISCLOSURE Type of R®pf4 - ROOF IN-PROGRESS
Will the applicant or fuwrt building ceapam store or handle harardous material
defined by the CuPeninn Municipal Cole,Chapter 9.11,anJ the 1{eelth anJ Safety
ore.sec0aa zss3xe)7 All roofs shall be inspected prior to an roofing material being Installed.
❑vex ❑No P P Y g 8
Will ruse applicant in future building by the B use Area
Air Qu or devices which
If a roof is installed without first obtaining an inspection, I agree to remove
emit haeaNnus air contaminants as defined by the Ray Arca Air Quality Management all new materials for inspection.
Di.nricR
❑Yes 0N
1 have mad the haeaNnus materials requirements under Chapter 6.95 of the Calif.r-
nia i balm At Safety Code,Sections 255115.25533 am115511.1 uncia staml that if the building
does not comically haw a tenant that 11 Is my reslarmiblllty to notily the m011pNI of me
requirements which must M met prions issuance of a Ccumcate of Occupancy. Signature Of Applicant Date
Ownmor authorized agent Dam All roof coverings to be Class "B" or better