02030167 CITY OF CUPF.R I'INOAri?,
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION '.
Bua1dK,AgigtissIMPERIAL AVE TAYLOR WOODROW HOMES PERMITN(02 03 0 16 7
41 NEMAYWR WOODROW HOMES 2300 CAMINO RAMON APPLICATIegly`TtTJ2002
PHONE: 92 5 3 6—5-310 0 SANITARY NO, 77 77 CONTROL NO.
ARCUITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MWI1
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P00 LICENSED CONTRACTOR'S UIiCLARATION 6� qq
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I hereby affirm that I am fronted under alPreons of Chapter 9(commencingsis NEW TOWNHOME d8RTfft'? 'n ON
wish Seninnbya rDivisionJof Ne Business and Pnsons of Gdc,andenci is
in fallfo. adeffen. 1456 SQ. FT. LIVING SPACE
&I_ License Class Lic.R
oy-� Da contmnar 469 SQ. FT. GARAGE : 12029 85
Fra' As shall
ARCHITECT'S DECLARATION AN ANALED
.0te� IunJcrvand my plans shell he used as Public records 69 �r�
spteV
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Licensed Professional
OWNER-BUILDER DECLARATION DEC 1 0 2003
yy�u�<f I hereby affirm that I am uchips from the Contractor's License Law for the
ac 6 02 following reason.(Section 7031.5. sInH1.5.Business d Professions Cole:Any city nr county
a. 3 which requires a permit m construct,alter,Improve,demolish,or repair any structure
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prior to its issuance,also requires the applicant for such permit to life a signed statement
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that In,is licensed pursuant to the previsions Of the Contractor a License Law(Chapter 9 Sq. I'l. FIOOrArea
asl`$ (commencing with Sectionuft)of Division 3 of the Business and Professions Cade)or
that he is exempt memBnm and the Was for she alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects she applicant to a civil penalty of
not more than fin hundred dollars(DBKp, e Occupancy Type
❑1.as owner of Ne Property,or my employees with wages a their sole Compensation,
will do the web,and the structure is not intended or offered for rate(Sec.7D14,Business 2
and Professions Cede:The Curhnnar's License Law does not apply to an owner of 102 - PIERS equlred Inspections
property who builds or improves thereon,and who doessuch work himself or through his
own employees,provided that such impar nmenes are not intended or offered for sale.If, 103 — UFER
however,the building or improvement is sold within one year of Completion,the owner. 1O4 — REBAR
builder will have the burden of pmving Nat he did not build or improve for purpose of
sale_) 105 - ANCHOR BOLTS
,as owner of me property,am exclusively contracting wish licensed contractors to 106 - SEWER & WATER
conswet the project(Sec.7(M4,Business and Professions Code:)The Contractor's Li.
cense Law does not apply man owner of property who builds or improves fact and 202 - UNDERFLOOR PLUMBING
who contracts for such projects with a contractors)licensed pursuannto the Contractor's
License Law. 203 — UNDERFLOOR MECHANICAL
Ism Bump,under Sec. ,B&PC far this rearm 204 - UNDERFLOOR FRAME
wtuin /'oL 205 - UNDERFLOOR INSULATION
WORKER'S COMPENSA ECLARATION 301 - ROUGH PLUMBING
IhercM1y amino under Penaltyo erjnynnn of the following deductions: 3 0 — TUB be OR SHOWER
❑1 have and will maintain a Certificate of Commnuo self-insum for Workers Compen-
sation,u prnvided for by Section 37W of she labor Curie,for the Performance of the 303 - ROUGH MECHANICAL
work for which this peanirs issued. 304 - 'ROUGH ELECTRICAL
❑I have and will maintain Worker's Compensation Insurance,as required by Section 3 05 - FRAME
37M of Be Labor Cudc,for Ne Performance of the work for which cha&Permit Is Issued.
My Worker's Compensation lnsumnce carrier and Policy number am: 306 — HOLDOWNS
cancer: Policy No: 307 - INSULATION
CERTIFICATE OF U? EMPr10N FROM WORKERS'
COMPENSATION INSURANCE 308 - SHEETROCK
(This section need notlWcomplevadifllw farmitisfornnchunnreddnllan(SI(xp 309 — EXTERIOR LATH
"rlem.) 310 - INTERIOR LATH
1 certify that in the Performance of she work far which this permit is issued.I shall not 311 - SCRATCH COAT
emplayenypcwnin any manners tqb j .�s sit the Workers Compensation
Lws a. ata—! 313 - ROOF NAIL
Applicant
NOTICE TO APPLICANT: L runt,making this Cmurl-the ' tion,you"aulA 501 - FINAL ELECTRICAL ENERGY.
hccume subject m the Worse,',Compensation pmvisions afvsr Code,you moa 502 - FINAL PLUMBING ENERGY
OO foMwith comply with such provisions or this permit shall eJcemed revoked.
Z 503 - FINAL MECHANICAL ENERGY
CONSTRUCTION LENDINGAGENCY
[. I hereby athrm Nat there isacnmwctiBN7,Cleading agency lnnhc Performance Of 504 - FINAL BUILDING ENERGY
k > meweek for which miapermhiaissued(seo3an,ayc)
Lend 505 - FINAL ELECTRICAL
fi7 Q ,,'a Namc
z Lcnder'aAddress 506 - GAS TEST
U O 1 ecnify that I have read this application and sate that the above information is 507 - FINAL PLUMBING
U. f. cortea.l agree to comply with all city and county ordinances and state laws relining In /
O building conamcsion,and hereby authndu representatives of this city to enter upon the S54FINAL MECHANICALN rhmr(WOa reetosawperty for emnify an keep ha IN E(Wel agme m save,indemnify and keep harmless me City ofe aganst againstH y liabilities,boned pro expenses which may in eny way ettroc egeimt uiJ City N GU z in consequence of she grammgof this Permit.APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON.Poerr Issued byWORKS Date / VV
CE REGULATIONS.
Re-roofs 603 - OF BATTENS
Signature o(AnplicxHAZARDOUS MATGRIAL .CLOSURE Date Type of R0pj'4 - ROOF IN-PROGRESS
Will the applicant or for..building cec pact arm at,handle hvaNnus mescal
as defined by the Cupertino Municipal Coda Chanter 9.12,sad the I lealth and Safety
40 dc,Section 25532(x)? All roofs shall be inspected prior to an roofing material being
❑Yes grf P P Y g g installed.
Will the applicant nr future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
trait haardnus air cunumonams as defined by the Bay Area Air Quality Management all new materials for inspection.
District'?
C3 Y. a<
I have read the haardaus materials requirements under Chapter 6.95 of the Callfur e.�
nits Healm&Sufety Code,Seadons 255115,25533 anJ 25534.1 undenecul that if dW building /O •/,O
does not cummly have a tenant,that his my resramobility to nosily tM occupant of the
realm whmhmn aanceOf.Centur=OfOccupancy. Signature of Applicant Date
0 nermuchimimdagent Date/ O All roof coverings to be Class "B" or better