02030194 CI rY OF CUPER,rINO or .;� .�.•� r r.,.'; ;.
nun DING DtvtSION PERMIT �CONTRACTOWINF.ORMATION
BUIL1)16G1A6b2'SEMPERIAL AVE TAYLOR WOODROW HOMES PERMITNIO 2 0 3 0 194
t-19 R WOODROW HOMES 2300 CAMINO RAMON APPLICATIyjV6OgTV 2002
PHONE: 92 5) 3 6 5—3 10 0 SANITARY NO. // LL // CONTROL N0,
ARCHinicriENGINEER:. BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
+�00 . LICENSED CONTRACTOR'S DECLARATION
es mi " 1 hereby ruffian Nal 1 am liccmed under pmvisimu of Chapter 9(commencing Job Description
with Sen inn 70,10)of Division 3 of me Busincv and Pro@ssiuns Cock,and my Scram is NEW TOWNHOME
<� infuillioce'an0 effect, 1589 SQ. FT. LIVING SPACE .
Z O Liccns Clnss Lic.X
0z —
Dam . Comracmr 492 SQ. FT. GARAGE : $12619 . 80,
ARCHITECT'S DECLARATION
�O6u .
', my plans shall W used as public records
FLLOyLicensed Promerelnal
g OWNER BUILDER DECLARATION
ce!p�00 ,'•I hereby.(lion that 11. cBusim from the Commcmfs Code:License Law for the �'�����
u 600 following reason.(Section 711JL5:construct,alter, and Endesions h,bAny city nr county
s�$lei which its iso x a permit m uim.stealoe improve,h e demolish,t nr repair any structure
triton its issuance,pursuant
theapplicantofor mchpermirsoicenle se ned Law(Chapter
< that littnud pursuant mthe provisions nfthe theRedeem
Liccnselswer Cudcar9 Sq. Ft. Floor Area 7 h n
s€�
(commencingathe
empth Section 701d and of baiiion)nf alleged
exe and Professions Code)nr ib If )II��
i Net Section
is 31e5 b any li oro and BeNe basis for me alleged exemption,Any violation of
not
than by any applicantfor apermit subjects the epplicam macivil penally of
nm more man five hundred dollars tss(gq' -3b,61IIN/NT�FeTlo ccur+�p ka'ncy Type
❑ h m owner of the property,or my employees with wages as their mole rompenamioo,
will do the work,and me structure is not intended uroffeecd forsalc(Sec.7W,Business
and Professions Code:The Contractor's License Law aces not apply to an owner(if102 - PIERS equired Inspections
property who builds or improves thereon,and who dcesmch work himself or through his
own employees,provided that such improvements are not intended or offered for sale,If. 103 — UFER
however,the building or improvement is old within one year of completion,the owner
builder will have the burden of proving that he aid not Wad or improve for purpose of 104 — REBAR
105 - ANCHOR BOLTS
L as owner of One property.am exclusively contracting with licensed conuaesorsm 106 - SEWER & WATER
consumer the project(Sec.7044.Business and Professions Cede:)The Conmmor's Lt
cense law does not apply to an owner of property who Wilds or improves thereon.arta, 202 — UNDERFLOOR PLUMBING
who contracts for such projects with a contractors)licensed pursuant o Ne Comtaelor's
License Law. 203 - UNDERFLOOR MECHANICAL
x,ml under Sec. ,B&PCfnnhis rcaatn 204 - UNDERFLOOR FRAME
-' Datel�•�•i!JL 205 - UNDERFLOOR INSULATION
WORKER'S COMPENSA/Tipp LCLARATION 301 - ROUGH PLUMBING
I hercbY ellimt under penalty of )�Cr'ury one cIOm followin8 acclantinns:
❑ihavc uta win mainlainaceniBcalc of Conunundel6msare for Wmker'acnmpem 302 — TUB & OR SHOWER
dation;as provided for by Section 3701 of the Labor Code,for the peAounnowe of the 303 - ROUGH MECHANICAL
work for womb this Permit is issaed. 304 - ROUGH ELECTRICAL
El 1 have and will maintain Worker's Compensation Insurance,a required by Section 3 05 — FRAME
3700 of the Labor Circe,for me performance of the work for which this permit is issued.
My Wo,rker's Compensation Insurance carrier and Policy number are: 306 — HOLDOWNS
carricl: . - Policy No.: 307 - INSULATION
CERTIFICATE OF EXEMPTION FROM WORKERS'
.COMPENSATION INSURANCE 308 - SHEETROCK
('Thisscelinnneed not WCtuddendiftbe permilisfnrunc hundreddnllars(51(X10 309 - EXTERIOR LATH
tir'e'd') 310 - INTERIOR LATH
I ccnify that in the performance of the work for which this permit is issued,l shall not 311 - SCRATCH COAT
employ any Person in any man rykmw nme. olhe Workers Componsainn
L"sof al, '°9`= °�`- 313 - ROOF NAIL
.. Applican
NOTICE TOA LICANT:If,after making this Cenilr"m or Er ole y should 501 - FINAL ELECTRICAL ENERGY
become object the Worker's ComNeration provisions 502 - FINAL. PLUMBING ENERGY
O 0 forthwith comply with such pmeisinnx.,,he,permit shall he deemed revoked, .
CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
4 1 Wortly offloon that there is a construction lending agency for the performance ot 504 - FINAL BUILDING ENERGY
ai > the worklurwhich lhisPermit isissued(See.3pn,Cie.C.) 505 - FINAL ELECTRICAL
W O, Leadcr',Adme 506 - GAS TEST
Oa Lead cr's Address
U O 1 candy that I have read this application and state that me above info ation is 507 - FINAL PLUMBING
Ug - correcslagreetocomplywithallcityandcountyonlinenaesandsuiteawsrellinng1. 5 FINAL MECHANICAL
O� Wun
building constritu,and hereby authnrire representatives of this city to enter upon the
Fw .hove-mentioned pmpeny for nspection purposes. O9 FIN
0. We)agree to save,indemnify and keep harmless the City of Cupenino agaiMt
y
liabilities,judgments,costs and capenses which may in any way averuc against said City Cj s Permit. N G' r
in
of the granting of
V APPLICANT eUNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by51 WORKS Date r
SOURC13 REGULATIONS.
"0 Re-roofs 603 - OF BATTENS
Signmam of ApplicaWCmnmpor - Date
HAZARDOUS MA ' Dlsc GsuRE Type of P4904 - ROOF IN-PROGRESS
Will me applicant orfmum but ng occupant store or handle hanodous malarial
a defined by the Cupertino Municipal Gavle.Chapter 9.13.and the Health and Safety
Section 255320)7 �N/ All roofs shall be inspected prior to any roofing material being installed.
Vea
Will the applicant urlmurc building Occupant use equipment or Devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hasardlu s air cumaminants as Jenna by the Bay Area Air Quality Management all new materials for Inspection.
District%
❑Yds [JfNo .
I have mall We hasardons materials requirements under Chapmr fi 95 of the Cxl dor
niallealdi&Safny C(hoc,Satitin,295)5,25533nnd25534JundemtandlhnUflhc hull did, !�- /�
docs not cmremly have a tenant.mat it is my resptmehility to notify the recupam of me _ (J
men Mchmns1Wmetp cenracenmcatenrOccupaneY. SlgnaturioofApplicant Date
OL All roe overings to be Class ••B••or better
Owner or authorized agent Date