02030200 CITY OF CUPEWI'INO
BUILDING DIVISION PERMITCOQ RACT3OR INFORMATION '••_
BuILplggAM.OEssIMPERIAL AVE TAYLOR WOODROW HOMES PERMITNT2030200
R?,Tt0R .WOODROW HOMES 2300 CAMINO RAMON APPLICAT1nU76� 2002
PHONE', 92S 365-3100 SANITARY NO. // �� �� ' CONTROL NO.
ARCHITECT/ENGINEER: - - BUILDING PERMIT INFO
' BLDG ELECT PLUMB MECH
cs z
1402 1'�- LICENSED.thatCONTRACnderprovisions
DECLARATION ,
z P 1 hereM1 firm that I am licensed under m inions of Chapter H(commencingCrl I1
withScctbut 7(XMp ofDiviihm 3 of me Business and Prufecanns Code,and my licenses TOWNHOME LIVIN SY. pl / /1 172707 .
~�ato full n,n'eanderrecb. GARAGE SP. 498 GAR�y VAL. 7430 .
Date!oClass Eta. Nq,
OZr-O Uatc" . . .- - Cotnmanr LS®
"q,� nb l shill ARCHITECTS DECLARATION
ae tool raudJ my planssh511muscdas public rccnids
KLLo° Liccasedreaessu al NOV 2 4 2003
Yyyg OWNER-BUILDERDECLARATION t
C <8 Thereby uflirm that;I um exempt rrnm he Cnmranor's License Law fnr the
i.00 follouiag reason,(section 7031.5,Badness and Professions Code:Any city or county
k$]� which requires d.reimit to coast fuct,:MlOer,improve,demolish,or repair any"suucture
mom" UM
prior to its issuance:also requires the applicant for such permit m file asigned statement
t—s< thmhcisIcensedpursuanuuthe provisions ofthe Contractor's LiceneLaw(Chapter 9 Sq. Ft. Floor Area Valuation
it1- (commencing with section 7000)of Division 3 of the Business and Professions Code)it '
o, Nat he'is exempt therefrom and he basis for the alleged exemption.Any violation of 35717018 . 00
Section 7031;5 by any applicant for a permit subjects the applicant to a civil penalty of ApN Number Occupancy
net momihanfvehundreddo]$..(s50(l 101 — FOUNDATION p y Type
of.,a owner of the property,or my employees with wages az their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7W,Business
and Professions Cale:The Conten tote License law does not apply to an owner of 103 - UFER Required Inspections
property who builds or Improve(lhe2nn,and who Jressuch work hlmYlfor through his
own employee,provided that such improvemerns arenot intended oroRared for We.If. 104 — REBAR
hriwcvec NebuildingoriMPMWmentismldwithinomruofmmpletion,Neowmr lOS — ANCHOR BOLTS
builder will have d¢burden of proving Nat he did not Wild or impmrc for purpose of
"°') 106 — SEWER & WATER
Les—at,at Nepropcmy,amexclusivelycontracting who licensed contractors m 202 — UNDERFLOOR PLUMBING
cabinet be pmjen(Sec.IIIaC,Rusin.aod Proressiom CW.:)The Canmcmrk Li-
crow fao.doe.s not apply an an owner of proforty who Wilds or improves Immon,and. 203 — UNDERFLOOR MECHANICAL
who contracts fnr such PmJecu with a eonnmor(d licensed pursuant o the Conuaciori
License Law. 204 — UNDERFLOOR FRAME
I un eaemPl under Scc. .B&PCfor Nis reazan 205 — UNDERFLOOR INSULATION
pe �'_ Date 301 — ROUGH PLUMBING
s.., '.,WORKER'. COMPEN.ATI CLARATION 302 TUB & OR .SHOWER
,)herehy ammo under penalty nfp fury one of the following declarelinns: 3O3 — ROUGH MECHANICAL
❑ I have and will maintain a Ccmifcam of Consent to self insum for Worker's Compete
aationlas provided for by section 3700 of the labor Code,for the performance of the 3 04 — ROUGH ELECTRICAL
work for which this permit is ieimd 305 — FRAME
❑ I'hivc andwill maintain Worker's Compensation Insurance,as required by section 3 0 6 — HOEDOWNS
3700 of the Labor Code, Insurance,
the performance of the work fa which this Pcrmt,is issued.
My workers Come pensation I mumnce carrier and Policy number am: 307 — INSULATION
Came: :'' PohcyNo.: 308 — SHEETROCK
CERTIFICATE OP EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE 309 — EXTERIOR LATH
2muisseaion need not m completed tom permit i.mronchundraddnuars(s1a) 310 — INTERIOR LATH
lea') 311 — SCRATCH COAT
I cenify that in the performance of the work for which this Permit is issued,1 shall not 313 — ROOF NAIL
empmy ay r0n many m� nen nmeatntmwnrker,cnmpen,arnn 501 — FINAL ELECTRICAL ENERGY
Inns of 1
Nf r NOTICE
OTICETO APPLICANT:Worker's
r'after Compensation
this Cc ifouv n( bra,you,youshould
at 502 — FINAL PLUMBING ENERGY
mcomesubmply me wnrh panCumpcor this earnaiha bur cake you must 503 — FINAL MECHANICAL ENERGY
OO fnnhwi0h comply with such prnvisinns or this permiuball mJcemcd revoked.
z 504 — FINAL BUILDING ENERGY
.y CONSTRUCTION LENDING AGENCY
(—r ..Ihemhyafrmthat Ncreisaconsnctionlending agency far the orforman.of 505 — FINAL ELECTRICAL
IYr.>
the wsirkfor which this perm itisissued(See,3097,Civ.C.)
Lcndcra Name 506 — GAS TEST
W.� '
: z ^bra"d�roxs 507 — FINAL PLUMBING
U O 1 certify that I have red this application and state that the above information is 508 — FINAL MECHANI CAL
Iy.F
correct.I agree to comply with all city and county ordinances and state laws holding to 5 FINAL GRADE
Q V building construction,and hereby authorim representatives of Nm is city enter upon the
i Po4mention d property for inspection purposes.
Wo)agree to save,indemnify and keep harmless the City of Cupertino against
liabil itics,judgments,ensu and expenses which may in any way came against said City 5 N LI WORKS
V.Z in consequence of the granting of this Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by 60 F NAIL Date /
RCE REGULA1'[O
1
• Re-roofs 604 — OF IN—PROGRESS
Signmurc of Applicumctor Dam
I AZAIAZARDOUSIALS DISCLOSURE Type of Roof
Will the applicant or(Marc hoe Jing re.Chapter
r 9,1 or handle Health ad
as tictined by the Cupcnino Municipal Code.Chapter 9J2,and the Health and Safety
de,section 25532(pf All roofs shall be inspected prior to any roofing material being installed.
❑Yes
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 haeardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
District?
E)yes o
1 have read the m.ahma materials bequitemenu under Chapter 6.95 of Ne Calif.'*
raizltcaldh I Safety Code,Sections 25515,25533 and 25511.1 understood Nat if ole Wilding
does nm comet,have a tenank Nat it is my responsibility an modify the occupant of the
cntytapiphmuummatt nkaCemifiemofOccupancy. Signature ofApplcant Date
Owner fir authorized agent Dam . All r
O o coverings to be Class "B"or better