03030080 CITY OF CUPERTINO I�
jBUUD
LDING DIVISION PERMIT I' �I QR I '�RMA.'CIQ Olt
i "<, x'iY:.. .« f; 4;v;N,g R w^.�s 'a«
ADDRESS: PERMIT NO.
HIGHLAND CONSTRUCTION AND PLUM
PERMIT mu
NAME: 20073 NORTHCREST SQASON STUBBLERIEDDSANITARY N L NO.
4082411858
BUILDING PaRM1T INFO
ARCHITECTIENGINEER:
O ELECT PLUMB1=3
p� LICENSEDCONfRACRJR'S DECLARATION lob Description
1 hemby affirm that 1 Am licensed under Provisions at Chapter 9(commencing
with Secd 7 )of Dividon Sof the Butftu! rad Profauinw Code.am my bean is
infullforce affect 7578''2 WATER SERVICE/SERVICE PANEL/REPLACE WINDOWS
a Lice Lk.N
Dem ARCNnECi'So�ec,, AMIN REWIRE GARAGE SHEETROCK
1 u dcnune my plans
lrm shall be usetl u public row's
t� Licensed MHARSIonal
Oat I am exempt
from
DECLARATION
1 hereby amen on 1 am eampt from Ne CssIrms o e:A License Law co Ne
O o following rcaan.(Section 7(171.3,Business ural ProfcWnns Code:Any city a county
lipwhich requires a permit ro wastNn,alter,improve,demoliN,or repair my akueturc
I�ivn prior On its issuance.also roquhas the applicant for such permit to fileasig...teen.... S Ft.Floor Area Valuation
j < that he is AO pursuant to do provisions of the Comracmf+UM=LAW(CMpter 9 Q
2 $ (commencing with section 700D)of Division 3 of Ne Business and Proteulow Cook)OR
1 ..
that em is Attempt Ncmfrom and Ne buts for the alleged exemption.Any violation or —
section 7031.5 by any applicant for a permit subjects the applicant m•civil penalty at APN Number "'"'s r+ Qccupancy Type
not mom than five hundred dollars($500).
❑I,uow^erafthepropeny.mmyemployeca with wagnn Nekmkcompemao^, 31623041 . 00
will do Newark. addle mature k netIntendeelar offered fonne(Sm.7044.Business Required Inspections,
and my.h b.Code:The.that h License law don not apply in w owner of �E Q �)
propenywhobulldeor improvuthnwn.andwhodmuucM1 work hlmulforNrou{M1 M1ts 10 - WU�ID�TIONI} IUq
awn employees.provided that such improvements aronot imusded mortared fmWe.IL 10 — E u 1
however,dM buildint or impmvement issold within am you of wmPlctim du swum•
builder will love Ne burden of proving Net he did not build or Improve for purpose of 103 — UFER {
ale.). 104 - REBAR
❑1,As swim of the property.am mclusholy cmuunint with licensed wnkscton M
construct the project(sec.7044,Business and PruteWons Code:)71e Conkumra LL 105 — ANCHOR BOLTS
cmcm LAW does not apply to an owner of property who bunds or improv Merton,and. 106 — SEWER & WATER
who contracts for auch project with a enntnetor(s)licensed pursuant to the CamrAClofa
Lkenee LAW. 202 - UNDERFLOOR PLUMBING
esempt undo See. .BkPCtw Mia won 203 - UNDERFLOOR MECHANICAL
Data—
WORK9TCOMPSNSATION DECLARATION 204 - UNDERFLOOR FRAME
I huebyamm ander penalty or perjury am or tit fodowint dectacs0ons: 205 — UNDERFLOOR INSULATION
Ihavesnd will mainWn•Cenlfinu of Consent An elf-In.um for weaker',Cmnpm- 301 — ROUGH PLUMBING
oda^,u provided for by Section 3700 of the Labor Code,for the Performance of em 302 — TUB & OR SHOWER
work for which this permit is issued. 303 - ROUGH MECHANICAL
❑1 Mw and WIN maintain Workers Compensation Insurance,u required by Section
3700of the Mbar Code.far the perfamame or the eAre"hich Nkpcmukmmd. 304 — ROUGH ELECTRICAL
My War CompenaWoeglnsunnm nrtlm and liry.n71r,7:6 Z 3'U2 305 — FRAME
�/z/aro
P/ (Qv7
CEKnFICATE OF FXEM MON FROM WORKERS 306 - HOLDOWNS
COMPENSATION INSURANCE 307 - INSULATION
(This section wood nothecompleed if the pcmlt Is foronehundreddtdlan($100) 308 — SHEETROCK
mkW 309 '- EXTERIOR LATH
t cmiry lAei in the perfomamr of the Work Ins which this pamk is usual.so WWII let 310 — INTERIOR LATH
employ any person In any manner u m become subject the Workers'Cam wuon
Lava of caRmrni..0^teApplic - 311 - SCRATCH COAT
NOTICE
DncE 70 APPLICANT:H,atter making this Cemm�te the Exemption,yaw Nagle 313 - ROOF NAIL
haeme subject y it Worker's Compewuon Introit
of the labra Code,you mwt
Z0 forthwith comply with such Provisions or thi+pcmk Mnl be dmnrtd revoked. 501 — FINAL ELECTRICAL ENERGY
CONMUCION LENDING AGENCY 502 - FINAL PLUMBING ENERGY
�► I hominy amen wt them is A commutation lending agency for tiM perfomnnce of 503 — FINAL MECHANICAL ENERGY
(+ mWork fmWhich this Permit aIssued(See.3o9,Civ.C.)
Lander''Name 504 - FINAL BUILDING ENERGY
Q l
=)z endeftAddn` 505 - FINAL ELECTRICAL
V0 I=try Nu I have mad Ws applicWon aM ROOM that the Above hromWonts —
k. comm I agree 0 comply with all city and county ordinances and ROOM laws mining ro 506 GAS TEST
O buil6ing eowwc0on,and hominy euNonm rcprcsenu0ves of Nue city to enter span the — FIN PLUMB G .
W aM1ovomentiWad property fm inspection puga¢s.
IWc)agrte m Rave,indemnify end keep harmless the City of Cupertino against 0 S F I L
i..�rA Habilitl .judgments.eons and expenses which may In any Way secrvc Maiost aid City 5
V in con are oft tranun tthtspemit. Date
�-+ APP Nf R"TA S AND WILL COMPLY WITH ALL O OINT Issued by:5
so ULA 3 3Re-roofs 514 NAL PUBLIC WORKS
�sf-=
S App HAZARDOUS MATERIALS DISCLOSURE Ds Type of Roof
1
Will" puicant or future building Occupant store of handle hazardous material
and by she Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
Section 25532(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yrs ON.
If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment at devices which
It hmmons air conuminenu An dcOood by the Bay Arca Air Quality Management all new materials for inspection.
District?
❑Yea ON.
than W Ne hemdnus matenW requirements under Chapter6.95 of the Glifon
niAHcaWt stet Cade.Sections25505.27333aad25534.1undcrwW mlfft WiWi^g
data nothaw a4 t 6m re"rehllil mufy the cfcu tof the
mqu c ch mus t �i aluuaceohCe1Mc t(isugu Signature of Applicant Date
All roof coverings to be Class"B"or better
Own. Art. an